hiia iothly januaryfebruary 2015 new license renewal ......hiia iothly januaryfebruary 2015 now...

Physicians’ Bi-Monthly January/February 2015

Now Available: A Practical Guide for Clinicians and

Community Partners to Improve Blood Pressure

Control in N.H. By Rudy Fedrizzi, MD and Kimberly Persson, MSW

The first phase of the New Hamp-shire Million Hearts Learning Col-laborative, funded by the Associa-tion of State and Territorial Health Officers (ASTHO) and Centers for Disease Control and Preven-tion, brought together partners from across the state to test prac-tical ways medical practices could improve blood pressure control for their patients. The project fo-cused on federally qualified health centers (FQHCs) in Nashua and Manchester and relied on key strat-egies that helped Cheshire Medi-cal Center/Dartmouth-Hitchcock Keene (CMC/DHK) to become a 2013 National Million Hearts Hypertension Control Champion organization. Between January 2014 and September 2014 these FQHCs saw significant improve-ments in the percentage of their patients with hypertension that achieved adequate control (BP < 140/90). Manchester alone saw an increase in control from 66% to 75% for its more than 1,400 pa-tients with hypertension.

Million Hearts, cont. on page 7

In partnership with Dartmouth-Hitchcock Norris Cotton Cancer Center (NCCC), the New Hampshire Comprehensive Cancer Collabora-tion (NH CCC) has released a new emerging issues brief, “Precision Medicine: How Genetic Sequencing

is Changing Cancer Care.” Issue briefs are released three to four times annually. In this brief, NCCC re-searchers Gregory J. Tsongalis, PhD, professor and director of Molecular Pathology at Norris Cotton Cancer Center, and Christopher I. Amos, PhD, associate director for Cancer Center Population Studies and head of the Center for Genomic Medicine at Norris Cotton Cancer Center, ex-amine what we know about a new and exciting opportunity to revolu-

N.H. Comprehensive Cancer Collaboration Emerging Issues Brief

By Sarah Blodgett, Executive Director, N.H. Board of Medicine

The N.H. Board of Medicine (board) has added two additional requirements for license renewal beginning in 2015. All physicians and physician assistants autho-rized to prescribe a schedule II, III and/or IV controlled substance will be required to register with the New Hampshire Prescription Drug Monitoring Program (NH PDMP). The board has long been a proponent of a prescription drug program and anticipates that this will be an invaluable resource for practitioners. As many of you know, New Hampshire is facing a prescription drug epidemic. Pre-scription drug-related deaths now

outnumber traffic fatalities in our state.i The annual milligram-per-person use of prescription opioids in the U.S. increased 399% from 1997 to 2007.ii While this is un-doubtedly a national problem, New Hampshire is facing a serious cri-sis as our state’s rate of non-med-ical use of pain relievers by 18- to 25-year-olds is the second highest in the country.iii Please note that failure to register with the NH PDMP by June 30, 2015, could constitute grounds for the board to impose disciplinary sanctions.

NH PDMP registration instruc-tions have been sent out to email addresses on record with the board. Please contact Sharon Can-

New License Renewal Requirements

License Renewal, cont. on page 6

Cancer Collaboration, cont. on page 8


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

How to Avoid Your Own Personal Financial Crisis ....................................3

‘Unfounded’ Doesn’t Mean ‘No Problem’ ........................................4

EVP Corner ............................................5Does your N.H. license expire

in 2015? ...............................................6Rx Theft and Forgery: How it happens

and what you can do about it ............10Corporate Affiliate Program .................122014 NHMS Council ............................13NHMS Welcomes New Members ..........13Look how much fun we had at the2014 NHMS Annual Scientific

Conference! .......................................14

Mission: Our role as an organization in creating the world we envision.The mission of the New Hampshire Medical Society is to bring together physicians to advocate for the well-being of our patients, for our profession and for the betterment of the public health.

Vision: The world we hope to create through our work together. The New Hampshire Medical Society envisions a State in which personal and public health are high priorities, all people have access to quality healthcare, and physicians experience deep satisfaction in the practice of medicine.

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

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

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A cold winter morning in Chicago was no excuse to be late for the end-of-the-week 7 a.m. residents’ session in the amphitheater, even if you got off your shift at mid-night. The only out was if you had worked overnight, wrapping up at 7 a.m. Then it was under-stood that going to bed took pri-ority over the two-hour meeting. There was a perpetual undercur-rent of weekly discordant com-mentaries regarding the utility of mandatory attendance at the meeting. Nevertheless, almost weekly, there would be one or two latecomers. Whether off the mark by a few minutes or greater, the outcome was the same. There would be a pause as there was a look directed to the back and in-struction to those who had quietly just sat down to go directly to the department and start seeing pa-tients. A one-on-one discussion would follow after the meeting. It was a year later when we received a rational explanation for the re-curring theme.

The following question was posed to us, “What do you think the most consistently challenging part

of your careers will be?” There was quiet introspection for some and shared input by others that ran the gamut from work-life bal-ance, medical-malpractice risks and job jumping to dilemmas be-tween income and job location. Not one of us hit the nail on the head. The answer was put forth as a very sensible diatribe. “You are all, at this point, clearly capa-ble and intelligent men and wom-en who have selected careers that have a high degree of responsi-bility and self-governance. Your biggest challenge and potential source of ongoing risk and aggra-vation is the behavior of your col-leagues or yourselves.” This was made even more apparent when a senior resident was permanently dismissed from the program after lying about having done a rectal exam on a patient with a GI bleed. There were no misgivings regard-ing the importance of credibility and honesty in our program, as it should be for physicians.

That was that. Over the years it has become crystal clear that the message could not be any more than stark reality on many levels. There have been ongoing efforts to offer structure and support for the most basic understand-ing of how important it is to be honest and respectful of each other and of our patients, sup-ported by mechanisms to turn to when there is outlying behavior or misalignment in our clinical practice. Refer to JAMA. 2014; 312(21):2209-2210. doi:10.1001/jama.2014.10218: “The Accredi-tation Council for Graduate Med-ical Education’s 6 core competen-

President’s PerspectiveZero Tolerance

President’s Perspective, cont. on page 9

Lukas Kolm, MD, MPH, MBA, FACEP


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By Robert C. Burns Jr., CFP®, CLU®, ChFC ® and Troy Zerveskes

While global financial crises are far beyond our individual control, it’s important to recognize that each of us is empowered to take control of our own personal fi-nancial future. One way to begin is by recognizing that there’s a lot of risk and uncertainty out there, and that planning to help mitigate risk and deal with uncertainty can go a long way toward keeping our personal financial goals on track.

Despite what seem to be uncon-trollable economic forces, there are plenty of actions that can be taken today to incorporate “risk mitigation” into your financial de-cisions to avoid having a personal financial meltdown.

From a financial perspective, con-sider some of the more common risks everyone faces:

Longevity Risk – Outliving your ability to financially sup-port yourself and your family.

Mortality Risk – Dying with-out properly protecting your family, your business or your assets.

Health Risk – Having to pay for a costly long-term illness, whether it’s your own or the ill-ness of a close family member.

Credit Risk – Not being able to borrow to grow your busi-ness or facilitate personal cap-ital expenditures.

Market Risk – Not being able to sell your business or other important assets for their fair market value.

Inflation Risk – Having the cost of goods and services go up, especially after retirement.

Creditor Risk – Having law-suits and/or bankruptcy po-tentially erode your life sav-ings.

Income Tax Rate Risk – The chance that income tax rates will increase, just when you need to draw down income-taxable retirement assets.

Obviously, any one of these risks could significantly impact your ability to keep your financial plans on track. However, a com-bination of these risks can be even more devastating. Imagine the outcome to the owner of a busi-ness who is about to retire if the market value of the business were to decline, the income tax cost of taking retirement distributions were to rise and inflation hikes were to make everything more and more expensive.

Now is the Time to Consider Taking Action

What combinations of risk keep you up at night? Whatever your answer, now is the time to consid-er taking protective action to help mitigate the risks that could upset your plans for tomorrow.

Let’s look at a hypothetical sce-nario:

If you have pre-tax money invest-ed in tax-qualified retirement sav-ings and believe there’s a strong possibility marginal income tax rates will go up in the future for you, consider one or more of the following:

Today: Diversify your retirement savings by using techniques and financial products that provide tax-favored retirement distribu-tions and/or risk mitigation op-tions, such as a Roth IRA or Roth 401(k), life insurance and annuities.

At Retirement: To the extent pos-sible, match future taxable retire-ment plan distributions with future personal and/or business income tax deductions to potentially create at least a partial tax offset.

If, however, tax rates are high to-day and you believe they will be lower for you at the time retire-ment income is needed: Maximize contributions to your tax-qualified retirement savings plan, thus cre-ating larger income tax exclusions or deductions for those contribu-tions at the higher tax bracket.

Conclusion

Being aware of the risks that im-pact you the most is a critical first step to risk mitigation. Next, iden-tify your financial goals and ob-jectives. Without clearly defined financial goals, opportunities you can take advantage of are much more difficult to recognize or im-plement. Of course, implement-ing an action plan to counter the risks you uncover is just as impor-tant, which is why it’s important to work with financial, tax and legal advisors to help ensure that even in times of economic uncertainty, you are making certain your fi-nancial goals stay on track. �

MetLife, its agents and representa-tives may not give legal, tax or ac-counting advice, and this document should not be construed as such. Cli-ents should confer with their qualified legal, tax and accounting advisors as appropriate.

How to Avoid Your Own Personal Financial Crisis


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By Wendy Gladstone, MD

Here it goes again. You open what looks like a form letter from the Division for Children, Youth and Families and see that it’s about a child you reported to the agency because you were suspicious of abuse or neglect. In a few sen-tences you learn that the concern was “unfounded.” That’s startling because you only called the agen-cy because you were really wor-ried. Are you losing your clinical skills? Or are the people at DCYF clueless? Does this letter make you think that DCYF never does anything about any child so why bother to report? What if you see this child again next month and there’s yet another problem that waves a red flag at you that some-one’s mistreating him (or her)? Should you keep quiet because DCYF has already ruled on this situation?

No, you’re not losing your clini-cal skills. No, the people at DCYF aren’t clueless. And if you see another red flag, pick up the phone and call DCYF again. Be-cause “unfounded” doesn’t mean “you shouldn’t have called us.” It doesn’t mean “there’s no problem with this child.” It doesn’t mean “DCYF doesn’t want to hear about this again.”

“Unfounded” is a term taken from the DCYF policy on how the agency must respond to concerns about a particular child’s safety and well-being. The agency uses the term if, after an assessment of a given situation:

• there is concern, but what-ever DCYF could document didn’t rise to the level of a le-gal definition of “abuse” or “neglect”;

• the child is a risk but DCYF has made changes to reduce the likelihood of maltreat-ment;

• there is not enough evidence for DCYF to decide if there has been abuse or neglect.

For example, a child who made a disclosure of abuse to a parent may deny it to the authorities. Parents who use harsh (but not illegal) discipline techniques may have accepted interventions to use other ways of correcting their children. Missed appointments or failure to give medication may be due to disorganized lifestyles, unreliable transportation, pov-erty, domestic violence or care-

taker depression, all of which are barriers to care that DCYF can help families overcome. Child behaviors that are typical for mal-treatment may be the result of other stresses in the child’s life. There are all styles of childrear-ing and even though what you see may be worrisome and worth reporting, unless DCYF can prove that someone has crossed a legal line into what is abusive or neglectful, it can’t force a family to accept interventions.

If, after getting a letter that says your initial concern was “un-founded” you feel you need more information about a child, by all means call up the district office and ask to speak to the person who did the assessment. You may be reassured that things are bet-ter than you thought or you may learn that DCYF is concerned like you are and would greatly appre-ciate hearing any further concerns so it might have another chance to help a child at risk.

But whatever you do, don’t give up. Children need you to speak up for them if there’s a reason to be concerned about them. �

‘Unfounded’ Doesn’t Mean ‘No Problem’

But whatever you do, don’t give up.

Children need you to speak up for them if there’s a reason to be

concerned about them.


5

After more than 4½ years, I will be leaving the N.H. Medical Society.

It was with mixed emotion that I offered the NHMS Council my resignation on October 14, 2014, providing the organization with 90-plus days’ notice of my de-parture. My last official day with NHMS was January 14, 2015.

I have been offered and have ac-cepted the position of acting vice president of regional operations and executive director for Minute-man Health of New Hampshire. I am hopeful that you are able to ap-preciate the excitement I feel over being given the opportunity to help launch a health plan for N.H.’s cit-izens and providers, which is truly charged with improving the health and well-being of N.H.’s residents. As a not-for-profit and consumer-governed plan, Minuteman is well positioned to realize the possibility of true collaboration with N.H.’s physicians and other healthcare providers to create a truly mem-ber- and provider-centric plan.

My time with the NHMS has been filled with tremendous challenge,

reward and support from the mem-bers, the staff and the Council. To-gether, and again with the full faith and support of the Council, NHMS has realized many accomplishments over the last 4½ years:

• Grown its dues and assess-ment-paying membership by 5.5%;

• Lowered full membership dues by almost 18%;

• Successfully implemented a new communication plan, which included a new brand-ing initiative and new web-site, eNews Update, and the launch of a social media platform incorporating Face-book, LinkedIn and Twitter accounts into the communi-cation arsenal;

• Improved the quality of its communication by instituting a formal proofreading pro-cess to minimize typographi-cal and grammatical errors in its external communications;

• Successfully launched a radio show – On Call with the N.H. Medical Society; and

• Completed much needed building upgrades and repairs.

In addition, considerable time and resources have been expended to formalize the accounting system and financial controls for the soci-ety, including expense reductions across the board.

Lastly, two years ago, NHMS suc-cessfully launched NHMS-IS, which is well positioned for growth and will continue to contribute fi-nancially to the support of NHMS’ mission.

All of this has been accomplished while maintaining an important focus on the legislative agenda, which has included the final dispo-sition of the JUA funds to N.H.’s providers, Medicaid expansion and preservation of the malprac-tice screening panel system. Sup-ported by two surveys of N.H.’s physicians, NHMS’ legislative agenda is now better informed by the thoughts and opinions of soci-ety members.

In closing, I wish to thank the Council, the search committee and the staff for the privilege of run-ning and managing the society over the past several years. To-gether, we have successfully posi-tioned NHMS for future growth and the challenges that lie ahead in health care.

I also want to send a heart-felt thank you along to you, the NHMS member, for without your sup-port, the good work of NHMS would not be possible.

It has truly been an honor.

Signing off for the last time and bidding you a fond farewell…Scott

P.S. I’m really going to miss writ-ing this piece for the newsletter. It’s always a fun piece to write! �

EVP CornerA Fond Farewell

Scott G. Colby

Supported by two surveys of N.H.’s physicians, NHMS’ legislative

agenda is now better informed by the thoughts and opinions of society

members.


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ney at [email protected] or 603-271-4728 if you need to up-date your email address. Once you have received your username and password email, the registra-tion process should take 5 to 10 minutes. Questions about the NH PDMP should be addressed to Mi-chelle Ricco Jonas at [email protected] or 603-271-6980.

Licensees who have a New Hamp-shire practice location will also be required to complete the New Hampshire Division of Public Health’s Physician Licensure Sur-vey (NHPH survey). The survey will capture physician/physician assistant workforce supply and capacity data, which will inform healthcare access planning, edu-cational and training programs, and emergency preparedness. The results of this survey will also assist the state to ensure access to health care for all citizens. Again, the username and password have

been sent to the email address on record with the board. If you have not received the survey, please confirm that the board has your correct email address on record.

The survey process should take between 5 and 15 minutes, de-pending on your specialty. Please note that failure to complete the NHPH survey could constitute grounds for the board to impose

disciplinary sanctions. Questions about the NHPH survey should be addressed to Danielle Weiss at [email protected] or 603-271-4547.

The board has begun addressing rule changes to implement these requirements. A public hear-ing will be scheduled in January 2015. Please check the board’s website at www.nh.gov/medicine for updated hearing information. We welcome your input into this process.

The board understands that these additional steps will increase the length of the renewal process, but believes the long-term benefits to both licensees and N.H. citizens will justify this increase. Thank you for your anticipated coopera-tion with this new process. If you have any questions, please contact me at [email protected] or 603-271-6985. �

License Renewal, cont. from page 1

New Hampshire is facing a serious crisis as our state’s rate of non-medical use of pain relievers by

18- to 25-year-olds is the second highest

in the country.

i NewHampshire.Governor’sCommissiononAlcoholandDrugAbusePrevention,InterventionandTreatment.CalltoAction:RespondingtoNewHampshire’sPrescriptionDrugEpidemic,LetterfromtheCommission(2012).

ii Id.at3.iii Id.at6.

Does your N.H. license expire in 2015? Here’s what the CME Coordinator needs from you by Feb. 28, 2015:

• Your signature on the first page of the CME biennial reporting form

• 100 total CME credits for calendar years 2013 and 2014

• Official transcripts or certificates documenting at least 40 Category 1 credits

• $35 processing fee (checks payable to “CME Coordinator”)

Please send all of the above to:

Mary West, CME Coordinator, NHMS, 7 N. State St., Concord, NH 03301

Questions?

Check out http://www.nhms.org/member-services/education or contact Mary at 603.224.1909 or [email protected]


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Phase 2 of the ASTHO/Million Hearts project will involve dissemination of blood pressure improvement strate-gies to other FQHCs and primary care settings throughout New Hamp-shire. Toward this end we created a practical how-to manual for improv-ing BP control in your practice and community. This manual, called “10 Steps for Improving Blood Pressure Control in New Hampshire,” distills the lessons learned from the Learn-ing Collaborative into 10 steps that any practice could implement with the help of community partners. Work is underway to develop a one-day training in March to support pro-viders in implementing the strategies described in the manual.

We learned that to affect and sus-tain health improvements, providers working together with a supportive team must:

• Understand the current health burden;

• Assess existing processes;

• Weigh possible best-practice in-terventions;

• Focus on data-driven decision making; and

• Engage a community of stake-holders.

Taken together the following 10 chapters provide an easy-to-follow, comprehensive approach to improv-ing hypertension care:

Step 1: Engaging Providers and Staff

Step 2: Agreeing on a Shared Vision and Measures

Step 3: Understanding the Current Process and Flow

Step 4: Creating Algorithms for Hy-pertension Care

Step 5: Ensuring Accuracy of Blood Pressure Measurement

Step 6: Sharing Provider Data Dash-boards

Step 7: Managing Patient Regis-tries

Step 8: Constant and Consistent

Communication and Celebrating Success

Step 9: Engaging Patients

Step 10: Fostering Community-Clini-cal Collaboration

The first seven steps are best imple-mented sequentially, whereas steps 8 through 10 can be undertaken anytime, as they involve patient and community engagement. However, considering that each practice envi-ronment and community is unique, the steps can be customized to ac-commodate the distinct degree of readiness or available resources for taking action.

The chapters are formatted with the following headings to help users understand the rationale and practi-cal elements necessary to accomplish each step:

• Why? - Based on research or experience, why is this step felt to be a critical component of a comprehensive BP control im-provement initiative?

• How? - How did CMC/DHK de-velop and implement this step in its improvement efforts?

• What? - What did the pilot sites in Nashua and/or Manchester do in undertaking this step or what might another practice do to accomplish this step?

• Lessons Learned? - What spe-cial conclusions were drawn from New Hampshire’s Million Hearts project regarding bar-riers to implementation and keys to success in the context of achieving change?

The manual is available free of charge to providers and practices in New Hampshire. If you would like to obtain access to an online version of the manual or receive a bound copy, please contact Kimberly Persson at [email protected] at the In-stitute for Health Policy and Practice at the University of New Hampshire. �

Million Hearts, cont. from page 1

NHMS works with CGI Business Solutions for your health, life and disability insurance needs.CGI Business Solutions (CGI) is one of the region’s fastest growing, most innovative benefit brokerage and consulting firms. Whether needs involve benefit design, compliance, or adminis-tration solutions, CGI has the resources to help NHMS and its members prepare for a quickly evolving marketplace.

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

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

Telephone: 888-383-0058 Facsimile: 603-232-9330 Email: [email protected]

Dedicated

Business SolutionsBusiness Simplified


8

tionize the management of cancer patients.

The full version of the brief can be found under “Quick Links” on the NH CCC website, http://www.nhcancerplan.org. Below is an ex-cerpt.

Broader clinical applications for genetic sequencing

While the first applications of NGS [next generation sequencing] have focused on sequencing the 50 genes known to be related to cancer, oth-er clinical applications include test-ing for traditional genetic diseases and for common chronic condi-tions such as atherosclerosis and diabetes.

For these applications, develop-ing panels of genes related to each condition may not be accurate or

efficient. While our genome (with 3 billion bases) contains approxi-mately 20,000 genes, only parts of the genome code for proteins that cells use to function.

The clinical exome is made up of the protein-coding regions of the 4,500 genes responsible for most human disease. NGS is able to sequence a clinical exome of this size and, us-ing this extensive panel, can provide clinicians with detailed information useful to managing patient care for most clinical scenarios, regardless of type of disease. In this case, one di-agnostic test may fit all.

The challenges of NGS: “inciden-tal findings” and “difference of unknown significance”

While NGS can routinely sequence the clinical exome, the benefit of

having this information remains unsubstantiated. Many genetic vari-ants, known as “incidental findings,” may be unrelated to symptoms or cell functions. For example, if NGS is performed on a patient with a suspected genetic disease, sequenc-ing the clinical exome may identify variations associated with condi-tions not under diagnostic study at this time. Should these findings be shared with the physician? If an inherited condition is uncovered, should it be reported to the patient and/or family? Would the patient or relatives want to know informa-tion they were not seeking?

A second and even more likely possibility is finding “variations of unknown significance (VUS).” As more individuals are screened with NGS technologies, genetic vari-ants not previously described will be identified. Some variants may be pathogenic, but most will be be-nign, without any known (or even likely) clinical significance. Diag-nostic centers, such as Dartmouth-Hitchcock, have established ethics committees to address these issues and develop the working policies needed to accompany this new di-agnostic science. �

Cancer Collaboration, cont. from page 1

Save the Date10th Annual Meeting

Aligning Strategies to Improve Cancer Care in a Shifting Landscape

Launching the “2015-2020 NH Cancer Plan”

Wednesday, April 1, 2015 Grappone Conference Center, Courtyard by Marriott, Concord, NH

NH Comprehensive Cancer Collaboration 10th Annual Meeting

April 1, 2015, Concord, NH

Who should attend? Individuals, organizations, leaders, and decision makers who are interested in addressing

policy and systems change to improve population health in NH communities Providers, nurses, social workers, cancer registrars, health educators, and others involved

in oncology care coordination who support effective use of health care services

What’s on the agenda? Official launch of the 2015-2020 NH Comprehensive Cancer

Plan; how to participate, contribute, and support Kurt Stange, MD - the critical link between oncology and primary

care practices J. Frank Wharam, MD - impact of health policy and health plans

on quality and vulnerable populations J. Russell Hoverman, MD - changing health systems to

improve patient-provider communications Cancer hot topics: E-cigarettes, HPV vaccinations, Genetics,

Lung Cancer Screening, Legislative Policy in NH Registration to open mid-January

www.NHCancerPlan.org, [email protected]

www.NHCancerPlan.org


9

cies form the basis of another set of professional standards. The 6 core competencies include patient care, medical and clinical knowl-edge, practice-based learning and improvement, interpersonal and communication skills, profession-alism, and system-based practice. These standards are the basis for the Ongoing Professional Practice Evaluation (OPPE) and the Fo-cused Professional Practice Evalu-ation (FPPE) that the Joint Com-mission instituted in 2002.”

These professional practice eval-uations are more often than not very straightforward, particularly regarding clinical practice. They are, however, far more ambiguous in addressing iso-lated and/or recurrent be-havior issues.

Cultures of safety initiatives offer proscribed means to incorporate and implement OPPE/FPPE evaluations, to help organizations identify and proactively address dis-ruptive behavior. There re-mains variability in outcomes and ongoing challenges of how to gauge the serious-ness of behavior infractions and where to draw the line. When is it appropriate to of-fer and/or continue to pro-vide counseling or mentor-ing versus simply executing a zero-tolerance policy resulting in immediate dismissal from all pro-fessional responsibilities?

For all of us who have and con-tinue to encounter stressful work environments, perceptions of loud discussions or yelling are not infrequent. JAMA. 2014; 312(21):2209-2210. doi:10.1001/jama.2014.10218: “A 2011 ques-tionnaire surveyed 523 physician leaders and 321 staff physicians in

a variety of health care settings re-garding disruptive behaviors such as degrading comments or insults, refusal to cooperate with others, and speaking loudly, character-ized as ‘yelling.’ Almost three-fourths (598 [71%]) of respond-ing physicians reported that they had witnessed disruptive behavior within the previous month, and 219 (26%) of those surveyed re-portedly had been disruptive at one time in their career.”

As a fourth-year medical student while holding a retractor in the OR, it was a WWF (World Wres-tling Federation) moment when

the surgical attending head-butt-ed the senior surgical resident right off the stool she was stand-ing on during the surgery. The confusion for many of us was made clear when the absurdity of it all was explained away; the attending and resident were fam-ily relatives. There really is no justifying physical abuse or com-plete and utter disregard for each other. It remains very difficult to

always be able to declare an oc-currence as a one-and-done, zero-tolerance circumstance. After all, we are humans, working under very stressful and unpredictable environments.

However, there should be less tolerance for clearly abusive oc-currences where protracted coun-seling opportunities are simply too permissive. Verbal or physi-cal abuse, such as demeaning or defaming comments, throwing objects or demonstrating aggres-sive personal contact should be considered zero-tolerance occur-rences. As an example, when a

physician speaks to a nurse on the phone, randomly, as a result of being on call, and the physician does not sim-ply raise his/her voice but instead screams, with every other word being a four-letter expletive directed at the nurse, there should be a ubiquitous means to move toward immediate dismissal until the matter can be prop-erly vetted.

Physicians, physician lead-ers and administrators have a responsibility to provide a clear and directed process to govern egregious disrup-tive behavior. The message regarding our behaviors be-ing the biggest challenge of

our careers couldn’t be any more truthful and should not be any less heightened then the recent and necessary attention to domes-tic violence in the NFL.

A physician’s career should have greater risk of being terminated by disruptive behavior than by not passing an MOC exam. There is more accurate and relevant data supporting the former. �

“The Accreditation Council for Graduate Medical Education’s 6 core competencies form the basis of another set of professional standards. The 6

core competencies include patient care, medical and clinical knowledge, practice-

based learning and improvement, interpersonal and communication

skills, professionalism, and system-based practice. These standards are the basis for the Ongoing Professional Practice Evaluation (OPPE) and the Focused

Professional Practice Evaluation (FPPE) that the Joint Commission

instituted in 2002.”

President’s Perspective, cont. from page 2


10

Jeremy A. Wale, JD, ProAssurance risk resource advisor

Prescription medication abuse is ram-pant throughout the United States. According to the Centers for Dis-ease Control and Prevention (CDC), 16,500 people died in 2010 from overdoses tied to common narcotic pain relievers.1 In 2009, 15,500 peo-ple died from opioid painkiller over-doses, more than the deaths from heroin and cocaine combined.2 Ac-cording to the CDC, approximately 1.4 million emergency department visits in 2011 were a result of misuse and/or abuse of pharmaceuticals.3

Who is stealing prescription drugs?

Pharmacists, pharmacy techs, nurses, receptionists, doctors, patients and even police officers have been caught stealing or forging prescriptions, stealing prescription pads or stealing prescription medications. It can hap-pen anywhere by anyone.

How does this affect you?

Prescription theft or forgery by an employee in your practice may have legal and ethical ramifications for all professionals employed by the prac-tice. If the practice fails to take prop-er precautions to prevent these ac-tions, an injured person may attempt to sue for negligence. If you have a medical practitioner practicing medi-cine under the influence of narcotics, there are myriad negative ramifica-tions affecting patient care, patient safety or staff safety. You may also discover recordkeeping errors or in-accurate medical records.

A healthcare provider also may en-counter issues with the federal Drug Enforcement Administration (DEA) if there is suspected drug diversion going on in the practice. A DEA in-vestigation could result in suspension or even revocation of a healthcare provider’s DEA license.

Prescription theft and/or forgery could lead to loss in business, unhap-py staff, increased medical errors,

increased malpractice exposure and more challenging defenses of poten-tial malpractice claims.

What can you do?

Electronically prescribing medica-tions can help limit the availability of paper prescription pads in your office. Electronic prescriptions also may have the added benefit of pre-venting pharmacy staff from making alterations to the prescription.

One of the best ways to prevent pre-scription pad theft is to keep them under lock and key. Only trained healthcare providers with prescrip-tion-writing authority should have

access to prescription pads. It is also a good idea to avoid pre-signing pre-scription pads.

In addition, New Hampshire’s elec-tronic drug monitoring program is aimed at combatting prescription drug abuse by tracking prescriptions given to each patient.4 The New Hampshire Prescription Drug Moni-toring Program provides prescribers and dispensers a tool to help:

• improve patient care in manag-ing their health and prescrip-tions;

• promote public health and safety through prevention of and treatment for the misuse and abuse of controlled sub-stances; and

• assist in reducing the diversion of controlled substances.

If you have a patient displaying pos-sible drug-seeking behavior, consider obtaining data from New Hamp-

shire’s electronic program to help de-termine if there is an issue. In New Hampshire, under 318-B:33 part II, only registered prescribers and dispensers are eligible to access the program.5

Maintaining accurate medication lists and limiting refills are also good ways to help determine whether a patient is abusing prescription medications. You may want to consider using NCR (no carbon required) prescription pads so your practice has accurate re-cords of exactly what was prescribed and to whom.

Being proactive about the process of prescribing controlled substance will help limit your practice’s susceptibility to prescription theft and/or forgery. �

_____________________1 KobaM.Deadlyepidemic:prescriptiondrugoverdoses.USAToday.July28,2013.http://www.usatoday.com/story/money/business/2013/07/28/deadly-epidemic-prescription-drug-overdoses/2584117/.AccessedSeptember3,2014.

2 BuntinJ.America’sbiggestdrugproblemisn’theroin,it’sdoctors.http://www.governing.com/topics/health-human-services/gov-biggest-drug-problem.html.June,2014.AccessedSeptember3,2014.

3 PrescriptiondrugoverdoseintheUnitedStates:FactSheet.CentersforDiseaseControlandPreventionWebsite.http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.UpdatedJuly3,2014.AccessedSeptember3,2014.

4 LavittJ.NewHampshireGovernorannouncesprescriptiondrugmonitoringprogram.thefixWebsite.http://www.thefix.com/content/new-hampshire-governor-announces-prescription-drug-monitoring-program.November14,2014.AccessedDecember2,2014.

5 N.H. Rev. Stat. aNN.§318-B:33(2012).

Copyright © 2014 ProAssurance Corpo-ration

This article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct.

ProAssurance is a national provider of medi-cal professional liability insurance and risk resource services. For more information about the company, visit ProAssurance.com.

Rx Theft and Forgery: How it happens and what you can do about it

Prescription medication abuse is rampant throughout the United States.


11

When you need it.

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Anthem BCBS

AutoFair

Baystate Financial

Bridge & Byron Printers/Speedy Printing & Copying

CGI Business Solutions

CMIC RRG

Coverys

Crown Healthcare Apparel Service

Foundry Financial Group, Inc.

Freedom Energy Logistics, LLC

General Linen Service Co., Inc.

HUB Healthcare Solutions

I.C. System

Kilbride & Harris Insurance Services, LLC

Medical Mutual Insurance Company of Maine

Minuteman Health, Inc.

Northeast Delta Dental

Northeast Health Care Quality Foundation

ProAssurance

Rath, Young and Pignatelli

Sage Payment Solutions

Shaheen & Gordon, PA

Software Advice

Sulloway & Hollis, P.L.L.C.

Sunovion Pharmaceuticals, Inc.

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


13

2015 NHMS Council President Lukas R. Kolm, MD

President-Elect John R. Butterly, MD

Immediate Past President Stuart J. Glassman, MD

Penultimate Past President P. Travis Harker, MD, MPH

Vice President Deborah A. Harrigan, MD

Secretary Seddon R. Savage, MD

Treasurer Paul F. Racicot, MD

Speaker Richard P. Lafleur, MD

Vice Speaker Tessa J. Lafortune-Greenberg, MD

AMA Delegate William J. Kassler, MD, MPH

AMA Alternate Delegate Cynthia S. Cooper, MD

Chair, Board of Trustees David C. Charlesworth, MD

Medical Student Vivienne Meljen

Physician Assistant Mark H. Rescino, PA-C

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

Young Physician Rep. Vladimir Sinkov, MD

Young Physician Rep. Jeffrey C. Fetter, MD

Member-at-large Tina C. Foster, MD

Member-at-large Gregg Kaup, MD

Member-at-large John L. Klunk, MD

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

Member-at-large Anthony V. Mollano, MD

Member-at-large Everett J. Lamm, MD

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

Lay Person Martin Honigberg, Esq.

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

Specialty Society Reps.:

· N.H. ACOG Oglesby H. Young, III, MD

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

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

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

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

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

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

· N.H. Psychiatric Society Leonard Korn, MD

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

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

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

Trustee David C. Charlesworth, MD

Trustee Charles M. Blitzer, MD

Trustee Cynthia S. Cooper, MD

Invited Guest: MGMA Rep. Dave HuttonHeadquarters: Concord NH

Offices in: Gorham NH and Portland ME603.224.2341 | www.sulloway.com

Trusted Advisors for Changing Times

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

estates in our hands.

NHMS Welcomes

New MembersCarrie D. Ayers, DO

Carrie L. Cocklin, MD

Emily S. Davie, MD

Adebanke C. Davis, MD

Joseph M. Dulac, MD

Emily S. Frydman, MD

Albert L. Hsu, MD

Audrey M. Kern, MD

Konstantinos Linos, MD

Todd A. Noce, DO

Richard W. Renner, PA-C

Amy D. Roy, MD

Jeffrey D. Schoengold, MD,

FACEP


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Look how much fun we had at the 2014 NHMS Annual Scientific Conference!

Can you guess who these adventurous NHMS members and staff are?

Answer key:

A: Albee Budnitz, MD F. John Robinson, MD

B. Bernard Rosen, MD G. Lukas Kolm, MD

C. Cindy Cooper, MD H. Mary West, NHMS

D. Deb Harrigan, MD I. Scott Colby, NHMS

E. David Cooper, MD J. Steven Powell, MD

Special thanks to Baystate Financial for sponsoring caricature artist Larry Frates. (www.fratescreates.com)

A B C D

E F G H

J I


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

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

Medical Mutual NH Premium Relief from Rate and Dividend Actions

10

5

0

-5

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-15

-20

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Dividends

Rates

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

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

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

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

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

ADDRESS SERVICE REQUESTED

Prsrt Std.U.S. Postage

PAIDConcord, NH

Permit No. 1584

Printed on recycled stock using soy-based inks.

SAVE the DATENew Hampshire Medical Society

Annual Scientific ConferenceNovember 6-8, 2015, Sheraton Harborside, Portsmouth, N.H.

THE MANY FACES OFADDICTION

The Journey of Prevention: From Awareness to Best Practices• Recognizing the addicted patient• Treatment and availability of services • Knowledge gaps regarding drug treatment programs• Appropriate use of opioid agreements • Provider-to-provider communications • Methadone maintenance – the NYC Model • Global solutions / strategies for public health care,

providers and communities

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