The Leg.Up Local, state and national news of interest to the physician community
February 3, 2016
Why Docs are Like Fine Wine
Click here to read a recent JAMA article, "The Graying of US Physicians: Implications for Quality and the Future Supply of Physicians."
"When should a physician retire?" asks Joel M. Kupfer, MD, of the Department of Medicine, University of Illinois College of Medicine Peoria. "This question is being asked more frequently as the number of physicians in the United States older than 60 years continues to increase."
With an estimated 26 percent (or nearly 241,000) of all actively licensed physicians in the U.S. older than 60, "Patient safety advocates, consumer groups, and policy makers have questioned whether older physicians maintain the necessary cognitive and motor skills to continue to provide safe and competent care." In response, Kupfer writes, the AMA has announced plans to identify organizations that should participate in developing new guidelines for testing the competency of aging and latecareer physicians "that may include periodic evaluation of physical and mental health, neurocognitive testing, and review of clinical care."
This emerging issue follows last year's spat over Maintenance of Certification by the ABIM. (see more below). As Kupfer puts it: "Adding new layers of regulations and administrative requirements that apply solely to aging physicians is unlikely to meet with physician acceptance or enhance patient safety."
He proposes asking the American Board of Medical Specialties and other physician groups to "consider developing a single, integrated national standard that builds in existing programs like ongoing and focused professional practice evaluations..."
Kupfer argues that "older physicians bring valuable skills, clinical expertise, and life experiences that can be gained only by years of practice ..." So "rather than isolating aging physicians, acceptable standards should be developed that can be applied to all physicians, regardless of age, wherever and whenever they work."
Click here to read more, especially the need to help out stressed out docs!
One Doc's Crusade for a Better (MOC) Way
Click here for an entertaining, eyeopening and short video by Dr. Paul Teirstein, a California cardiologist and founder of the new, alternative board certification group, the National Board of Physicians and Surgeons.
A RAM member who shared the link calls Dr. Teirstein "a rare ray of hope and voice of reason regarding the ever burgeoning burden" of ABIM's MOC, and "an example of professional courage and the power of one." Dr. Teirstein shows "the power of one"
W.H.O. Issues Zika Warning, Sexual Transmission in Dallas The World Health Organization this week "declared the Zika virus and its suspected link to birth defects an international public health emergency," reports The New York Times, "a rare move that signals the seriousness of the outbreak and gives countries new tools to fight it."
The Zika virus has moved from Brazil (where it was detected last May) to more than 20 countries in Latin America, including two new ones announced this week: Costa Rica and Jamaica.
And in an alarming twist, "A case of Zika virus infection transmitted by sex, rather than mosquito bite, was discovered in Texas on Tuesday, a development sure to complicate plans to contain a global epidemic," reports The New York Times.
The Dallas patient with the Zika virus was infected after having sex with someone who had returned from Venezuela, where Zika is circulating.
The main worry over the virus' possible link to microencephaly has increased in Brazil, though the Times reported "researchers have yet to establish that Zika causes the condition."
W.H.O. officials said research on the effects of Zika in pregnant women is underway in at least three countries Brazil, Colombia and El Salvador.
Despite its warning, the agency stopped short of advising pregnant women not to travel to the affected region, a precaution that American public health officials including those in Virginia began recommending last month.
Some American health experts contend that this was more about politics than medicine. Brazil is preparing to host the Olympics this summer, "and any ban on travel, even just for pregnant women, would deliver a serious blow to the Brazilian government."
"I think there was a political overtone," said Lawrence O. Gostin, a health law professor at Georgetown. "If it were my daughter and she was pregnant, I would absolutely warn her off of going to a Zika affected country, and the W.H.O. should have said that."
A new vaccine is probably years away, the Times reported last week.
"Not only are scientists still learning about the virus, which until recently was viewed as relatively benign, but any vaccine must go through rigorous testing to ensure that it is safe and effective."
Researchers are not only exploring ways to develop a vaccine, "but also are hoping to create a rapid test that would detect the presence of the virus' antibodies."
Another problem is that "most drug companies have been reluctant to invest in drugs or treatments for diseases in the developing world unless they see a financial reward."
Click here for a look at microcephaly, which "has long afflicted and mystified," reports The New York Times. "For doctors, the diagnosis means an ailment with no treatment, no cure and no clear prognosis."
With the Zika outbreak, "If the condition surges, it will significantly burden a generation of new parents for decades."
While there have been small scale studies of a Zika outbreak in the South Pacific in 2007, "The current outbreak is the first in which scientists have seen the virus invade a large continent where no one is immune."
Virginia Health Commissioner Dr. Marissa Levine was one of those on the forefront of advising caution. "Pregnant women are strongly encouraged to consider postponing travel to Zikaaffected countries while pregnant."
Click here to read more.
Click here to check the CDC's travel notices.
The virus is transmitted by the Aedes aegypti mosquito, which is also known to carry the dengue, yellow fever and Chikungunya viruses, Reuter reports.
Mark your calendars for RAM's Next 2016 White Coat Day: February 9th Make plans now to attend RAM's next 2016 Lobby Day at the General Assembly (Tuesday, February 9th). Join your colleagues for breakfast and a legislative briefing before meeting with local legislators and sharing your valuable input and perspective with them.
WHAT WILL YOU HAVE TO DO?
Take the morning off from your duties February 9th (from 8:00 AM to 12:00 PM). Meet at the Hilton Richmond Downtown (MSV's base of operations during the General Assembly session) at 8:00 AM Attend a morning briefing about what's happening on that day at the General Assembly. In small groups, visit one or more elected officials (RAM staff will arrange the meetings and take you there). Wear a white coat!
WHAT WILL RAM/MSV DO FOR YOU?
Arrange transportation from your hospital to the Hilton Richmond Downtown. Arrange meetings for small groups of physicians with elected officials. Provide you with background information so you can discuss issues with the elected officials. Feed you breakfast and lunch. Lend you a white coat if you don't have one. Return you to your hospital.
CLICK HERE to sign up for the February 9th White Coat Day
or call Lara at 8046228137 or email her at [email protected] to register!
Click here if you want to see a great photo gallery of last week's great White Coat RAM event! MSV Action Alert to Oppose Scope of Practice Bills
The Medical Society of Virginia just issued an "action alert" on two scope of practice bills SB369 and SB 620 "which both involve granting nurse practitioners independent practice" that need your immediate attention!
With an 8 a.m. Thursday meeting of the Senate Education and Health Committee on tap, MSV asks that you please contact your senator by clicking here to express opposition to SB 369 and SB 620 "and help preserve teambased patient care in Virginia."
Richmond Mag's "Top Docs" Appeal
Richmond magazine's annual online survey to select the metro area's "Top Docs" is underway. Here's the pitch from our friends at the magazine:
"This survey is special because the top doctors in a range of specialty areas are selected in a vote of their peers. Winners will be announced in the April issue. Voting continues through Feb. 15. You can participate online at richmag.com/2016topdocs. Use this password: tpdcs2016."
Contact Tharon Giddens, the magazine's lifestyle editor, at [email protected] for additional information.
Va.'s Tanning Bill Goes Dark, Will FDA Issue Ban?
At last week's White Coat Day, RAM members bent the ear of many a legislator to garner support for House Bill 356 to "protect minors from the harmful effects of indoor tanning."
Unfortunately, the tanning bill didn't make it out of the House Commerce & Labor Committee, with five members voting for it and five against. Click here for the vote.
While the bill could always be revived later, our friends at the Medical Society of Virginia tell us not to hold our breath.
Virginia currently has no restrictions on the use of tanning beds by children age 15 and older, and only requires parental consent for children age 14 and under.
Click here for more from MedPage Today on the skin cancer "epidemic."
According to a recent study, "Women with a melanoma diagnosis before age 30 had almost a 100 percent positive history for use of indoor sun tanning facilities."
There is a ray of hope for our members who keep shedding light on this unhealthy practice: The FDA has proposed a national ban on the use of indoor tanning equipment by people younger than 18.
How to Avoid the 2017 Meaningful Use Penalty
The AMA is encouraging ALL physicians subject to the 2015 Medicare Meaningful Use program to apply for hardship exemptions that CMS has said will be granted due to delays in publishing their regulations. Applying for the hardship will not prevent a physician from earning an incentive. It simply protects a physician from receiving an MU penalty.
Click here to learn more and/or apply.
Health Insurers' Fight with Rx‐makers Over Opening Books
"Two lobbying behemoths have been quietly duking it out behind the scenes at the Virginia General Assembly over whether drug companies should have to open up their books," reports the Associated Press.
Hoping to capitalize on the public's concern over rising drug prices, health insurers are pushing legislation "that would require pharmaceuticals to publish the cost of developing, manufacturing, and marketing of drugs that cost $10,000 or more for a single course of treatment."
Supporters said this is a simple transparency measure, but the Rx makers claim the bill would give a false reading of their books and could be a "first step toward governmentrelated price controls that would stifle future innovations," AP reports. Anthem Blames Ocare for Earnings Drop
Anthem Inc., Virginia's largest health insurer, missed Wall Street's earnings projections for the fourth quarter of 2015 and blamed its individual Obamacare health plans for lowering profits over the three month period, The New York Times reports.
Anthem has nearly 800,000 people enrolled in plans through the ACA exchanges, which is 30 percent below its expectations. "Without the membership it had planned for, costs of running the business were too high, Anthem said."
Meanwhile, Aetna "wrapped up 2015 with a 38percent surge in fourth quarter earnings," but issued a guidance to Wall Street that misses analysts' forecasts for 2016.
Henrico Doctors' Soil Tests Cause Dust‐up
The clearing of trees and vegetation as part of a proposed new cancer treatment center near Henrico Doctors' Hospital caused quite a stir, reports the TimesDispatch.
In a plan still pending with Henrico County officials, the hospital "plans to buy the land from neighboring Three Chopt Elementary School for the center," the TD reports. "But that $3.2 million sale is contingent on the county granting the hospital's rezoning request" which will be heard Feb. 11 by the Planning Commission.
Subcontractors hired by the hospital were testing the soil as part of "due diligence" to ensure the land would be suitable for the cancer center, hospital officials said.
But that explanation didn't satisfy nearby Woodley Road residents who told the TD that "they're acting like it's already approved" and that the clearing was "excessive."
The hospital was later "told not to clear any more unless the rezoning and other site plans are approved," the newspaper reports.
Supreme Court Rejects GOP Bid to Block New Map
The U.S. Supreme Court has turned down a bid by Republicans in Virginia's congressional delegation to block implementation of the state's new congressional map.
"The onesentence order means Virginia will hold congressional elections in November with the new map which transforms the districts of Reps. Robert C. "Bobby" Scott, D3rd and J. Randy Forbes, R4th unless congressional Republicans win their appeal to the high court," reports the TimesDispatch.
The Politics of Virginia's Gun Deal
Click here if you'd like to sort out the politics behind last week's surprising bipartisan agreement on guncontrol in Virginia.
Although Gov. McAuliffe and the GOP privately agreed to portray the deal as a "winwin" for Dems and Republicans alike, "the gunsafety camp said it has been betrayed," writes Laura Vozella of The Washington Post.
Later, the state Senate narrowly rejected a measure that would have done away with the state's concealed handgun permit requirement, reports the Associated Press.
After a 2020 vote, Democratic Lt. Gov. Ralph Northam cast the vote that broke the tie, leaving intact the gun permit law.
Lt. Gov. Northam at RAM last year.
Ground Control to "Major Joe"
Vice President Joe Biden's proposal for a "cancer moon shot" has hit a nerve in the nation's research community, "where cuttingedge scientists blame an entrenched medical establishment for hoarding the data needed to make breakthroughs," reports Politico.
"The tension boiled over this month when Jeffrey Dazen, editor of the New England Journal of Medicine, and coauthor Dan Longo, wrote in an oped that while sharing was all well and good, it had to be done collaboratively, not by 'data parasites' who stole or misused work that might have taken bench scientists decades to assemble." Click here to read the NEJM piece.
Later, "the Twittersphere exploded" at the Journal article. As Politico put it: "The debate, which revolves around how fast researchers should have to share results from government funded clinical trials, aired biomedicine's dirty laundry in public."
But "in the medical trenches" where researchers need to "publish or perish" "that's not an easy sell," Politico reports.
VP Biden has promised to "break down silos and bring all the cancer fighters together." First, though, it appears Biden who lost his son Beau to brain cancer last May is going have to set up a new Mission Control.
Click here to read how one big insurer's VP Biden with late approval of genetic testing for some son, Beau. cancer testing "thrusts the insurer into an ongoing debate about handling an array of these expensive tests."
Talking )!@*#! Is Illegal!
If anyone curses in your office (presumably not including in an exam room!), they may be breaking Virginia law. Click here to find out why. Mobile Apps' Liability Risks
With more than 100,000 mobile health apps now available, physicians now have to handle an increasing amount of constant data and patient information that they did not have in the past. Mobile apps offer many benefits, but the use of these apps does not come without liability risks for doctors.
Click here to read more from The Doctors Company!
"E" (mail) for Empathy?
When the head of a California orthopedic surgery center first heard about "messaging technology" to improve patient satisfaction, it "almost made me nauseous," she told Kaiser Health News.
After all, Kaiser asks, "How can you automate something as deeply personal as empathy?"
But she was soon sold on the new technology from HealthLoop because it raised her 500surgeon practice's patient satisfaction scores, lowered readmission rates and, of course, brought higher reimbursements from Medicare.
"Automating empathy" is the new buzzword for helping doctors stay in touch with patients before and after medical procedures cheaply and with minimal effort from already overextend physicians, Kaiser reports.
With HealthLoop now used by such bigname medical centers as the Cleveland Clinic, "Startups ... are promising that their technologies will help patients stick to their treatment and recovery programs, avoid a repeat hospital stay, and be more satisfied with their care."
Other firms in the emerging "patient engagement" sector include Wellframe, Curaspan and Infield Health.
Click here for a "metaanalysis" of 3,000 chronically ill patients about whether text messages helped them comply with medication regimens. While the findings seemed to show a marked increase, the study's authors advised caution since some of the studies they examined relied on patients to self report.
The researchers found that patients may eventually suffer from "message fatigue." Sound familiar?
Comments? Criticisms? Witticisms?
We draw from a wide range of print, online and other sources, including the shifting realm of social media to bring you information we hope is relevant to your practice of medicine. But as a a former journalist and nonfiction author, I recognize that mistakes do happen especially on deadline! So please contact me if you have any concerns, complaints, or articles you'd like to share by clicking here or calling me at 6228136.
Click here if you'd like to see some of my other writing. THANK YOU for being part of the Academy and its continuing conversation about the practice of medicine.
And check out some back issues.
Chip Jones RAM Communications & Marketing Director
The Richmond Academy of Medicine, 2821 Emerywood Pkwy, Ste 200, Richmond, VA 23294
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