Awareness and Advocacy in the Era of Health Care Reform

winter 2014

This Edition Approved for 2 CME Credits. Complete and Return Journal CME Quiz at www.mdafp.org.

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Awareness and Advocacy in the Era of Health Care Reform Exciting and Health Insurance All Politics is Physician of the The Sunshine Act – Challenging Times Exchanges, The Local: A Report Day: Face-to- What Does it Mean in Health Care Affordable Care from AAFP’s 2013 Face Encounters for Us? Act, and the State Legislative with Maryland Maryland Health Conference Legislators Connection The Maryland familydoctor / Winter 2014 • 1 Maryland’s largest medical professional liability insurer is always on call for you.

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2 • The Maryland familydoctor / Winter 2014 THE MARYLAND familydoctor Winter 2014 Volume 50, Number 3 contents

FEATURES

President 5 Exciting and Challenging Times in Health Care by Yvette Oquendo-Berruz, M.D.

Health Insurance Exchanges, The Affordable Care Act, and the Maryland Health Connection 12 by Matthew T. Burke, M.D.

All Politics Is Local: A Report from AAFP’s 2013 State Legislative Conference 15 by Patricia A. Czapp, M.D.

MAFP President Dr. Yvette Oquendo-Berruz with Physician of the Day: Face-to-Face Maryland Delegate Guy J. Guzzone (D., District 13). Encounters with Maryland Legislators 17 by A. Stephen Hansman, M.D.

The Sunshine Act – What Does it Mean for Us? 18 by Janna Becker, M.D. Mission Statement To support and promote Maryland family physicians in order to improve the health of departments our State’s patients, families and communities.

4 Board of Directors, Commissions and Committees

6 CME Quiz 11 Calendar

7 Editor 21 Residency Corner: Happenings at the University Awareness and Advocacy in the Era of Health Care Reform of Maryland and Franklin Square Medical Center by Patricia A. Czapp, M.D. Family Medicine Residencies

8 Guest Editorial 23 Membership Reigniting a Passion for Advocacy by Matthew T. Burke, M.D.

The Maryland familydoctor / Winter 2014 • 3 President Western Yvette Oquendo-Berruz, M.D.* [email protected] Kristen M. Clark, M.D. [email protected] President-Elect Central vacant (see note) Mozella Williams, M.D. [email protected] At Large Treasurer Nancy B. Barr, M.D. [email protected] 2013-2014/2015 Ramona G. Seidel, M.D.* [email protected] Kevin P. Carter, M.D. [email protected] Secretary Shana O. Ntiri, M.D. [email protected] Eva S. Hersh, M.D.* [email protected] Marc E. Wilson, M.D. [email protected] Vice presidents AAFP Delegates Central Howard E. Wilson, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Adebowale G. Prest, M.D. [email protected] Eastern AAFP Alt. delegates Eugene J. Newmier, D.O. (acting) [email protected] Yvette L. Rooks, M.D. [email protected] Southern Eugene J. Newmier, D.O.* [email protected] Patricia A. Czapp, M.D. [email protected] Immediate past president Western Eugene J. Newmier, D.O. [email protected] Matthew A. Hahn, M.D. [email protected] Resident Director Directors Jonathan Gibson, M.D. (UMIII) [email protected] Eastern Student director

officers & directors & officers Kim Herman, M.D. [email protected] Southern Tiffany Ho (JHUII) [email protected] Trang M. Pham, M.D. [email protected] *Member of Executive Committee Note: Dr. Kisha N. Davis, MAFP’s President-Elect must interrupt her chapter office during her 1-year tenure as New Physician Director on the AAFP Board of Directors, having been elected to that position at the National Conference of Special Con- stituencies in May, 2013. Her term began with the 2013 AAFP Congress of Delegates (COD) and will run through the 2014 COD. MAFP President Dr. Yvette Oquendo-Berruz will serve an extended term to cover Dr. Davis’ service on the AAFP Board.

Executive Committee of Board of Directors Commission on Legislation & Economic Affairs Yvette Oquendo-Berruz, M.D., President [email protected] Vice President Southern District vacant Patricia Czapp, M.D. [email protected] Ramona G. Seidel, M.D., Treasurer [email protected] Eva S. Hersh, M.D., Secretary [email protected] Governmental Advocacy Committee Eugene J. Newmier, D.O., Immediate Past Pres [email protected] Matthew T. Burke, M.D. ** [email protected] Meenakishi G. Brewster, M.D. [email protected] Commission on Membership and Member Services Kevin P. Carter, M.D. [email protected] Vice President Central District Patricia Czapp, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Kevin S. Ferentz, M.D. [email protected] Robert S. Goodwin, M.D. [email protected] Bylaws Committee Kim R. Herman, M.D. [email protected] Yvette Oquendo-Berruz, M.D. ** [email protected] Katherine J. Jacobson, M.D. [email protected] Adebowale G. Prest, M.D. [email protected] William P. Jones, M.D. [email protected] Finance Committee Niharika Khanna, M.D. [email protected] Ramona G. Seidel, M.D. ** [email protected] F. George Leon, M.D. [email protected] Kristen Clark, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Christine L. Commerford, M.D. ** [email protected] Donald Richter, M.D. [email protected] Kisha N. Davis, M.D. [email protected] Roxanne Richards, M.D. [email protected] Kevin S. Ferentz, M.D. [email protected] Yvette L. Rooks, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Neil M. Siegel, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Tobie-Lynn Smith, M.D. [email protected] Gregory Taylor, M.D. [email protected] Nominating Committee Elizabeth Wiley, M.D. (PGYI, UM) [email protected] Eugene J. Newmier, D.O. ** [email protected] Joseph W. Zebley, III, M.D. [email protected] Patricia Czapp, M.D. [email protected] commissons &commissons commmittees Kevin S. Ferentz, M.D. [email protected] Commission on Education Jonathan Gibson, M.D. [email protected] Vice President Eastern District Matthew Hahn, M.D. [email protected] Eugene J. Newmier, D.O. (acting) [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Education Committee Member Support Committee Shana O. Ntiri, M.D. ** [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Nancy Beth Barr, M.D. [email protected] Kisha N. Davis, M.D. [email protected] Kristin M. Clark, M.D. (SAM) [email protected] Eugene J. Newmier, D.O. [email protected] Lauren Gordon, M.D. [email protected] RH = Rural Health Eva S. Hersh, M.D. [email protected] Donald Richter, M.D.** [email protected] Heather M. Kearney, M.D. [email protected] Matthew A. Hahn, M.D. [email protected] Niharika Khanna, M.D. [email protected] F. George Leon, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Andrea L. Mathias, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Adebowale G. Prest, M.D. [email protected] Adebowale G. Prest, M.D. [email protected] Ramona G. Seidel, M.D. [email protected] SC = Special Constituency Netra Thakur, M.D. [email protected] Kisha N. Davis, M.D. ** (New Phys) [email protected] Howard E. Wilson, M.D. (SAM) [email protected] Kathy Byrne, M.D. (GLBT) [email protected] Marc E. Wilson, M.D. [email protected] F. George Leon, M.D. (IMG) [email protected] Joseph W. Zebley, III, M.D. [email protected] Shana O. Ntiri, M.D. (Minority) [email protected] Publications Committee Mozella Williams, M.D. (Women) [email protected] MFD = MFD Editorial Board Technology Committee Joyce Evans, M.D. ** [email protected] Kristen Clark, M.D. [email protected] Janna Becker, M.D. (PGY1, UMMC) [email protected] Matthew Hahn, M.D. [email protected] Kathryn A. Boling, M.D. (PGY3, FSMC) [email protected] Richard Kolodrubetz, M.D. [email protected] Matthew T. Burke, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] F. George Leon, M.D. [email protected] Neil M. Siegel, M.D. [email protected] Matthew Loftus, M.D. (PGY 3, FSMC) [email protected] David McClure, M.D. [email protected] Commission on Health Care Services and Public Health Sarah Ramirez, M.D. (PGY 2, FSMC) [email protected] Vice President Western District Saif Usman, M.D. [email protected] Matthew A. Hahn, M.D. [email protected] Joseph W. Zebley, III, M.D. [email protected] Public Health Committee EB = E-Bulletin Niharika Khanna, M.D.** [email protected] Joseph W. Zebley, III, M.D. ** [email protected] Kisha N. Davis, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Judy B. Davidoff, M.D. (HIV, onc, w hlth) [email protected] Kisha N. Davis, M.D. [email protected] Lauren Gordon, M.D. (women’s hlth) [email protected] Eugene J. Newmier, D.O. [email protected] Amanda P. Guzman, M.D. (domestic violence) [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Jocelyn M. Hines, M.D. (underserved) [email protected] Public Relations Committee Kenny Lin, M.D. (screeng tsts, lifestyle couns) [email protected] Kevin S. Ferentz, M.D. ** [email protected] Christine A. Marino, M.D. (oncology) [email protected] Kevin P. Carter, M.D. [email protected] Ariana M. Martin, D.O. (minority/women’s hlth) [email protected] Joseph W. Zebley, III, M.D. [email protected] Yvette Oquendo-Berruz, M.D. (Cardiov/Stroke) [email protected] James P. Richardson, M.D. (geriatrics) [email protected] **Chair Donald Richter, M.D. (PCMH) [email protected] Elizabeth Salisbury-Afshar, M.D., MPH [email protected] Tobie-Lynn Smith, M.D. (underserved) [email protected] Bernita C. Taylor, M.D. [email protected]

4 • The Maryland familydoctor / Winter 2014 president THE MARYLAND familydoctor Winter 2014 Exciting and Challenging Volume 50, Number 3

Times in Health Care Editor-in-Chief Joyce Evans, M.D. care providers will lead teams of health professionals that focus on coordination of Edition Editor personalized care that meets the complex Patricia A. Czapp, M.D. needs of vulnerable patients. Incentives and Managing Editor standardized quality measures will enhance Esther Rae Barr, CAE physician practice participation. CIMH will engage with local health improvement Editorial Board Janna Becker, M.D. (R1, UM) coalitions that will help manage our most Richard Colgan, M.D. vulnerable patients. Patricia A. Czapp, M.D. Local health improvement coalitions Yvette Oquendo-Berruz, M.D. Trang Mai Pham, M.D. (LHICs) are state-recognized regional Sarah Ramirez, M.D. (R3, FSq) This edition of The Maryland Fam- or county-based groups that combine Joseph W. Zebley, III, M.D. ily Doctor focuses on topics related to established public health resources and health care reform, as well as advocacy community-based providers of care. for family physicians and patients, par- LHICs are currently charged with iden- ticularly in Maryland. tifying local health needs and address- We are fortunate to practice medi- ing disparities in care. They monitor the cine in a state that has taken seriously the health status of their communities and need for health care reform. Maryland make plans to address their community’s pcipublishing.com has included multiple stakeholders in the unique needs. In the proposed CIMH Created by Publishing Concepts, Inc. design and implementation of mecha- model, the LHICs will take on a more David Brown, President • [email protected] For Advertising info contact nisms to broaden access to care and active role, with boots-on-the-ground Tom Kennedy • 1-800-561-4686 [email protected] improve population health. Despite the community health workers (CHWs). CHWs political maneuverings that have threat- are trained to assess patients and families EDition 15 ened health care reform at the national in their homes to identify and address level, Maryland has moved ahead with obstacles to care, including social factors implementation of parts of the Affordable that adversely affect health, for example, Publisher Maryland Academy of Family Physicians Care Act, as well as its own innovative ini- transportation problems, unsafe home 5710 Executive Dr., Suite 104 tiatives to improve the health of the state. environments, or lack of adequate nutri- Baltimore, MD 21228-1771 There are many new concepts and tion. The CHWs collaborate with physician 410-747-1980; 410-744-6059 Fax; acronyms in health care; we will present practices and other providers of care and [email protected] and define briefly the most common and are well-versed in local community-based The Maryland Family Doctor is published four important ones for Maryland family physi- resources that can address social needs. times annually and is the official publication of cians to know. The CIMH model emphasizes the com- the Maryland Academy of Family Physicians. The opinions expressed herein are those of the The state of Maryland, through the lead- plementary work of primary care and pub- writers and not an official expression of Academy ership of the Maryland Health Care Commis- lic health and supports the integration of policy. Likewise, publication of advertisements sion, envisions a transformed health system the two, especially in the care of the most should not be viewed as endorsements of those products and services by the publisher. that integrates patient-centered primary vulnerable populations. Research sug- Readership: over 10,000. Copyright: All contents care with innovative community health ini- gests that integration of community-based 2003 MAFP. All rights reserved. tiatives. To that end, Maryland is designing a services may be the determining factor Contributions and Deadlines multi-payer Community Integrated Medical whether or not patient-centered medical Those interested in submitting articles for publication can view the Author’s Protocol Sheet Home (CIMH) program statewide. Primary continued on page 6 by clicking on News and Publications at www. mdafp.org or contacting the headquarters office. Deadline schedule for submitting articles: May 15, August 15, November 15, February 15. The Maryland familydoctor / Winter 2014 • 5 President (continued) home (PCMH) models can ultimately and pital admissions to any facility in Maryland. At the risk of greatly sustainably deliver cost savings. Maryland The Prescription Drug Monitoring Program oversimplifying this is thus testing that hypothesis by combin- (PDMP) is also available through CRISP and complicated change, ing the strengths of PCMH with LHICs. allows prescribers access to a patient’s history Maryland has multiple ongoing initiatives of dispensed controlled prescriptions. the basic premise is that that leverage data to identify and track our Meanwhile, starting in 2014, Maryland instead of being paid most vulnerable patients. A statewide all- hospitals will undergo a major change in the on a “per case” basis, payer claims data base, coupled with state- way they are reimbursed for care. At the risk Maryland hospitals will wide hospital data and other sources can find of greatly oversimplifying this complicated be paid on a “per capita” “hot spot” patients who would potentially change, the basic premise is that instead of benefit from interventions from the CHWs. being paid on a “per case” basis, Maryland basis that gives them a Statewide Health Information Exchanges hospitals will be paid on a “per capita” basis “budget” to take care of (HIEs) gather real-time patient data from hos- that gives them a “budget” to take care of a a defined population. pitals, radiology, laboratory facilities and long defined population. This change for hospitals term care centers and provide this informa- has implications for us. Notably, for the first care management resources, better/quicker tion via secure query portals to authorized time, hospitals and PCMH practices will be discharge summaries and enhanced, patient- care providers. Maryland’s HIE, The Chesa- aligned in their incentives to reduce ambu- friendly discharge instructions, and patient peake Regional Information System for our latory-sensitive admissions (not just readmis- and caregiver support initiatives. Patients (CRISP), supports query portals that sions), for example those hospital visits for We hope that you stay tuned to the can be established free of charge for regis- CHF and COPD. The state describes such activ- changes occurring around us that will tered health care professionals. The amount ity as Potentially Avoidable Volume (PAV). affect the way we deliver health care. and type of data accessible is rapidly expand- Your local hospital, tasked with reducing PAV, Enjoy this edition! ing as CRISP matures. The Encounter Notifi- will likely be providing more resources to cation System (ENS) will let clinicians know help transition patients safely to the outpa- Note: CME questions for this article are posted of their patients’ emergency room or hos- tient arena, including enhanced transitional at www.mdafp.org; CME Quiz tab,. Winter, 2014

journal CME quiz

Obtain CME Credit via The Maryland Family Doctor Articles 1. Exciting and Challenging Times in Health Care p. 5 ONLINE COMPLETION AND SUBMISSION OF MAFP JOURNAL 2. HIE, The ACA, and the MD Health Connection p. 12 CME QUIZZES AT WWW.MDAFP.ORG 3. All Politics is Local: A Report From AAFP’s 2013 SLC p. 15 The process for completion and submission of MAFP Journal CME quizzes is fully automated. Read the CME articles in this edition (listed above) either from your mailed version or the online 4. POD: Face to Face Encounters with MD Legislators p. 17 version. Each “live” version is posted online at the Publications and News tab. Access the quiz by 5. The Sunshine Act – What Does it Mean for Us? p. 18 clicking on the CME Quiz tab at www.mdafp.org. Once on the CME Quiz page (where quizzes for each “live” edition are posted), follow the The Maryland Family Doctor has been reviewed and is acceptable for directions. Upon sending, you will receive an immediate confirmation that your quiz has been Prescribed credits by the American Academy of Family Physicians received by MAFP. The confirmation will list the edition and the amount of credits earned. (AAFP). This Winter, 2014 edition (vol. 50, No. 3) is approved for Those unable to complete/send the quiz using the automated system can get a hard copy of ??? Prescribed Credits. Credit may be claimed for two years from the quiz by contacting the MAFP office. Once completed and returned to MAFP, the sender will the date of this■ edition (expiring October 31, 2015). AAFP Prescribed be sent a confirmation by MAFP staff. Quiz answers for each edition are posted at www.mdafp. Credit is accepted by the American Medical Association (AMA) as org; Publications and News tab. equivalent to AMA PRA Category 1 Credit toward the AMA Physicians Readers are responsible for reporting credits directly to AAFP or other entities. Confirmation Recognition Award. of quiz submission will suffice for verification. Questions? Contact the MAFP office via email to [email protected] or call 410-747-1980.

6 • The Maryland familydoctor / Winter 2014 editor

Awareness and Advocacy in the Era of Health Care Reform Congress does anything, one thing is cer- as a high-quality, cost-effective physician tain: we are not going back to the old days is another’s rude awakening and loss of of the “no-questions-asked” fee-for-service market share. One person’s compassion- payment system. Market pressures, magni- ate discussion about end-of-life goals of fied by unprecedented consumerism, as care is another’s Death Panel. well as transparency of performance data, As changes in health care delivery and have brought about change apolitically payment in Maryland are just beginning and unapologetically. The nation demands to get traction, these points of conten- to get more value out of its health care dol- tion abound, but pockets of optimism lar, not just from physicians, but hospitals, are emerging. Medicaid parity (payment Patricia A. Czapp, M.D. vendors, payers, and even patients them- equal to Medicare) has come to frui- As we planned this edition of Mary- selves. Because of this change, we find our- tion for Maryland practitioners. Primary land Family Doctor, we were challenged selves now in a new era of accountability. care practices are experiencing finan- to keep a tight focus on what our reader- In this evolving landscape, stakehold- cial rewards from their successful par- ship would like to know about health care ers are constantly scanning the horizon ticipation in various PCMH programs and reform, and to assure the information we for opportunities and threats. Depending incentives. New strategies to reach the provided was both timely and accurate. on your perspective, the view may appear underserved and lessen disparities in care Rather than create an exhaustive primer favorable – or not. One person’s informa- are being planned and implemented. along the lines of “Affordable Care Act tion-sharing is another’s intrusion of pri- With all of this change happening, 101,” we chose instead to provide you with vacy. One physician’s reward for expense family physicians are often invited to relevant and informative updates, as well management is (or rather was) another’s the table to help guide decisions and as some controversial and uncomfortable revenue. One person’s welcome expan- implement initiatives, across the nation topics to ponder. sion of coverage is another’s painful loss and here in Maryland. Don’t pass up the Whether our state is blue or red or pur- of an affordable health insurance policy invitation. As the saying goes, “If you’re ple, whether or not the Affordable Care Act that no longer meets minimum standards. not at the table, you’re on the menu.” In is repealed or defunded, whether or not One person’s positive (and public) rating this new era of accountability, we won’t be heard if we simply complain or make demands; we must go a step further and offer solutions that demonstrate the value we have to offer. Your Maryland chapter encourages you to become involved in decision-making not just at the legislative level, but in discussions with payers and employers, and in your local medical community, whether that is a consortium of practices, a public health arena or an organized medical staff at a health system. Be aware, and be vocal. ■

Dr. Czapp, a self-described health policy “junkie,” edits this edition. She is Chair of Clinical Integration at Anne Arundel Medi- cal Center in Annapolis.

The Maryland familydoctor / Winter 2014 • 7 guest editorial

Reigniting a Passion for Advocacy

built on robust foundations of primary care When we advocate for have been shown to promote health and Family Medicine, we lower per capita spending.1 With 32 million advocate for patients. Americans expected to acquire coverage in In getting started, The the coming months to years, much of the new demand for health services will need to Committee has scheduled be met by primary care. an Annapolis Lobby Day The Governmental Advocacy Committee for March 6, 2014, open to of the Maryland Academy of Family Physi- all members of the MAFP. cians (MAFP) met on October 28, 2013, with Matthew T. Burke, M.D. the goal of identifying and addressing is- with a sturdy platform and broad audience This era of change in the American health sues currently faced by patients and primary for us to advocate for policies that enhance care system is an exciting time for family phy- care physicians in Maryland. We practice in population health, patient care and reduce sicians because of the central role we play in a state that has embraced the Affordable overall spending. To this end, the Commit- the care of individuals and populations. We Care Act (ACA), as well as broader tenets of tee plans to move forward with a united and are poised to contribute to positive changes health reform that address rising costs and strong voice for Family Medicine in Mary- that improve health outcomes, promote persistent disparities in health outcomes. We land, one that listens to and respects other health equity and control costs. Systems believe this environment provides the MAFP continued on page 10

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8 • The Maryland familydoctor / Winter 2014 ■

Consultative Your “No obligation” review includes Insurance the following: Employee Benefits: Review • Group Medical, Dental, and Vision Med Chi Insurance Agency was Coverage • Group Life & Disability established in 1975 “by physicians • Voluntary Benefits for physicians” to satisfy the needs Property & Liability: of doctors and medical practices. • Medical Malpractice • Workers Compensation Contact Keith Mathis at 800.543.1262, • Medical Office Insurance ext. 4422 or [email protected] • Employment Practices Liability today to schedule your “no obligation” • Directors & Officers Liability review at no cost! • Privacy/Data Breach Coverage • Bonds (Fiduciary/Fidelity/ERISA) Personal: • Life Insurance Insurance and Financial Services • Disability (Individual/Pension/Business Owned by MedChi, The Maryland State Medical Society Overhead) • Annuities 1204 Maryland Avenue, Baltimore, Maryland 21201 • Long Term Care 410.539.6642 or 800.543.1262 • Estate Planning/Retirement Planning 410.649.4154 fax • Auto/Homeowners/Umbrella Coverage www.medchiagency.com The Maryland familydoctor / Winter 2014 • 9 Reigniting a Passion (continued) voices and is always guided by the best in- coordinate care and deliver timely preven- payment programs, innovative training terests of our patients. tive services. In this way, primary care lowers models for Family Medicine, public health When we advocate for Family Medicine, unnecessary hospital expenditures, reduces issues and scope of practice. Our chal- we advocate for patients. Broad spectrum, disease incidence and promotes the efficient lenge will be to identify our legislative compassionate primary care promotes management of chronic conditions. priorities, determine which ones are “win- health through improved access and longi- The Committee will tackle a wide range nable battles,” and develop an approach tudinal relationships with patients and fami- of issues that include primary care work- to each which is unified and balanced. lies. These relationships allow us to better force development, state-based loan re- In getting started, The Committee has scheduled an Annapolis Lobby Day for March 6, 2014, open to all members of the MAFP. We plan to make this an invigorating day for all. The event’s primary objective is to advocate on behalf of family physicians and our patients regarding various relevant health-related bills pending in the 2014 Legislative Session. Additionally, we hope this day will be an educational experience that validates how valuable our members’ voices are, showcas- Are you looking for a satisfying career anda life outside of work? ing the influence we can have in Enjoy both to the fullest at Patient First. local and state health affairs. Ulti- mately, the Committee hopes to Founded and led by a physician, Patient First has been a regional healthcare leader in see the MAFP become a reliable Maryland and Virginia since 1981. Patient First has 49 full-service neighborhood medical source of health information and centers where our physicians provide primary and urgent care 365 days each year. In a trusted working partner for state fact, over 300 physicians have chosen a career with Patient First. We are currently legislators going forward. looking for more Full and Part-Time Internal and Family Medicine Physicians in Virginia, Please join us as we create a Maryland and Pennsylvania. At Patient First, each physician enjoys: strong voice for Family Medicine in Maryland, one that helps lead • Unique Compensation • Malpractice Insurance Coverage positive changes that improve the • Flexible Schedules • Team-Oriented Workplace health of our state. Let us know of • Personalized Benefits Packages • Career Advancement Opportunities your interest at [email protected] or • Generous Vacation & CME Allowances call 410-747-1980. ■

To discuss available positions please contact Eleanor Dowdy, (804) 822-4478 Dr. Burke, on faculty at the Frank- or [email protected]. We will arrange the opportunity for you lin Square Medical Center De- to spend time with one of our partment of Family Medicine in physicians to experience firsthand Baltimore, is Chairman of MAFP’s how Patient First offers each Governmental Advocacy Com- physician an exceptional career. mittee. See his article on p. 12 .

1B. Starfield, L. Shi and J. Macinko. Contribution of Primary Care to Health Systems and Health. The Com- monwealth Fund. 2005. http://www. commonwealthfund.org/usr_doc/ starfield_milbank.pdf

10 • The Maryland familydoctor / Winter 2014 calendar

2014 February 21 April 7-8 MAFP DOT Medical Examiner AAFP Family Medicine Certification Training Course Congressional Conference Doubletree Hotel Washington DC Symposium Pikesville (see page 20) April 30-May 3 on Tick-borne AAFP Annual Leadership Forum MAFP SAM Study and National Conference of Diseases Module: Health Behavior Special Constituencies Doubletree Hotel Sheraton Crowne Center Pikesville Kansas City, MO A One-day (see page 20) June 12-14 Medical February 22 MAFP Annual CME Assembly & Conference MAFP Winter Regional Conference Trade Show Doubletree Hotel Holiday Inn Saturday, Pikesville Frederick (see page 20) May 17, 2014 August 14-16 March 6 Southeastern Family Medicine Forum The Hyatt, MAFP Advocacy Day Orange Beach, AL Family Physicians for Patients Cambridge, MD in Annapolis October 24-26 FMEC Northeast Region Meeting March 27-30 Crystal Gateway Marriott “History, Diagnosis and AAFP Family Medicine Board Review Arlington, VA Treatment of Lyme Disease” Express Hilton Hotel - Dr. Joseph Burrascano Baltimore “Tick-borne Co-infections”

AAFP Scientific Assembly Schedule - Dr. Richard Horowitz National Conferences of Family Medicine Residents and Medical Students: “Psychiatric Manifestations of 2014 Aug. 7-9 , Kansas City Tick-borne Diseases” 2015 July 30-Aug. 2, Kansas City (dates/location are tentative) - Dr. Robert Bransfield 2016 Aug. 3-6, Kansas City (dates/location are tentative) “The Lyme and Gut Congress of Delegates (CoD) and Scientific Assembly (SA): Connection” 2014 Oct. 20-22 (CoD); Oct. 21-25 (SA), Washington, DC 2015 Sept. 28-30 (CoD); Sept. 29-Oct. 3 (SA), Denver - Dr. Sunjya Schweig 2016 Sept. 19-21 (CoD); Sept. 20-24 (SA), Orlando “When Antibiotics Don’t Annual Leadership Forum (ALF) and National Conference of Special Work – A 16-Step Matrix” Constituencies (NCSC): - Dr. Richard Horowitz 2014 May 1-3, Kansas City 2015 April 30-May 2, Kansas City Conference is open to medical 2016 May 5-7, Kansas City professionals of varied disciplines. Request a brochure and registration information by contacting the CME Author Disclosure Statements Lyme Disease Association of the The authors of CME articles in this publication, except for any listed below, disclose that neither they Eastern Shore of Maryland at: nor any member of their immediate families have a significant financial interest in or affiliation with any commercial supporter of this educational activity and/or with the manufacturers of commercial [email protected] products and/or providers of any commercial services discussed in this educational material. or by calling MAFP receives no commercial support to offset costs in the production of The Maryland Family Doctor Publication. 410-749-LYME

Next Edition □ Selected Topics in Cancer Management

The Maryland familydoctor / Winter 2014 • 11 Health Insurance Exchanges, The Affordable Care Act, and the Maryland Health Connection

Coverage expansion and health insur- we go about getting them access to this ance exchanges are key to meeting the coverage? Health Insurance Exchanges, ACA’s goals. In 2012, the uninsured rate mandated by the ACA, are intended to among younger Americans was 27%, sig- facilitate coverage expansion (and meet nificantly higher than the national aver- the goals of the ACA) by being both con- age of 17%.4 An influx of these younger, venient and consumer-friendly. Designed relatively healthier Americans into the to be a one-stop shopping experience for risk pool will offset insurance outlays for individuals or families, the exchanges offer older, less healthy Americans, while giv- anyone who does not have health insur- ing younger Americans better access to ance a plan to fit his needs and meet the Matthew T. Burke, M.D. prevention and securing them against the deadline of March 31, 2014 to obtain cover- The Affordable Care Act (ACA) of 2010 threat of bankruptcy from catastrophic age without incurring a financial penalty. aims to secure coverage for all Americans, illness. Access to care begins with cover- Despite early technical problems, the ex- promote population health, improve the age, and recent work has shown Medicaid changes continue to enroll new patients. care experience for individuals, reduce expansion by early adopters has resulted Seventeen states (including Maryland) and costs, and emphasize primary and preven- in a relative reduction of mortality of 6.1% the District of Columbia have opted to run tive care.1 Included in the ACA are various in those states,5 particularly among older their own exchanges while the others de- mechanisms to reach those goals, includ- adults, nonwhites and residents of poorer fault to a federally run exchange. ing changes in the way care is accessed, delivered and paid for, plus special funding to encourage the development and broad adoption of innovative, effective and efficient models that provide care to vulnerable populations and individuals. After enactment in 2010, the ACA was vigorously challenged owing to objections to what is known as the Individual Man- date, the expectation that every Ameri- can must have health insurance or pay a fine. On July 26th, 2012, the Supreme Court upheld the constitutionality of the Individual Mandate, but struck down another key ACA provision requiring states to expand existing Medicaid programs to cover a broader portion of individuals and 2 families. Although 22 states reacted to Source: The Health Extend Blog, August 2013 the Supreme Court’s decision by electing not to expand Medicaid,3 Maryland was counties, suggesting coverage expansion Per federal law, all coverage offered already well on its way to Medicaid expan- of any kind promotes population health. in the exchanges must meet certain re- sion, and currently offers this option to in- So then, if more individuals and fami- quirements such as providing easily un- dividuals and families with incomes up to lies are eligible for Medicaid, and every- derstandable coverage plan information, 138% of the federal poverty level (FPL). one must have health insurance, how do barring denials based on preexisting

12 • The Maryland familydoctor / Winter 2014 conditions and covering children on par- eral government pays 100% of the cost of tions, would also be transferred into Med- ents’ insurance until age 26. Co-pays Medicaid expansion for two years (with icaid (given the ACA’s new regulations and deductibles for preventative services state financial responsibility increasing barring denial of coverage for preexisting such as routine vaccination, birth control after that), Maryland stands to save $725 conditions) further creating cost savings and cancer screenings, have largely been million through 2020.9 Savings projections for the state, and uniting this group with a eradicated. Furthermore, plans in the ex- chart would be: larger pool to diffuse risk. change must offer tiered “metal” levels of bronze, silver, gold and platinum, which meet basic minimum coverage requirements and cover 60, 70, 80 and 90% of cost respectively. The Department of Health and Mental Hygiene in Maryland has posted sample rates for bronze and silver plans across the state and these can be found at their website.7 So, how might successful coverage expansion affect patients in Maryland? The Maryland exchange, Maryland Health Con- nection (MHC), seeks to enroll as many of the state’s 800,000 uninsured as possible, and The Hilltop Group at the University of Maryland, Baltimore County has estimated 143,000 could enroll in Medicaid by 2020. Source: The Hilltop Group, UMBC Navigators and Assisters are specially trained individuals who have been placed strategically in communities of need to help implement enrollment. As of Novem- ber 1st, MHC has enrolled 3,186.8 The MHC and coverage expansion could have a broad impact on Maryland. Significantly, individuals previously covered by the Primary Adult Care (PAC) Pro- gram will be automatically transferred to Medicaid by December 31st, 2013. Histori- cally PAC has provided limited coverage to childless Marylanders earning 116% of the FPL but did not cover inpatient expenditures. These individuals will be transferred to Medicaid and opt into a state managed care organization (MCO) with subsidies for persons of annual earnings up to 138% Source: The Hilltop Group, UMBC FPL. Therefore, more individuals will be covered, more services will be covered, In addition to these positive outcomes, Furthermore, unemployment is pro- and hospitals would stand to recoup $3.1 Maryland Health Insurance Plan (MHIP) jected to drop in the coming years at a billion in projected uncompensated costs which has previously created a high risk faster rate due to these changes, as the through 2020. Additionally, since the fed- pool for persons with preexisting condi- continued on page 14

The Maryland familydoctor / Winter 2014 • 13 Health Insurance (continued) outlined above. And while the NEJM has shown mortality reductions associated with Medicaid expansion, it would be pru- dent not to anticipate immediate health improvement from the state’s coverage expansion. Family physicians in Maryland should direct their uninsured patients towards MHC to discover their coverage options. This is a foundational step towards access, improved health quality and re- duced health spending over time. ■

Dr. Burke, Chair of MAFP’s Governmental Advocacy Committee, is on faculty at the Franklin Square Medical Center Depart-

Source: The Hilltop Group, UMBC ment of Family Medicine in Baltimore. See his guest editorial on p. 8. financial security of health coverage is pre- Designed to be a one- dicted to promote new job creation and Note: CME questions for this article are posted stop shopping experience spur economic activity. at www.mdafp.org; CME Quiz tab,. Winter, 2014 Some of these projections are con- for individuals or families, References sistent with the experience of states that the exchanges offer 1US Department of Health and Human Services. have already expanded Medicaid, and es- anyone who does not http://www.hhs.gov/secretary/about/goal1.html 2A. Liptak. The New York Times. June, 2012. pecially notable are the gains in access and have health insurance http://www.nytimes.com/2012/06/29/us/ self reports of mental health. Two years supreme-court-lets-health-law-largely-stand. a plan to fit his needs html?pagewanted=all&_r=0 ago, secondary to budget constraints, 3S. Cliff. The Washington Post. April, 2013. http:// Oregon expanded its Medicaid programs and meet the deadline of www.washingtonpost.com/blogs/wonkblog/ wp/2013/04/25/the-outlook-for-medicaid- to 10,000 of the state’s 90,000 eligible March 31, 2014 to obtain expansion-looks-bleak/ 4 by random lottery, essentially creating a Kaiser Family Foundation. September, 2013. http:// coverage without incurring kff.org/uninsured/fact-sheet/key-facts-about- large randomized control trial regarding the-uninsured-population/ a financial penalty. 5B. Sommers, et al. New England Journal of Medi- the effects of coverage expansion to the cine. July 25th, 2012. http://www.nejm.org/doi/ underserved. Clinical data from the past coverage and access but rather through pdf/10.1056/NEJMsa1202099 6J. O’Donnell and K. Kennedy. USA Today. October two years suggest increased care-seeking broader structural improvements outside 8th, 2013. http://www.commonwealthfund.org/ behaviors (also emulated in Massachu- the health delivery infrastructure. Despite Maps-and-Data/State-Exchange-Map.aspx 7MD Insurance Administration, sample rate charts setts after its 2006 health reforms10) and the obvious financial benefits to the state, for 2014 monthly health premiums. http://www. improved self-reported scores on total health quality improvement may prove mdinsurance.state.md.us/sa/consumer/md- health-connection-plans.html health with a notable 30% reduction in more elusive without ongoing research 8S. Cliff. The Washington Post. November, 2013. depression.11 However, improvements in and perhaps more investment in the pub- http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/31/in-first-month-the-vast-ma- other “harder” indicators, including blood lic health infrastructure and its integration jority-of-obamacare-sign-ups-are-in-medicaid/ 9C. Milligna. Health Affairs Blog. August 29th, pressure and diabetic control, are not yet into primary care. 2012. http://healthaffairs.org/blog/2012/08/29/ apparent. This delay in outcome realiza- In summary, Maryland’s health insur- expanding-medicaid-the-smart-decision-for- maryland/ tion may stem from the short evaluation ance exchange, MHC, is live. It is imperative 10Kaiser Family Foundation. May, 2012. http:// interval (more time may be needed to see that coverage expansion attracts a broad kaiserfamilyfoundation.files.wordpress. com/2013/01/8311.pdfOR data an effect in health indicators). Or perhaps swath of Maryland’s 800,000 uninsured to 11Associated links. Kaiser Health News. May 2nd, the data suggest that health promotion become financially viable and harness the 2013. http://www.kaiserhealthnews.org/daily- reports/2013/may/02/medicaid-and-oregon- cannot come solely through expanded state-based cost reduction projections health-study.aspx

14 • The Maryland familydoctor / Winter 2013 All Politics Is Local A Report from AAFP’s 2013 State Legislative Conference

sion are eligible for federal funds to help the design of CIMH, particularly regarding meet those needs, but federal subsidies those features that enhance the program’s will decline over ensuing years. appeal (and manageability) to the great- Providing care for more people in a sus- est number of primary care physicians. If tainable way will require deliberate plan- awarded federal funds, Maryland will be- ning on the part of all states. This planning gin implementing CIMH in 2014-2015. includes the right program design, param- eters and providers. Stakeholders need to Scope of Practice be at the table to shape the development Predictably, when any state address- of these plans. Appropriate incentives, es the problem of access to affordable Patricia A. Czapp, M.D. linked to straightforward quality perfor- health care, a scope of practice discus- The 2013 State Legislative Conference mance standards, must be in place to help sion ensues, which then leads to a debate of the American Academy of Family Physi- the physician workforce expand its capac- pitting physicians against non-physician cians (AAFP) was held in Denver, Colorado ity to serve more people. providers of care. on November 1 and 2. At the same time, primary care physi- Many states have passed legislation The Maryland chapter’s delegates, Dr. F. cians cannot and should not alone bear increasing the scope of practice and in- George Leon and I, were treated to a 2-day the responsibility for the health and cost dependence for non-physicians because conference with our Family Medicine col- outcomes of populations. This responsi- elected officials have been told that non- leagues from around the nation. Predict- bility must be shared with other entities, physicians can solve the access problem ably there was much discussion about cur- including patients themselves. Reforms by providing care in underserved areas. rent issues affecting family physicians and at the state level are needed to revise the We may counter-argue (with good evi- our patients. Uppermost in the minds of role of public health resources to comple- dence) that non-physicians typically work attendees were these topics: 1) the role of ment primary care by providing boots- and live where physicians work and live: family physicians in state “laboratories” for on-the-ground support to address social in populated areas with good schools for innovation in providing universal health determinants of health that adversely their children and good work opportuni- care, 2) scope of practice and autonomy of affect outcomes for the most vulnerable ties for their spouses. But we would do non-physicians, and 3) effective methods individuals and populations. Identify- better to remind legislators of our own of interacting with elected officials. ing individuals and populations for such strengths and speak to those truths - a What follows is a synopsis of fam- interventions is the responsibility of the strategy that family physicians in other ily physicians’ viewpoints and experience state and is accomplished through the states have found to be both influential across the nation regarding each of these epidemiologic study of claims data, pop- and effective. main topics, with added remarks relevant ulation health statistics and related data Non-physicians are part of a team to Maryland in particular. sources from hospitals and their emer- that provides care reliably, efficiently and gency departments. competently in the complex world of Family Physicians and Meanwhile, Maryland has applied for medicine. Physicians lead teams to ensure Healthcare Reform federal funding to implement a statewide patients are getting the care they need. Whether they opted for Medicaid ex- program, the Community-Integrated Med- Teamwork requires collaboration between pansion or not, states across the nation are ical Home initiative (CIMH), which reflects physicians and non-physicians so that care challenged with providing healthcare to these elements. CIMH is designed to ad- is neither fragmented nor haphazard. Un- more people, but with increasingly limited dress statewide healthcare delivery and af- necessary tests, prescriptions and referrals resources. Those states (Maryland is one) fordability issues in a sustainable manner. should be avoided. The biggest cost saver that chose to implement Medicaid expan- Family physicians are providing input in continued on page 16

The Maryland familydoctor / Winter 2014 • 15 Politics Is Local (continued) they serve on. This will prepare you well when you are ready to make an “ask.” • Offer to take your legislator (plus spouse) out for breakfast – nothing fancy. This has worked effectively for other family physicians in other states. • Develop relationships across a broad spectrum: don’t align with just one party or one legislator. • Follow up when your legislator asks you to. A state legislator can sit on as many as five committees, each covering different issues. In addition to sending a thank you message, be sure to fol- MAFP President Dr. Yvette Oquendo-Berruz meets with Maryland Delegate Guy J. Guzzone (D, District 13), at his district low up on any questions your legislator office, to brief him on issues relevant to Family Medicine. Are you engaging with your elected State representatives? If asked during your meeting. Legislators you are considering and need talking points, contact MAFP! rely on their constituents to share per- in medicine is “getting it right” – the FIRST • Demand a certain time or place for your spectives and ideas – your time and time: right care, right place, right time. legislator to meet you – they have highly commitment to your cause will be not- Physicians are trained to do much more unpredictable and volatile schedules. ed and appreciated. than follow protocols. Rather, we have a • Burn bridges: this morning’s enemy • Consider hiring a lobbying firm to sim- fluency in the entire health system, which could be this afternoon’s friend and ply monitor legislation and alert your is increasingly important given the grow- today’s majority could be tomorrow’s chapter of upcoming bills – this service ing complexity of patients’ needs. minority. Avoid sending letters and is one-tenth the cost of a full-time lob- Expect to see bills addressing scope of emails that will alienate anybody to byist, and many times is all you need. practice and non-physician autonomy in your cause! Our Maryland chapter is pleased to an- the upcoming Maryland Legislative Ses- • Be shy about dropping by their office nounce it competed for and was awarded sion. Participate in the debates if you are in your district, unannounced, with no AAFP funding for advocacy for Family Med- able, and remember the unique expertise, agenda. Offer yourself as a resource. icine at the state level. Activities are being training and experience you bring to the Leave your card and cell phone number. planned. If you would like to participate or table as the leader of a team of dedicated Don’t be disappointed if the legislator learn more, contact us at [email protected] health professionals. isn’t there – try again another time. or 410-747-1980. See also Dr. Steve Hans- man’s article about serving as Physician of Effective Lobbying Methods. Do the Day for the General Assembly. ■ Much discussion at the conference • Learn who your legislators are - simply centered around the do’s and don’ts of ef- use a search engine: “Who are my legis- Dr. Czapp of Annapolis is a MAFP Director fective lobbying. Experienced, effective lators?” Learn where their offices are in from the Southern District and member lobbyists and politically seasoned family your own district. All politics is local. of MAFP’s Legislative Committee. She is physicians provided these cogent pointers: • Develop a relationship with your legis- Chair, Clinical Integration at Anne Arundel lator that is not attached to any bill or Health Systems. She writes this, her 4th Don’t issue in particular. When it comes to consecutive report as the Maryland Chap- • Have your legislator meet you for the influencing elected officials, grassroots ter’s delegate to the Annual AAFP State first time when you are providing testi- participation trumps corporate dona- Legislative Conference. mony in Session – you will be far more tions every time. influential if your legislator already has • Research your legislators’ past voting Note: CME questions for this article are posted an established relationship with you. behavior and know what committees at www.mdafp.org; CME Quiz tab,. Winter, 2014

16 • The Maryland familydoctor / Winter 2014 Physician of the Day Face-to-Face Encounters with Maryland Legislators

to volunteer, as well, here is a recap of my dropper! The typical visitor to the Health experience as you consider participating Room might be someone who has a head- in the program. ache and needs an analgesic, or may have The goal of the POD program is to be come down with a minor illness and needs available in case of medical emergencies, advice. The Health Room also gives out flu but also to familiarize legislators with the shots and does blood pressure checks. There work of MedChi and to provide them with are times when things are more serious, the opportunity to speak to physicians such as the time a blind visitor fell all the way who are not politicians or lobbyists. down an entire flight of marble stairs. The Health Room is located in the lower On one occasion during my POD duty, A. Stephen Hansman, M.D. level of the State House, and is staffed by the assistant of a prominent senator called As a longtime member of MedChi, Coleen, a nurse who is employed by Med- and requested that I provide a prescrip- the Maryland State Medical Society, I was Chi to be available to legislators, staff, and tion for a “Z pack for bronchitis.” Of course, aware of their Physician of the Day (POD) visitors to the facility during the legislative I in turn requested that he come down to program to provide medical care at the sessions. Adults and even children have see me. During that encounter, it became State House in Annapolis during legisla- sought medical help and advice from the apparent that he was having a significant tive sessions. Eight years ago, I decided to POD serving in the Health Room, because problem with asthma, a diagnosis which find out for myself what that was like and the State House is a frequent destination was news to him. I treated him as any oth- gave it a try. Being POD was such a pleas- of school field trips. er patient and instructed him to follow up ant experience that I have done it nearly Coleen is delightful to work with and has with his personal physician. every year since. Because you might want many stories to share - but she isn’t a name- PODs may sit in on a legislative session as part of their day of volunteer service. I, In this age of electronic communication and social media, in fact, was introduced on the Senate floor having a face-to-face encounter with our legislators is a as the POD and greeted by my own legisla- novel and powerful means to communicate effectively tor! Watching the legislative process from the floor of the Senate or House is an eye- with those elected officials who represent us. opening experience. The sheer number of bills and votes makes me wonder how our legislators manage to process all the information presented to them. If you like, Coleen will arrange for the legislator(s) from your own district to visit the Health Room and meet you. This is encouraged because it gives the POD an audience with his or her own district representatives. PODs may attend the House or Senate sessions if desired, or may leave to go out in the local downtown area and stay in touch by cellphone during their service. Free nearby parking is provided. The legislators themselves are very grate- continued on page 18

The Maryland familydoctor / Winter 2014 • 17 Physician of the Day (continued) represent us. Because serving as POD has coordination of the program when other spe- I, in fact, was in some small way furthered the cause of cialty physicians voiced desire to participate. This physicians and health care in Maryland, I year the MAFP is planning an Advocacy Day in introduced on the keep going back every year. I hope more Annapolis which we are calling “Physicians for Senate floor as the family physicians will volunteer to serve as Patients.” So now more than ever we are inviting POD and greeted by POD – usually there are slots left unfilled MAFP members to join in by volunteering as POD by volunteers, so the need is apparent. as suggested by Dr. Hansman. Remind our leg- my own legislator! Physicians are not required to be a islators that THERE ARE FAMILY DOCS IN MARY- Watching the legislative member of MedChi to serve as POD. If you LAND! Remind them of our scope of practice and are interested in serving as POD, please how we differ from other providers. process from the floor contact Stephanie Wisniewski at (410) 539- Jos. W. Zebley, M.D. of the Senate or House 0872 ex. 6001 or [email protected]. Member, MAFP Editorial Board A fax-back form may also be downloaded is an eye-opening at www.medchi.org The Legislative Ses- MAFP thanks the following members who experience. sion for 2014 runs from Wednesday, Janu- served as POD during the 2013 Session of ary 8 through Monday April 7. ■ the Maryland General Assembly: ful that PODs are “on duty” and many will Gene F. Ashe, M.D., Woodsboro stop by the Health Room just to say hello. Dr. Hansman is a family physician practic- Matthew T. Burke, M.D., Baltimore In this age of electronic communication ing at Johns Hopkins Community Physi- Harvey J. Steinfeld, M.D., Shady Side and social media, having a face-to-face cians at Annapolis. Rosaire M. Verna, M.D., St. Michaels encounter with our legislators is a novel and powerful means to communicate ef- Editor’s Note: The POD program was initiated Note: CME questions for this article are posted fectively with those elected officials who many years ago by the MAFP. MedChi assumed at www.mdafp.org; CME Quiz tab,. Winter, 2014

The Sunshine Act – What Does it Mean for Us?

physicians? Pharmaceutical companies those very same drugs. With the Sun- and medical device manufacturers are shine Act in place, transfers of funds from now required to keep records and report Pharma and medical device companies to any “transfers of value” to physicians and physicians will become transparent to all. teaching hospitals to CMS. This informa- What gets reported to CMS and the tion is then shared with the public. The public? Anything that could be con- legislation behind this new policy was sidered to have “cash value” including sparked by relationships between physi- services, stock options, travel expenses cians and pharmaceutical companies and or lodging for conferences, charitable medical device manufacturers. Obvious donations, royalties for speaking at con- Janna Becker, M.D. conflicts of interest had become appar- ventions, teaching hospital facility fees, The Centers for Medicare and Medic- ent to the public; for example, some phy- and food and beverage. If the transfer aid Services (CMS) began implementing sicians were receiving honoraria of over is worth less than $10.00 per person, for the Physician Payments Sunshine Act on $150,000 per year to promote drugs while example a lunch costing $8.00 per per- August 1, 2013. What does that mean for also receiving federal funding to research son, the interaction does not need to be

18 • The Maryland familydoctor / Winter 2014 errors. Reports are linked to a physician’s National Provider Identifier (NPI). Is any provider excluded? Residents, nurse practitioners, and physician assistants are excluded from reporting, although any transfers of value received by an NP or PA will be reported as payment to the super- vising physician. Physicians employed as faculty by a teaching hospital are consid- ered “covered recipients” meaning transfers of value will be reported to the hospital, and not to that physician alone. If however that same physician accepts some transfer related to his or her own private endeavors, such as being a consultant, this will be reported as payment to the physician. The goal of the Sunshine Act is not to punish physicians. The law intends to improve transparency of financial relationships which could be perceived as a con- flict of interest. Being aware of the new changes regarding the Sunshine Act, as well as any new developments regarding the Act, is important. Designating someone in the office to keep records of inter- actions with industry suppliers, signing up for electronic updates via the CMS website, and reviewing reports prior to publi- With the Sunshine Act in place, transfers cation are all methods to ensure accurate representation of relationships between of funds from Pharma and medical physicians and vendors. ■ device companies to physicians will Dr. Becker is a 1st year Resident at the Uni- become transparent to all. versity of Maryland Family Medicine Resi- dency in Baltimore. She serves this year reported. If, however, the same company of meals and snacks during CME confer- as a Resident Editor, also contributing to continues to buy a medical practice lunch ence will not be required. Residency Corner on p. 21. so that the total value of transfer over How do physicians ensure accurate infor- the year exceeds $100.00 per person, the mation is being reported to CMS and the Note: CME questions for this article are posted at interaction is reported. Product samples, public? All information should be carefully www.mdafp.org; CME Quiz tab,. Winter, 2014. patient coupons or vouchers or educa- reviewed before the information is made tional materials, and short-term loans of public to ensure no errors in reporting were References Agrawal S, Brennan N, Budetti P. The Sunshine a medical device (less than 90 days) are made. The CMS gives a 45-day window Act – effects on physicians. N Engl J Med. all excluded from reporting. What about beginning each April to review the reporting 2013;368(22):2054-2057. Hurd P. The Sunshine Act: How to Avoid Get- CME events? The law states that because records electronically. Physicians can verify ting Burned. Fam Pract Manag. 2013Sept- of the nature of the CME event, reporting the information is correct, or dispute report Oct;20(5):8-10.

The Maryland familydoctor / Winter 2014 • 19 3 CME EVENTS IN 2 DAYS! FRIDAY - SATURDAY, FEBRUARY 21 – 22, 2014 DOUBLETREE BY HILTON BALTIMORE NORTH PIKESVILLE, MARYLAND Register for one, two or all three! DOT Medical Examiner Certification Training (8 CME Credits) ABFM Self Assessment Module (SAM) Study Hall (12 CME Credits) Kisha N. Davis, M.D. Separate Online Registrations or Download Forms DOT Trainer and Winter Regional Conference: CAM IN PRIMARY CARE (6.75 CME Credits ) at www.mdafp.org or CAM Program Coordinator Contact MAFP: 410-747-1980, [email protected]

1 – DOT Training (Friday) 3 – CAM in Primary Care (Saturday) The National Registry of cer- Americans are now spending more money on CAM than on traditional tified Medical Examiners is a medicine. That trend has continued as many forms of CAM are effective. new U.S. Department of Trans- This conference will explore issues in CAM, providing the most up-to- portation (DOT) Federal Motor date information on the therapeutic and administrative areas of focus. carrier Safety Administration Glimpse of topics and speakers…. (FMCSA) program. It requires all medical examiners who per- form physical examinations for Safety and Efficacy of Common Herbal Supplements For Naturopathic Medicine: commercial motor vehicle driv- Weight Loss Dispelling Myths ers to be trained and certified in FMCSA physical qualification standards. Medical examiners who have completed the training and successfully passed the test are listed in an online directory on the National Reg- istry website. The requirement becomes effective in May, 2014. This course is open to physicians, nurse practitioners and physician assistants. This training course will include the core curriculum speci- Andrea R. Gauld, PharmD Kristaps Paddock, N.D. fications established by the FMCSA. MAFP will provide necessary certificate to present at the testing center for the NRC- ME test. A workbook will be provided. Trainees will receive The MeVisit: Chronic Pain Management: E-Health Initiative a certificate of completion needed for the certifying exam. Alternatives to Opioids

2 – ABFM SAM: Health Behavior (Friday)

American Board William C. Thornbury, Jr., M.D. Delia Chiaramonte, M.D. of Family Medicine

Office Implementation of CAM Other… American Board of Family Medicine (ABFM) Maintenance of Certification (MC-FP) • Nutrition and Digestive Health Assessment Module (SAM) Study Hall with Dinner • Stress Reduction Interactive group learning session • Profit, Purpose, and CAM • meet part II requirement for ABFM MC-FP • Medical Marijuana • go through 60 core competency questions • receive 12 AAFP prescribed/AMA category 1 CME credits Frederick T. Sutter, M.D., M.B.A. with completion of online ABFM Clinical Simulation • Pre-Registration Mandatory 20 • The Maryland familydoctor / Winter 2014 residency corner

News from the Franklin Square Medical Center and University of Maryland Family Medicine Residencies

Franklin Square Medical Center FM Residency by Sarah Ines Ramirez, M.D., PGY-3 With the Fall season the 32nd annual Family Medicine Educa- teringPregnancy model of care. Through behind us our third years tion Consortium (FMEC) this October in this initiative, prenatal care is provided to are busy planning for Philadelphia. There, Matthew Loftus (R3) non-English speaking, uninsured, Latin the next phase of their read from his “This We Believe” award- women who would have otherwise likely careers. While some are winning essay. He also led a breakfast gone without such care. interviewing for fellow- discussion workshop on “Restoring At- Also busy on the conference trail was ships in Sports Medicine and Obstetrics Risk Communities Through Relocation” Joey Nichols (R3) who recently attended others are interviewing for positions in where he talked about his experiences the American Public Health Association academia, private and urgent care prac- living in Sandtown, West Baltimore. Af- meeting, where he met family physicians tices. For two of our December gradu- ter Philadelphia, Dr. Loftus was Louisville from around the country that are making ates, the next chapter of their lives is only bound for the Global Missions Health an impact in their communities and na- weeks away. Katherine Jacobson (R3) was Conference, which explores best prac- tionwide. Dr. Nichols’ interests in health welcomed by our Family Health Center as tices in medical missions and community policy resulted in a three-month elective one of their new faculty starting this Janu- development; overseas and in America. this summer rotating as a Longitudinal ary. Dr. Jacobson will step into the role of From this conference he learned about Scholar at the Robert Graham Center, the providing comprehensive care by includ- asset-based community development AAFP’s health policy think tank in Wash- ing obstetrics in her practice. Margarete (e.g. asking “What are your community’s ington, D.C., where he researched how Everts (R3) will resume work to complete strengths to address problems?” instead well family physicians do at addressing her Masters in Public Health at The Johns of “What’s wrong with your communi- smoking and obesity in their practices. Hopkins School of Public Health. ty?”), cross-cultural engagement in com- Thanks to the support and encourage- This has also been a season of na- munity development, and the role of ment of our amazing faculty, our group of tional meetings. With poster boards, public health in medical missions. residents has been able to seek intellec- costumes, and enthusiasm in hand I was FMEC also afforded me the opportu- tual opportunities outside of our program. joined by Richard Bruno (R1), Matthew nity to share my outcomes data from a In doing so, we have entered into stimulat- Loftus (R3), Katherine Jacobson (R3), Kel- collaborative project conceived by Balti- ing conversations with other family physi- ly Ryan (R3) and some of our faculty, Drs. more Healthy Start and Healthy Howard cians and policy makers from around the Michael Dwyer, Claudia Harding, Netra of Howard County where prenatal care is country about how to best provide care to Thakur, Tobie Smith, and Sallie Rixey at provided in a group model under the Cen- the communities that we serve.

University of Maryland FM Residency by Janna Becker, M.D., PGY-1 As recruitment season cine requirements, as well as the changes In October the residents completed brings bright and eager associated with the implementation of af- their annual In-Service exam. After 4 hours 4th year medical students fordable health care are at the forefront of of testing, the resident’s enjoyed lunch into the department discussion. Faculty members who started and an afternoon of laser tag while fac- for interviews, the cur- merely a few months ago have gotten right ulty Dr. Kevin Carter and Dr. Jason Ramirez rent University of Mary- to work, and along with senior faculty have covered the inpatient service. The PGY3’s land Residents continue to excel in their implemented new evaluation systems and proved their superior laser tag skills and academic and personal endeavors. The resident educational activities for an overall won 1st place! release of the new ACGME Family Medi- improved resident experience. continued on page 22

The Maryland familydoctor / Winter 2014 • 21 Residency Corner (continued) Dr. Erin Jones (PGY1) has continued to touch football team for the spring season of Burkill (PGY2) continues to serve as a fantastic be active in public health efforts despite recreational sports, and we are all taking bets role model and mentor. Dr. Burkill has been a busy intern year schedule. Along with a on who the team MVP may be-- new faculty contributing to the revitalization of urban colleague at the CDC, she has been draft- Dr. Jason Ramirez is a group favorite. landscape by buying and improving proper- ing a publication entitled “Community November was National Quit Smoking ties in a mid to low income urban, blue-collar Heath Assessment Following Mercaptan Month, as well as National Lung Cancer neighborhood. Dr. Burkill continues to show Spill.” She has also been peer reviewing Awareness month, and Dr. Maria Chura- that family physician involvement in the com- articles for the Journal of Global Public man (PGY2) took the lead in an effort to munity can span beyond health fairs while Health. We look forward to seeing the final increase smoking cessation rates. She inspiring his classmates to look for opportuni- products of all of her projects! gathered nicotine replacing therapy (NRT) ties to better the community they serve. Dr. Hersch Bhatia (PGY1), former Univer- samples for patients, created educational Perhaps the most noticeable change at sity of Maryland medical school class of 2013 materials for fellow residents, and created the University of Maryland Department of president, continues to lead team building ef- displays in the office with patient educa- Family and Community Medicine in recent forts among his intern class, as well as the rest tion material. The Great American Smoke- months has been the high percentage of of the residents and faculty. He organized a out Day in November, established by the pregnant residents and faculty! Without Fall fantasy football league, of which Dr. Casey American Cancer Society in 1977, was the giving too many spoiler alerts, be on the Scott, new faculty and former chief resident, kick off day for Dr. Churaman’s project. lookout for upwards of 10 baby announce- blew away all competition. He is in the pro- Community outreach is one of the foun- ments in the upcoming months. The entire cess of organizing a UMMC Family Medicine dations of Family Medicine, and Dr. Peter department is excited!

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News For and About MAFP Members MAFP Participates in Tour 4 Diversity of her residents and a medical student from Johns Hopkins University School of Medicine exhibiting and participating in panel discussions. Students excitedly approached the MAFP booth with great questions, many concerning the work-life balance in medical school. Representatives from each health field also participated in a lun- cheon break-out discussion. It was amazing to talk to students who aspired to become a reproductive endocrinologist or pediatric oncologist. Overall the residents and I believed the booth could have been more informative if we had more medical students representing. The undergraduates had great questions about the application UM Residents and JHU Student represent MAFP at Tour 4 Diversity. process, but the residents struggled to The Tour4Diversity national initiative identify a career path. More than 100 ex- answer them. I too was unfamiliar with is organized by a diverse group of health cited students attended, many interested the new changes in the MCAT and appli- professionals who aim to promote and in- in becoming physicians. cation. Otherwise many students want to spire minority students to pursue a career MAFP participated in the Baltimore stay locally for graduate school, and they in health care. Hosted at Bowie State Uni- event with Dr. Yvette L. Rooks, Vice seemed excited to learn about the two versity on September 27, 2013, Tour4Di- Chair and Residency Director, University medical institutions in Maryland! versity scheduled a day full of breakout of Maryland Department of Family and Tiffany Ho sessions dedicated to helping students Community Medicine, along with several MS3, JHUSM

Philippines Disaster Relief Through The AAFP Foundation The AAFP Foundation is collecting doing with partner organizations specializ- nations to support the disaster relief ef- ing in rapid-response and on-the-ground forts for those impacted by the massive ty- support. Contributions can be made on- phoon that swept through the Philippines, line at http://www.aafpfoundation.org/ Vietnam, and other areas of the region. online/foundation/home.html. Contact During times of disaster, the Foundation Brenda Cherpitel at [email protected] ensures timely and effective aid by work- or ext. 4452 with questions.

Improving the Health of Your Patients and Your Practice According to the CDC, many seniors reasons MAFP is working with Atlantic ing customer service. Atlantic’s mission is are still not being vaccinated for the po- Health Partners, the nation’s leading vac- to positively impact medical practice per- tentially fatal conditions of influenza cine buying group. Atlantic offers our formance and public health outcomes by and pneumonia. Effectively address- members the most favorable pricing and empowering physicians to provide immu- ing this problem is just one of the key terms for vaccines, along with outstand- continued on page 24

The Maryland familydoctor / Winter 2014 • 23 members (continued) nizations to patients in a cost-effective immunizing Medicare patients including contact Cindy or Jeff at Atlantic at 800- and efficient manner. Atlantic’s program vaccines covered under Part D. 741-2044 or email info@atlantichealth- is especially effective for family physi- MAFP members currently participat- partners.com to better determine how cians, and can help you with everything ing with Atlantic are most satisfied with Atlantic can help your practice. You can from back to school immunizations and the pricing, support, and ease of admin- also visit their web site www.atlanti- the influenza season, to more effectively istration. We strongly recommend you chealthpartners.com

Congratulations to MAFP Members for Special Appointments, Honors, Features, Achievements! Kisha N. Davis, M.D. of N. Potomac au- runs through June when she will be eli- of Delegates, served on the AAFP Creden- thored “Patient Encounter Offers Remind- gible for subsequent re-appointment to tials Committee at the 2013 COD in San er About Finding Work-Life Balance” in the two 4-year terms. Diego. In so doing, he participated in cre- November 20, 2013 AAFP Leader Voices Max Romano of Baltimore, MS 4 at the dentialing the duly-elected delegates and Blog. Dr. Davis is the new physician mem- Johns Hopkins University School of Medi- alternate delegates for the Congress. ber of the AAFP Board of Directors. cine, has been named a 2013 Pisacano The following members were honored N. Joseph Gagliardi, M.D. of Colum- Scholar. The Pisacano Scholars Leader- in the annual “Top Doctors” edition of Bal- bia had published his Letter to the Editor ship Program offers many career develop- timore Magazine, November, 2013: “Horizon should focus on Howard, not a ment opportunities, as well as scholarship Jason W. Black, M.D. cola war” in the November 6, 2013 edition funding to the future leaders of Family Mel P. Daly, M.D. of The Baltimore Sun. Medicine. The Program provides educa- Michael X. Dwyer, M.D. Niharika Khanna, M.D. of Columbia tional programs, leadership training, and Maryellen R. Goodell, M.D. was honored at the White House Cham- funding for outstanding 4th year medical Tracy L. Gutierrez, M.D. pions of Change event on September 10, students for a 4-year period. This premier Christopher D. Kearney, M.D. 2013 for her work as Director, Maryland leadership program is extremely competi- Joyce E. King, M.D. Learning Collaborative. She was recog- tive. The total number of awards granted Ruth A. Robinson, M.D. nized, along with a group of individuals each year will not exceed five. Yvette L. Rooks, M.D. from across the United States for “doing Howard E. Wilson, M.D. of Bowie, Se- Kenneth Sibila, M.D. extraordinary things to empower and in- nior MAFP Delegate to the AAFP Congress Sarah F. Whiteford, M.D. spire members of their communities.” See more in the November, 2013 MAFP E-Bulle- tin posted at www.mdafp.org Andrea L. Mathias, M.D. of Snow Hill was awarded the 2013 Dr. Henry P. & M. Page Laughlin Award in the category of Distinguished Public Officer during the MedChi House of Delegates in September, 2013. Dr. Mathias was acknowledged for her outstanding service and dedication to Maryland’s physicians and patients in her roles as Deputy Health Officer for Worces- ter County and Chair of the Maryland Board of Physicians. MAFP President Yvette Oquendo- Berruz, M.D. of Columbia was appointed by Maryland Governor Martin O-Malley to MAFP President Dr. Yvette Oquendo-Berruz (l) was one of a number of MAFP members who advised over 30 UM/ JHU medical students about the specialty of Family Medicine at an event held on the Hopkins medical school the Maryland Advisory Council on Heart campus during Primary Care Week in the Fall. The MAFP Foundation sponsored the event which was organized Disease and Stroke Prevention. Her term by Student Trustees Tiffany Ho (JHU) and Julie Taylor (UM).

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Contact Katie Bond, Director of Patient Care at [email protected] Partners in for questions Quality Care We understand we are an extension of your care and will provide superior outcomes to your patients. The Maryland familydoctor / Winter 2014 • 25 members (continued) Welcome New and Transferred Members May 1, 2013 - October 31, 2013 Active Tobie-Lynn Smith, M.D., MPH Jordan Alger David K. Jacobs Ghulam Abbas, M.D. Kristin S. Sochet, M.D. Nicholas Anastasio Christine Y. Kang Madhavi Ambati, M.D. Sandra L. Swann, M.D. Christine L. Anderson Daphna Katz Nnemdi Baird, D.O. Gregory H. Taylor, M.D. Subodh Arora Ariana Khaladj-Ghom James E. Baronas, M.D. Deaunte B. Thompson, M.D. Hasan Ashraf William King-Lewis Geoffrey Coleman, M.D. Saif Usman, M.D. Michael Atlas Anthony Kronfli Mohamed S. Dauda, M.D. Jillian Verby, M.D. Sherry Badri Ellen Lesh Mark J. Davis, M.D. Andrew White, M.D. Lennette Berry Aparna Kishor, PhD Tramaine A. Davis, M.D. Crystal P. Yeidell, M.D. Christopher R. Bickett Christina N. Lakin Rajwinder S. Deu, M.D. Emily Bien Heather Lillemoe Ngozi M. Everts, M.D. Life Louis Bivona Lorena M. Leite Binetou S. Fall, M.D. Lisa Smirnow, D.O. Gideon Bollino Maya Matheny Jill A. Foster, M.D., MPH Jorge A. Carpio Shaun C. Moeller Mitchell S. Gittleman, D.O. Resident Chan G. Chan Thiri Myint Jonathan J. Hennessee, D.O. Hersh Bhatia, M.D. Soraya Chanyasubkit My-Linh Nguyen Olaoluwapo M. Richard A. Bruno, M.D. An Chen Julia Olson Ikugbagbe, M.D. Cynthia Calixte, M.D. Daron Davis Donique Parris Afsheen Khan, M.D. Jennifer G. Christie, M.D. Kathryn Davis Karthya Potti Gillian K. Lowe, M.D. Seung J. Chung, D.O. Harsh Desai Akua Prempeh Thea L. Manlapaz, M.D. Mary K. Diehn, M.D. James Dizmang Andrea Riner Ursula Mclymont, M.D. Erin A. Jones, M.D. Christa Doerwaldt Craig Sadler Laine A. Montgomery Ariana M. Martin, D.O. Benjamin Ehrenreich Sandra M. Salzman Cornelison, M.D. Allison L. Parker-Gahey, M.D. Patrick R. Engelbert Sarah Sauter Obafemi O. Okuwobi, M.D. Naeha Quasba, M.D. Brainerd Erhiawarien Kristin Schreiber Stephen Robinson, M.D. Kerry E. Reller, M.D. Cassie M. Fairchild Jennifer Scott Vanessa R. Ruales, M.D. Amanda Sollars, M.D. Brooke Farquhar Ari Seifter Troy M. Russell, M.D. Charlotte A. Watts, M.D. Sarah Flynn Meggan Shell Nabila Shad, M.D. Elizabeth A. Wiley, M.D., MPH, JD Kriti Gandhi Jessica Shiu Kewal K. Sharma, M.D. Opal B. Williams, M.D. Jeffrey Glaser Gabriela S. Siegel Manisha A. Sharma, M.D. Dewansh Goel Joseph Slattery Cheryl A. Shaw, D.O. Student Karina Gonzalez Clarence Steele Arfassa Shiferaw, M.D. Tamara Aghamolla Erin K. Haser Julie A. Taylor Armel Simo, M.D. Maria Aguilar Natalie Held Kevin Wile

In Memory The Maryland Academy of Family Physicians is saddened by the passing of its members Wilbur H. Foard, M.D., Manchester J. Roy Guyther, M.D., Mechanicsville* Klaus H. Huebner, M.D., North East Arthur J. Levens, M.D., Spencerville Thomas F. Lusby, M.D, Prince Frederick To honor them, memorial contributions have been made to the MAFP Foundation. *MAFP President 1958-59 (article will appear in Spring edition of this publication)

26 • The Maryland familydoctor / Winter 2014 AAFP Family Medicine FALL 2013 Board Review Express™ for advertising information ISSUES IN CARDIOVASCULAR in Baltimore MEDICINE contact CVD A Global Epidemic Beyond Aspirin: A Review of Initial Management in Non-ST Elevation Attend a three-and-a-half Acute Coronary Syndrome TMP PRODUCTION New Frontiers in Lipidology: Use of BOS029961BTom3 Kennedy2013 at Advanced Lipid Testing day live course with your Beyond LDL in the Prevention and Management of Atherosclerotic 5.125 X 7.5 Cardiovascular Disease NCAPONE WHS0001 colleagues to review the It’s Not Just a Man’s Problem 800.561.4686 ext.104 reh/baf/baf Promoting Cardiovascular Health Maryland Family Doctor evidence-based principles ALSO… • Residents Corner • Celebrate the Foundation! or email of family medicine and • MAFP CME º 2013 Assembly Review º 3 Great Conferences strategies. Earn up to 27.25 in 2014! [email protected] This Edition Approved for 3.5 CME Credits. Complete and Return Journal CME Quiz at www.mdafp.org. AAFP Prescribed credits. THE MARYLAND familydoctor / FALL 2013 • 1 March 27 - 30, Baltimore, MD. Go to www.aafp.org/ baltimorebr to register and You’re about healing. prepare to pass. You’re about giving back. YOU’RE ABOUT TO MAKE Members: Send in your AN INCREDIBLE DECISION. practice-related, captioned photos for inclusion Full and Part-Time Family Practice in MAFP’s new MAFP Physicians Opportunities in Maryland Member Photo Page at Excellent Income, Reasonable Hours, No Hassles www.mdafp.org. Benefits: • Company-paid medical • Generous paid-time off malpractice insurance program that combines • Generous company-paid CME vacation and sick leave list of advertisers allowance with paid time off to • Paid holidays attend • Comprehensive health • No completing insurance forms insurance through Blue Cross Medical Mutual Insurance...... 2 and waiting for reimbursement Blue Shield Carilion Clinic ...... 8 • No hassles or overhead • Dental and Vision insurance costs associated with private • 401(k) retirement saving plans practice Med Chi Insurance • Company-paid short-term Agency Inc...... 9 • Steady income with no need to disability look for new patients Patient First ...... 10 • Healthcare and dependent care • Annual review with spending account Lyme Disease Association...... 11 performance increase MedStar Medical Group...... 22 Maryland opportunities available in: Professional SportsCare & • Baltimore • Cumberland Rehab...... 25 • Hagerstown • Jessup Wexford Health Sources Inc...... 26 • Westover To learn more and apply, MedExpress...... 28 please contact Kelly Walker at Shred-it...... 29 1-800-903-3616 x247 or email: [email protected] Advanced Clinical Products...... 29 Wexford Health Sources is an EOE/M/F/D/V Baltimore Medical System...... 30 Take Shape Now...... 31 Medical Device Depot...... 32

The Maryland familydoctor / Winter 2014 • 27 members (continued) AAFP/MAFP CME Requirements for Active/Supporting Members Active and Supporting Family Physi- cian Members must accrue at least 150 The AAFP will send Maryland Chapter members, hours of AAFP Prescribed and Elective at regular intervals, correspondence showing credit within each 3-year reporting period, of which: each member’s reported number of hours and • At least 75 must be AAFP Prescribed reminding members of what is required. credit; of which at least 6 of those being obtained from MAFP sponsored • Not more than 15 are from preparation required. All details about the AAFP/MAFP’s programs every 3 years (eg. CME and presentation CME records, reporting and information can conferences and journal CME). Members are encouraged to review the be obtained thru the AAFP web site at www. • At least 25 are from live learning activities document AAFP Continuing Medical Educa- aafp.org/cme , toll free at 800-274-2237 (ask for • Not more than 25 are from enrichment tion Requirements for Members at http:// the CME Records Department) or the MAFP at activities www.aafp.org/PreBuilt/cmea_member- 410-747-1980; [email protected] (e-mail). • Not more than 30 are from presentation requirements06.pdf or contact the MAFP or publication of an original scientific office to request a copy; office @mdafp.org Other Aspects of or socioeconomic paper pertaining to The AAFP will send Maryland Chapter MAFP CME Policy medical care members, at regular intervals, correspondence The MAFP Board of Directors has ap- • Not more than 45 are from publication in showing each member’s reported number proved the following: a state or national “refereed” journal of hours and reminding members of what is 1. MAFP members who are faculty members

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28 • The Maryland familydoctor / Winter 2014 at MAFP conferences may claim the credits for those sessions (even if they are not registrants) for the MAFP CME requirement. 2. MAFP members who are authors of CME articles published in The Maryland Family Doctor may claim those credits (according to AAFP policy; www.aafp. org) for the AAFP and MAFP CME requirements. The top law enforcement 3. MAFP CME credits will be Mobile Paper Shredding & Recycling agencies and corporations waived for those Active and • Security-cleared personnel in the world use Shred-it! Supporting members who re- • Offices coast to coast locate to the Maryland Chapter • Locked containers supplied PAPER SHREDDING AND • Shredded in our truck at your location within 6-months of the end of electronic media • Call for a free estimate their cycle of AAFP reelection. destruction ON-SITE 4. Active and Supporting members Est. 1988 who have not met the chapter 410-796-1500 requirement to report at least 6 1-800-697-4733 (1-800-69-SHRED) www.shredit.com chapter credits within their AAFP reelection cycle may receive a waiver for that cycle, to be made up in the subsequent AAFP Re- election cycle, by following the process noted below: 1) Member must contact the MAFP office submitting a request (written, email, phone call) for a one-time waiver for the chapter requirement in- dicating a desire to continue membership, pledging to acquire the credits during the next AAFP reelection cycle. There is a waiver request administrative fee of $50. 2) Member must make up waived credits in the subsequent AAFP reelection cycle (in addition to the required 6 credits). 4) If failing to acquire the required chapter hours in the subsequent AAFP reelection cycle, MAFP will not accept another waiver request from member.

The Maryland familydoctor / Winter 2014 • 29 members (continued) Several Ways to Obtain MAFP CME 1. MAFP Online CME at www.mdafp. CAM in Primary Care, DoubleTree org is easily accessible, affordable and by Hilton Pikesville, Baltimore, Mary- convenient: land, (see details on p. 20). • Journal CME through The Maryland Family Doctor publication. Read selected articles and submit quizzes – free service. • Video CME through posted CME video-casts – nominal registration fees. • Presented by Reid B. Blackwelder, M.D., President, AAFP Blackweld- 2. 2014 Live CME Conferences • Annual Assembly: “Educational er photo, Caption: MAFP looks Spectrum for Family Medicine” forward to having Dr. & Mrs. (with a little baseball and football Blackwelder with us in June! thrown in…), June 12-14, Holiday • Comprehensive Educational Pro- Inn Hotel and Conference Center, gram will keep you up to date Frederick, MD. Here are a few high- • Baseball Night with the Frederick lights (more details to come…): Keys at the Harry Grove Stadium • Welcome to Frederick! Tourism • Promotion of Healthy Lifestyles Council of Frederick County featuring “Fuel Up to Play 60” • Winter Regional Conference: Febru- • Keynote Address: “Practical Ap- with a special surprise guest ary 21-22: DOT Training, SAM Study, proach to Patient Centered Care” (hint… NFL!)

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Competitive Salaries and Benefits Contact: CME Allowance, Paid Holidays and Paid Time Kevin Ferentz MD Off [email protected] Minimal on-call Alana Cornejo, Recruiter No hospital rounding Phone: (410) 558-4888 Loan repayment programs Fax: (410) 510-1393 Sign on bonuses [email protected] 30 • The Maryland familydoctor / Winter 2014 Are Metabolically Healthy Overweight and Obesity Benign Conditions? Caroline K. Kramer, MD, PhD; Bernard Zinman, CM, MD; and Ravi Retnakaran, MD

Conclusion: Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight. “Annals of Internal Medicine, December 3, 2013”

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Join a large group of dedicated clinicians who provide high quality care to underserved communities What Percentage of Your Patients With over 350 employees at 6 centers, BMS offers opportunities for growth, enrichment, and stability We strive to be the employer of choice by hiring highly qualified and dedicated are Over Weight or Obese? staff who understand the communities we serve. Help us carry out the mission, vision, and values of BMS and make Baltimore a better, healthier community! You Can Make a Difference!

Competitive Salaries and Benefits Contact: Enhance Your Practice While Helping Your Patients CME Allowance, Paid Holidays and Paid Time Kevin Ferentz MD Off [email protected] Minimal on-call Contact Lori Andersen, RN Support Nurse Coordinator, to get your Alana Cornejo, Recruiter No hospital rounding Phone: (410) 558-4888 office started today! 410-280-3520 or [email protected] Loan repayment programs Fax: (410) 510-1393 Sign on bonuses [email protected] The Maryland familydoctor / Winter 2014 • 31 Presorted Standard MARYLAND Academy U.S. Postage Paid of Family Physicians Little Rock, AR Permit No. 2437 5710 Executive Dr., Suite 104 Baltimore, MD 21228-1771

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32 • The Maryland familydoctor / Winter 2014