physicians’ i-monthly january/february 2016 2016 new … · 2016-05-19 · physicians’...

Physicians’ Bi-Monthly January/February 2016

Correction This is a notice related to the “10 Steps for Improving Blood Pressure Control in New Hampshire” guide mentioned in the Nov/Dec 2015 Million Hearts Corner article of the NHMS Physicians’ Bimonthly. 5 of the “10 Steps” guide includes a figure of a sample fishbone dia-gram for understanding the barri-ers to adequate hypertension con-trol. The figure was inadvertently credited to a Cheshire Medical Cen-ter/Dartmouth-Hitchcock Keene Quality Improvement Initiative. In fact, the diagram reflected work done by Gerald H. Angoff, MD, FACC, MBA, and the Quality and Outcomes Improvement Commit-tee at Dartmouth-Hitchcock (DH) Manchester. Future versions of the guide will correctly attribute the figure to Dr. Angoff and the D-H Manchester Team.

By Seddon R. Savage, MD

This is the first in a series of articles on issues of substance use and addiction and how all physicians can engage in addressing these challenges to improve the health of patients and the public.

Physicians & OpioidsIt is impossible to practice medicine in New Hampshire without being confronted by the opioid crisis on a near daily basis—in the media, in our work, and in conversation with

our neighbors, friends and family. Opioid overdose deaths are expect-ed to rise to greater than 400 in NH in 2015, up from 128 in 2010i and opioids have surpassed alco-hol as the most common drug class for which persons in New Hamp-shire seek addiction treatment.ii Governor Maggie Hassan called a Special Session of the legislature in November devoted exclusively to addressing opioid-related harm in the state and the New Hampshire

Board of Medicine released emer-gency opioid prescribing rulesiii and is currently working on per-manent prescribing rules.

At the same time, many patients tell us it is difficult to find effec-tive treatment for pain, that their prescribers will no longer prescribe opioids to them, and that they feel like criminals if they say they have pain, let alone suggest that opioids might provide relief. The World

Substance Use & Addiction: Engaging all Physicians

The New Hampshire Division of Public Health Services, in coop-eration with the New Hampshire Board of Medicine (BOM) and the New Hampshire Medical Society, will be collecting key practice and capacity data from New Hamp-shire-licensed physicians who are due to renew their medical license in 2016.

Why does this survey sound fa-miliar?Last year, we surveyed New Hamp-shire physicians during the license renewal cycle and now we’re gear-ing up to release the survey for

physicians due to renew their New Hampshire license this year to en-sure complete physician data.

Who can take the survey?Only physicians due to renew their New Hampshire medical license in 2016 will have access to the survey, once it is released.

How will the data be used?The data will be a key resource in statewide health care workforce as-sessment, healthcare access plan-ning, informing educational and training programs, emergency pre-paredness, recruitment and reten-

Substance Abuse, cont. on page 7

2016 New Hampshire Physician Survey Coming Soon

Physician Survey, cont. on page 6

New Hampshire Medical Society 225th Celebration

Friday, May 6, 2016 ~ Manchester Country ClubSave your seat at nhms.org


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New Hamphire Medical Society7 North State Street Concord, NH 03301 603 224 1909603 226 2432 [email protected] www.nhms.org John R. Butterly, MD ................. PresidentJames G. Potter, CAE ......................... EVPMary West ....................................... Editor

Low Adoption Rates for Medicare’s New Chronic Care Management Program in Small Provider Groups ....3

Look How Much Fun We Had at the 2015 NHMS Annual Scientific Conference! .........................................4

EVP Corner ............................................5Corporate Affiliate Program ...................6Introducing our Newest Corporate

Affiliate ................................................9Patient Tracking & Follow Up–

What You Don’t Know Can Hurt You .....122016 NHMS Council .............................15NHMS Welcomes New Members ..........15

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 (NH PHP) is here to help! The NH PHP is a confidential resource that assists with identification, intervention, referral and case management of NH physicians, physician assistants, pharmacists, and veterinarians 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. NH 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 NH 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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President’s Perspective, cont. on page 3

I do not understand the recent virulent and politically-driven at-tacks on Planned Parenthood. From everything I see or read in the news it is being driven purely by ideology, generally ignoring the facts, and certainly ignoring those who will be seriously disad-vantaged and harmed if the at-tempt to defund it is successful. Perhaps this is not the best subject to choose to write about as one of my first newsletter submissions, but I find that I cannot avoid do-ing so in all good conscience. I do want to make a few things clear at the outset: the first is that this is my opinion, and does not necessar-ily reflect the opinion of the New Hampshire Medical Society or its constituent members; the second is that this is not about abortion, it is about access to needed health care and the health of 50% of our population – women. And not just women, but the most vulner-able women in our country – the un-insured and under insured; frequently single mothers.

Planned Parenthood, first named the American Birth Control League, was founded in 1916, by Margaret Sanger and was renamed

the Planned Parenthood Federa-tion of America in 1942. Since that time it has become the larg-est single provider of reproductive services in America, and as such, the frequent target of attempts to discredit, defund, or destroy it.

Planned Parenthood gets approx-imately $500 million a year from government, $390 million from private donors, and $300 million from non-government sources. Of the public funds, the major-ity come from Medicaid, with the rest provided by Title X (enacted under President Richard Nixon in 1970 as the only federal grant program dedicated solely to pro-viding comprehensive family planning and related preventive health services, and designed to prioritize low-income and unin-sured citizens). According to their own statistics, Planned Parenthood provided services for 2.7 million men and women in 2013. Only three percent of the services they provided were related to abortion. Forty-two percent of the services they provided were related to the prevention or treatment of sex-ually-transmitted infections and disease (including HIV/AIDS). Thirty-four percent were related to contraception; 11% to other women’s services, e.g. education; 9% to cancer screening; and 1% to “other”. I have not heard or seen anyone credibly deny these numbers; 97% of the services pro-vided by Planned Parenthood are specifically directed to critically important public health measures directed towards the treatment and prevention of infectious dis-ease, thoughtful family planning (and some might say abortion

President’s PerspectiveWomen’s Health: an undeniable social good

John Butterly, MD


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By Vanessa Bisceglie, CEO, EHR & Practice Management Consultants

Eligible Providers in smaller prac-tices and healthcare organizations are slow to adopt the new chronic care management (CCM) program offered by Medicare. Eligible pro-viders that offer CCM services to their Medicare patients with two or more conditions can benefit by receiving on average $43 per pa-tient per month. Several surveys1 have been released and most have come to the same conclusion: only about 25 percent of respondents said they or their organizations had launched a CCM program by late summer. Of those, less than half said they had success-fully submitted a claim and been

paid. Respondents said the main obstacles to implementing the pro-gram included payment amounts that don’t cover the additional time and effort required to offer the services. Over 50 percent of respondents were also concerned that they would have to hire addi-tional staff to handle CCM duties.

Among those who have already started a CCM program, most were from large organizations. For example, almost 20 percent of practices employing between one and five physicians were providing a CCM program compared with 38 percent of organizations em-ploying more than 100 physicians.

Small organizations reported lack of staff or organizational infra-structure, support, and under-standing of the program as being the primary barriers to adoption. Small organizations that were of-fering CCM also experienced less patient resistance and higher lev-els of physician engagement com-

pared with larger organizations.

Practices that identify 600 quali-fying Medicare patients can stand to make an additional $300,000 per year gross revenue by partici-pating in this program. At EHR & Practice Management Consul-tants, Inc. (a corporate affiliate of NHMS) we offer a comprehensive service offering to allow your prac-tice to participate in the Chronic Care Management Program with-out hiring additional staff or plac-ing burden on your existing staff. Call us today to learn more 800-376-0212 or join us on February 9th or 11th at 12:30 pm EST for an educational webinar to learn more about how your practice can begin receiving theses additional reimbursements. Email [email protected] to register. �

_____________________1 2015 National Chronic Care

Management Survey. Enli Health Intelligence & Pershing, Yoakley & Associates

Low Adoption Rates for Medicare’s New Chronic Care Management Program in Small Provider Groups

President’s Perspective, cont. from page 2

prevention); prevention and early detection of treatable cancers, and generally the health and well-be-ing of women.

I do not think that anyone would argue about the benefits of screen-ing for and treating STDs such as syphilis, gonorrhea or chlamydia. The CDC estimates that there are 19 million new infections each year, and as health care providers we are all aware of the morbidity and potential mortality that may be associated with these. Respect-fully, I would say that while some are opposed to contraception a majority of the population agree

that thoughtful contraception and family planning is a social good, and I hope it would be very hard, if not impossible, to find anyone who would disagree with the ben-efit of prevention and early detec-tion of the most common cancers affecting women.

I have recently been very trou-bled by the polarization of politics nationally and regionally. I find more and more politicians (and journalists), beginning their posi-tions based on their ideology, and then collecting the “facts” that happen to support their cause, rather than objectively gathering

the available facts and then draw-ing appropriate conclusions. The facts do not support defunding, and essentially destroying, the largest single provider of wom-en’s health services in the country; specifically the provider of these services to one of the most vulner-able groups of our fellow citizens, single mothers and women in low-income households.

Please remember, as Mahatma Gandhi and many others have said, the single most important criteria for how one judges a soci-ety is by how it treats its most vul-nerable members.


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Pictured, left to right: Richard and Pamela LaFleur, Dmitry Tarasevich, & Frank and Melanie Lavoie

Look How Much Fun We Had at the 2015 NHMS Annual Scientific Conference!

NHMS presidents and Deputy EVP Janet MonahanPictured, left to right, front row: Janet Monahan, Georgia Tuttle, Lukas Kolm, Seddon Savage, Cynthia Cooper, Albee Budnitz, &

F. Burton Dibble. Back row: John Butterly, Stuart Glassman, Gary Sobelson, Charles Blitzer, Travis Harker, John Robinson, & Bill Kassler.

Gov. Maggie Hassan and Dr. Sally Garhart

Pictured, left to right: Dartmouth students Andrew Blake, Nu Na & Jacob Wasag

Pictured, l to r: Lukas Kolm, Deborah Harrigan, Stuart Glassman, Georgia Tuttle, Catherine Pritchett & Dennis Dimitri

We hope to see you this year! Save the Date: Nov. 4-6, 2016 at the Mountain View Grand in Whitefield, NH


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EVP CornerThe NHMS Quasquibicentennial – 225 Years of Service and Leadership And Finding the Bartlett Portraits

I ask that you please join your col-leagues in celebrating the 225th anniversary, otherwise referred to as the quasquibicentennial (pronounced: kwos’kwi-bı-sen-ten’e-ul), of our New Hampshire Medical Society, on the evening of Friday, May 6, 2016, at the newly renovated Manchester Country Club.

Invitations should be appearing shortly in the mail and a sign-up link can be found on the NHMS website. Dr. Gary Sobelson, along with NHMS President Dr. John Butterly, will be hosting this spe-cial event where stories will be told and awards and recognitions presented, along with entertain-ment and oratory elicited.

Medical Society OriginsDr. Josiah Bartlett, New Hamp-shire’s first constitutionally-elect-ed governor and a signer of the Declaration of Independence, prepared a charter petition that he and eighteen other physicians presented to the legislature that resulted in their incorporation as the New Hampshire Medical So-ciety. This Act, as passed by the newly-formed first constitutional General Court of New Hamp-

shire, was signed into law on Feb-ruary 16, 1791, by Dr. Bartlett as the state’s chief executive. On May 4 of that same year, at Lam-son’s Tavern in Exeter, he was elected its first president and led the Society’s first meeting.

A brief history lesson for those unfamiliar with the Society’s founder, Dr. Josiah Bartlett – a distinguished physician, Granite State patriot, and one of our na-tion’s founding father: Actively engaged as a representative from Kingston in the colonial Provin-cial Assembly and serving as a colonel in the royal militia – the highest ranking military officer of the province, Dr. Barlett was sub-sequently stripped of all offices for taking the colonial side in the bitter controversies leading to the revolt again Great Britain and his home burnt to the ground alleg-edly by a loyalist spy in early 1774.

Rebuilding his homestead that same year (that stands today in Kingston), Dr. Bartlett then served as the Granite State’s prin-cipal delegate to the Second Con-tinental Congress. In voting for independence on July 2, tradition has it that “He made the rafters shake with the loudness of his approval.” On July 4, he was the first to vote in favor of adopting the Declaration of Independence (as the roll was called geographi-cally from north to south among the then 13 colonies), calling it “the greatest state paper ever con-ceived by the mind of man.” And a month later was the second to sign it, after John Hancock who

was the president of the Conti-nental Congress. Dr. Bartlett also served as one of the primary au-thors of the 1776 Articles of Con-federation (precursor to the 1789 U.S. Constitution), NH Chief Justice, and was the first constitu-tionally-elected chief executive of New Hampshire to bear the title of Governor.

The Dr. Bartlett PortraitsWith my interest in our Medical Society’s founder, I had viewed an online image of a single oil painting of Dr. Bartlett with the span of his governorship listed below in a brass plate that ap-peared to resemble other paint-ings of the period in the hallways of the State House. However, coming across the actual painting had escaped me after multiple passes of all three main floors, as well as several online search-es and inquiries with a number of long-time lobbyists. Another concerted online room by room search indicated that perhaps the Executive Council chambers held the key. It took a couple attempts to gain access to the chambers as they were often in use by the Ex-ecutive Council or the Governor and her executive team.

Finally, after a hearing a few weeks ago, we at last found the chambers unoccupied. And there he was on the far wall of the cham-bers across from the Governor’s office, along with an adjoining portrait of his physician son, Dr. Josiah Bartlett, Jr. who served as a Member of Congress (US) from 1811-1813, then the Medical Soci-

EVP Corner, cont. on page 14


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tion initiatives including the Na-tional Health Service Corps and the New Hampshire State Loan Repayment Program, and other functions requiring accurate state-wide data on provider capacity.

Will 3rd party entities have ac-cess to my data?The data collected will be confi-dential and protected; it will only be used for the aforementioned purposes. The data will be de-identified and aggregated to speak on the physician landscape as a whole.

What format is the survey in?The electronic survey will be user-friendly and take anywhere from

3 to 15 minutes to complete. You will be able to review the survey before getting started, return to previously answered questions, time-out and return later to finish it, and even complete it on a mo-bile device. Also, due to the so-phisticated logic incorporated in the survey, only questions that are relevant to you will be displayed.

Why can’t I find the survey any-where?The survey will be available to complete during the Board of Medicine licensure renewal cycle but has not yet been released. Please keep an eye out for survey notifications including early sur-

vey release from the New Hamp-shire Medical Society and the New Hampshire Board of Medicine.

Where can I find the survey when it is released?Survey information will be found on the New Hampshire Medical Society’s website as well as the New Hampshire Department of Heath and Human Services Health Pro-fessions Data Center page as soon as the survey opens.

What if I still have questions? Contact Danielle Weiss, Primary Care Workforce Program Manag-er, at [email protected]. �

Physician Survey, cont. from page 1

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EHR & Practice Management Solutions

First Healthcare Compliance, LLC

Freedom Energy Logistics, LLC

HUB Healthcare Solutions

I.C. System

Kilbride & Harris Insurance Services, LLC

Medical Mutual Insurance Company of Maine

Minuteman Health, Inc.

New England Employee Benefits Co., Inc.

Northeast Delta Dental

Pfizer

ProAssurance

Professional Office Services, Inc.

Rath, Young, and Pignatelli

Shaheen & Gordon, PA

Software Advice

Sulloway & Hollis, PLLC

Sunovion Pharmaceuticals, Inc.

Wadleigh, Starr & Peters, PLLC

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


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Health Organization has traditionally tracked per capita opioid consumption as a marker of how well countries care for their sick and dying.iv However, with the rise of opioid related harm, our country’s status as the highest opioid prescribing nation is increasingly viewed as a marker of poor medical practice.v Clearly, as physicians we face a difficult conundrum in the prescribing of opioids: they are powerful in healing when used well, but powerful in harm when misused. Is it possible to capture the healing without contributing to the harm?

At a meeting in Quebec, a few years ago, which was considering the concept of pain relief as a human right, I sat between two ER Directors. One, from Washington State, prided himself on the fact that his ER never prescribed opioids to anyone for chronic pain, “We take care to never feed into anyone’s ad-diction” he said proudly. The other, from across the border in British Columbia, prided herself that her ER got pain under control in all patients within 30 minutes of the patient entering their doors. “Rapid pain relief is an important marker of the quality of

care we provide” she said proudly. I like to imagine that the actual care patients received in their emer-gency rooms was not all that different and based fully on their individual medical presentations and needs; but the conversation certainly highlighted the divergent opinions thoughtful physicians can have on where the balance should lie in considering the use of opioids.

For millennia, since opium was first included our healing armamentarium, opioids have fallen in and out of favor in medical practice. In response to wide-spread opioid-related harm of the first American opioid epidemic of the late 1800s and early 1900s, opioids were used very conservatively through much of the twentieth century. In 1901, Dr. John Wither-spoon exhorted his colleagues at an AMA meeting to reduce opioid prescribing in order to “save our people from this hydra headed monster that stalks the civilized world, wrecking happy homes and fill-ing our lunatic asylums”. Numerous Federal regula-tions passed between 1914 and 1920 put significant brakes on the medical use of opioids and a percep-tion gained traction that the inevitable evolution of opioid tolerance and addiction rendered opioids both rapidly useless and unacceptably harmful.

When the nascent hospice and palliative care move-ment of the 1970s demonstrated that opioids could in fact be used safely and effectively without inevi-table negative consequences, the beneficent qualities of opioids were rediscovered and prescribing rapidly spread from treatment of pain related to terminal illness, to acute pain and gradually to chronic non-cancer related pain. With the enthusiastic embrace of opioids continuing into the 1990s, along with the rise of procedures and technologies that promised to eradicate physiologic generators of pain, it appeared human suffering from physical pain could finally be vanquished. The truth of potential opioid-relat-ed harm that had nurtured caution seemed to be in large part forgotten, buried along with myths of the inevitability of such harm.

As pain became a quality of care marker across the healthcare system and the evolving financial structure of healthcare reduced clinician time with patients, the prescription pad more frequently became a first-line response to many symptoms, including pain, that often have complex biopsychosocial contributors and more effective multidimensional solutions. Pre-scribing of opioids soared through the first decade of this century. It is worth noting that there have been

Substance Abuse, cont. from page 1


The Professionals Health Program provides a range of direct services to

support health, well-being and resilience of New Hampshire physicians, physician assistants, pharmacists, and veterinarians.

We work with individuals who are experiencing difficulties with substance

abuse and addiction, psychiatric and mental health concerns, stress, burnout,

work-related conflict and a variety of marital or family life issues.

For a confidential consultation, please call Dr. Sally Garhart at

603.491.5036 or email [email protected].

For more information visit http://www.nhphp.org/.


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major increases in the prescribing of anti-depressants,vi stimulantsvii and other classes of medications over the same time period as well, but none have been so intensely challenged, likely because of the greater propensity for serious harm with opioid misuse.

Data compiled by the CDCviii re-veals parallel rises in opioid-pre-scribing and in opioid-associated deaths and demand for addiction treatment in the first decade of this century, indicating that as more opioids are available for clinical treatment, more opi-oids are available for misuse and opioid-associated harm. Opioid prescribing has declined about 3% nationally in the past three years, but heroin and street fen-tanyl (acetyl fentanyl manufac-tured for illicit distribution) use have increased and opioid-asso-ciated addiction and deaths risen sharply. The pattern of entry into opioid misuse has changed over time, but in the first decade of the 21st century, about three of four persons who use heroin, state that they initiated their opi-oid use with prescription opioids.ix These facts have led many to view prescribers as the prime drivers of the opioid epidemic and pivotal to its resolution.

The simplest narrative is that opi-oid prescribing leads to addiction and/or to overdose, so if clinicians prescribe fewer opioids, fewer people will become addicted and fewer people will die of overdose. There is almost certainly truth to this, but the reality that should in-form effective solutions is far more complex. Tens of thousands of persons use opioids in the United States every day to relieve diverse types of pain without develop-ing opioid addiction or overdose. However, difficulty predicting in-

tensity and duration of pain and the desire of prescribers to pro-vide adequate relief clearly con-tributes to excess opioids being available for misuse; data from the National Survey on Drug Use and Health indicate that over 70% of people who use prescription opi-oids for non-medical purposes get these from family or friends who have received them from one prescriber for medical purposes. But not all misused opioids are diverted from patients; some of our patients themselves have vul-nerabilities that can lead them to

misuse opioids or to become ad-dicted and/or to overdose. At the same time, imprecision in pre-dicting individual risk of misuse and addiction makes it difficult to tailor prescribing to avoid all risk. In addition, the complex na-ture of pain, particularly chronic pain, means that while opioids are often effective in the short term, they may not be a component of effective long-term treatment and may actually contribute to distress over time. There is also evidence that persons with mental health



ANYONE, ANYTIME CAN ACCESS NALOXONE.

FOR HELP:

AnyoneAnytimeNH is an initiative of the New Hampshire Department of Health and Human Services

N E W H A M P S H I R ECan experience addiction • Can ask for help

Can recover • Can save a life

A NH law passed in June allows NH healthcare providers to write prescriptions for naloxone for anyone at risk for an opioid overdose or for a friend or family member. NALOXONE CAN BE A LIFE-SAVING MEDICATION in the event of an overdose of heroin, fentanyl or prescription pain relievers after calling 911 and rescue breathing.Please talk with your primary care clinic today about a naloxone prescription for yourself or a loved one. Anyone Anytime can have access to this lifesaving medication.

NH Alcohol and DrugT R E A T M E N T L O C A T O R

www.nhtreatment.org

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www.medicalmutual.com

© 2015 Medical Mutual Insurance Company of Maine

If current legislatioin is enacted, the JUA will sunset

and — pow! — the specter of having to fi nd new

medical liability insurance coverage will become

reality. There’s no need to panic. You have options.

But if you’re looking for a true partner, not just a

carrier or vendor, there’s really only one choice.

You see, clients of Medical Mutual, which already

include 4 hospitals and over 300 physicians

in New Hampshire, all cite the strength of the

relationships they forge with key people at the

Company for making their jobs easier.

A direct line to people you know, answers you can count on.

When you have a question about any aspect of your

coverage, or need free risk management advice,

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Medical Mutual and your organization: a dynamic duo.

So, if you’re looking for a partner as opposed to

a vendor in the pursuit of healthcare quality and

liability protection, call John Doyle, VP of Marketing

and Administration, directly at (207) 523-1534

today. Because if New Hampshire House Bill 508

goes through as anticipated, there won’t be a

moment to lose.

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by Laurette Salzman, MBA, CPHRM, ProAssurance Senior Risk Resource Advisor

Lapses in patient care, including follow up, can lead to dire conse-quences beyond those to patient well-being. Substantial malprac-tice settlements and verdicts have been paid as a result of “lost” di-agnostic reports and physicians’ failure to review and follow up.

Patients who miss or cancel ap-pointments risk undetected and untreated medical conditions, threatening continuity of care. If the patient later experiences an illness or injury, he or she may hold you responsible. The best way to prevent such lapses—and the corresponding malpractice allegations they create—is to de-velop written policies and proce-dures. The goal is to effectively track lab and diagnostic tests, as well as missed appointments and referrals.

Lab and Diagnostic TestsEstablish a tracking system that documents and follows patients referred for diagnostic imaging or laboratory testing. An effective system will verify the:

• test is performed;

• results are reported to the of-fice;

• physician reviews the results;

• physician communicates the results to the patient;

• results are properly acted upon; and

• results are properly filed.

It is important that the physi-cian or allied health professional (AHP) review, authenticate, and date all diagnostic test results as soon as they are available—before filing. When test results are ab-normal, it is important to let the patient know both the results and the need for follow up. If the pa-tient does not follow through as advised, it is prudent to make—and document—repeated efforts to encourage the patient’s return.

Cancellations and No-ShowsTracking missed or cancelled ap-pointments will help you improve patient care and reduce liability risk. When patients miss or can-cel appointments, attempt to re-schedule, and document both the reason for cancellation and each of your efforts to reschedule.

We suggest the AHP review all missed or cancelled appointments and discuss them with the physi-cian to determine if follow-up is necessary. More aggressive follow up may be necessary for patients with urgent conditions. Docu-ment all such efforts in the medi-cal record.

Consultations/ReferralsPlan to develop an effective sys-tem to identify and track patients who are scheduled for referrals and consultations. Document in the patient’s medical record all recommendations that a patient see a specialist for consultation or continued care. Include any letters or other communications between physicians in the medical record.

Types of Tracking SystemsTracking systems do not have to be complex or expensive; they just have to work. Many medical practices use simple and inexpen-sive methods, such as logbooks. Others utilize tracking functions provided in their electronic medi-cal records system. Whatever tracking method you choose, be sure to follow up on laboratory and diagnostic tests, cancellations, no-shows, and consultations. �Copyright © 2015 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.

Patient Tracking & Follow Up– What You Don’t Know Can Hurt You

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Concord, NH, should email a current CV to [email protected] to begin the process. The medical

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ety’s president from 1814-1821, while also serving as president of the NH State Senate during that period. I encourage you to visit the Executive Council Cham-bers in the NH State House to view both Bartlett por-traits and a tall dresser which belonged to our Medi-cal Society’s founder. �

EVP Corner, cont. from page 5

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2016 NHMS Council President John R. Butterly, MD

President-Elect Deborah A. Harrigan, MD

Immediate Past President Lukas R. Kolm, MD, MPH

Penultimate Past President Stuart J. Glassman, MD

Vice President Leonard Korn, MD

Secretary Seddon R. Savage, MD

Treasurer Tessa J. Lafortune-Greenberg, MD

Speaker Richard P. Lafleur, MD

Vice Speaker Everett J. Lamm, MD

AMA Delegate William J. Kassler, MD, MPH

AMA Alternate Delegate Stuart J. Glassman, MD

Medical Student Vivienne T. Meljen

Physician Assistant Mark H. Rescino, PA-C

NH Osteopathic Association Rep. Robert G. Soucy, Jr., DO

Young Physician Rep. Vladimir A. Sinkov, MD

Young Physician Rep. Polina Y. Sayess, MD

Member-at-Large John L. Klunk, MD

Member-at-Large Jose T. Montero, MD

Member-at-Large Gregory W. Kaupp, MD

Member-at-Large Albert L. Hsu, MD

Member-at-Large Diane L. Arsenault, MD

Member-at-Large Lars E. Nielson, MD

Physician Member of NH Board of Medicine Nick P. Perencevich, MD

Lay Person Lucy Hodder, Esq.

Physician Rep. of the NH Dept. Health Human Services Doris H. Lotz, MD, MPH

Specialty Society Reps:

• NH Chapter of the American College of Cardiology Daniel M. Philbin, MD

• NH Chapter of the American College of Physicians Richard P. Lafleur, MD

• NH Academy of Family Physicians Gary A. Sobelson, MD

P. Travis Harker, MD, MPH

• NH Chapter of Emergency Physicians Michelle S. Nathan, MD

• NH Society of Eye Physicians & Surgeons Sonalee M. Desai-Bartoli, MD

• NH Pediatric Society Leonard M. Small, III, MD

• NH Psychiatric Society Jeffrey C. Fetter, MD

• NH Society of Anesthesiologists Steven J. Hattamer, MD

• NH Society of Pathologists Eric Y. Loo, MD

• NH Amer. College of Obstetricians & Gynecologists Oge H. Young, MD

• NH Orthopaedic Society Glen D. Crawford, MD

Trustee Charles M. Blitzer, MD

Trustee Cynthia S. Cooper, MD

Chair, Board of Trustees David C. Charlesworth, MD

NH Med. Group Management Assn. Rep. Amanda Maselli

NHMS Welcomes

New MembersHerlen J. Alencar, MD

Claudia E. Bartolini, MD

David B. Bernstein, MD

Maria T. Boylan, DO

Matthew J. Daily, MD

Michael J. Deleo, III MD

David V. Dent, DO

Duane A. Dietz, MD

James M. Estes, MD

Rebecca E. Evans, MD

Michael A. Hokenson, MD

Mark A. Horton, MD

Rasa K. Miller, MD

Ellen Minerva, MD

Matthew W. Mitschele, MD

Seema Mukerjee, MD

Matthew T. Murray, MD

Carol Lynn H. O'Dea, MD

Joshua M. Philbrick, MD

Debra S. Poskanzer, MD

Erin J. Rafferty, MD

Preethi Rajanna, MD

Sheila Ramanathan, DO

Amit Rastogi, MD

Jennifer Renz, MD

Ari M. Salis, MD

Bryan T. Suchecki, MD

Timothy W. Sullivan, MD

David J. Syrek, MD

Richard C. Tomb, MD

Michael A. Urbano, MD

Kevin B. Zent, MD


16

and/or substance use disorders are more likely to end up being prescribed opioids on a long-term basis. Clearly a complex convergence of challenges leads to opioid misuse.

If we are to better serve both our patients and the public health, we need to shift the prescribing nar-rative from a focus on how many opioids are pre-scribed to how well opioids are prescribed. We don’t know what the optimum milligrams per capita of opi-oids to support the well being of the population is; some physicians probably prescribe too many, some too little, and some about right. There is reasonable consensus, however, reflected in numerous profes-sional guidelines on strategies to provide safer and more effective medical use of opioids.x Depending on the context of care, best practices may include: implementation of comprehensive pain treatment with diverse interventions; targeting opioid dosing to expected pain requirements with patient con-tact before renewal; assessment of patients for opi-oid misuse risk with prescribing tailored to mitigate identified risk; opioid agreements that include docu-mentation of risk-benefit discussion, goals of treat-ment, and plan of care; use of objective monitoring strategies such as the Prescription Drug Monitoring Program, drug screens, and pill counts; continuation of opioids only when benefits clearly outweigh risks; and referral of patients with opioid use disorders to appropriate care, among others.

Quality of care in medicine has traditionally been driven by voluntary adherence to guidelines and professional standards, with licensing sanctions if

we consistently provide care significantly below the community standard. However, as opioid deaths and addiction continue to rise, the public sector is moving rapidly to require adherence to various as-pects of opioid prescribing best practices. The CDC is expected to release a new national opioid prescrib-ing guideline in early 2016 that will likely shape rules and regulations adopted at the state level; a draft of the proposed guideline is posted at http://www.cdc.gov/drugoverdose/prescribing/guideline.html with an opportunity for public comment through Janu-ary 13. The New Hampshire Board of Medicine’s rules are in process and expected to be presented for public input in late January as well. Given the com-plexity of the health issues involved, it is critical that physicians and others in the healthcare community engage in these public processes in order to assure that adopted rules achieve the goal of optimizing prescribing of opioids and positively affect the care of our patients and the public health.

_____________________i Office of New Hampshire Medical Examinerii SAMHSA, Treatment Episode Data Set, 2014iii https://www.nh.gov/medicine/iv http://www.painpolicy.wisc.edu/world-health-organization-

guidelinesv http://www.annualreviews.org/doi/pdf/10.1146/annurev-

publhealth-031914-122957vi AHRQ, 2014vii J Clin Psych, 2014viii MMWR, 2011ix http://www.drugabuse.gov/publications/research-reports/

relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

x CDC Common Elements, 2015

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HEALTHCARE AND LITIGATION PRACTICE GROUPS

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A well-designed employee benefits program does more than just help employees. A well-designed employee benefits program aids in creating the best practice possible. It does so by making a practice more efficient and more profitable. Success requires more than a comprehensive lineup of products and excellent customer service - it takes a passion for great results.

After 27 years of delivering astounding results, medical practices throughout NH and the region have found NEEBCo to be a reliable and critical component in providing the best in practice with regard to employee benefit programs. As the endorsed broker of the NH Medical Society, let NEEBCo provide your practice with the best in practice as well.

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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

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Does your New Hampshire medical license

expire on June 30? Here’s what the CME Coordinator needs from you by Feb. 28, 2016:

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

• 100 total CME credits for calendar years 2014 and 2015

• 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/cme-reporting or contact Mary at 603.224.1909 or

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