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 health-care, and physicians experience deep satisfaction in the practice of medicine

NH Medical Society

7 North State Street

Concord, NH 03301

(603) 224-1909

(603) 226-2432 fax

nhmed@nhms.org www.nhms.org

John Robinson, MD ......... President Scott Colby ...............................EVPCatrina Watson ....................... Editor

Meaningful Use ............................1 President’s Perspective ..............2Increase Your Involvement .........3EVP Corner ..................................4CAPS ............................................7CME ..............................................8Risk Management ........................9Rite Aid Settlement....................10FAQ’s ..........................................14Benefits Corner .........................15

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” at the above address

Physicians Bi-Monthly

NEW HAMPSHIRE MEDICAL SOCIETY NEWSLETTERNH Medical Society; For The Betterment of Public Health Since 1791

September/October 2010

Meaningful Use – What You Need to Know Now

This article is intended to provide you with a brief overview of the 2011 ex-pectations for Meaningful Use under the HITECH Act. Please remember, William Kassler, MD, MPH, will be presenting on this topic at the NH Medical Society An-nual Scientific Conference in October.

The final rule issued by CMS for the Electronic Health Record [“EHR”] Incen-tive Program created under the HITECH Act , was published in the July 28, 2010 Federal Register Vol. 75, No. 144. Under the rule, physicians and other providers [“EP”] are eligible to receive incentive payments for utilizing an EHR from either Medicare or Medicaid beginning in 2011. However, the incentives are available only to the extent EPs use the EHR in a mean-ingful way. Meaningful Use is incorpo-rated into the EHR Incentive Program to ensure, among other things, quality, safety efficiency and improved care coordination.

NH Medical Society staff is working with CMS and the AMA to better understand the implications for all physicians, regard-less of specialty or employment arrange-

ment. To view a PowerPoint presentation prepared by CMS for the AMA go to: http://www.nhms.org, under Hot Topics click on: AMA Making Health IT Work For You. There are three stages of Meaningful Use:➣ 2011 - Stage 1 – Data Capture and Sharing

➣ 2013 - Stage 2 – Advanced Clinical Process

➣ 2015 - Stage 3 – Improved Outcomes

More details will follow on Stages 2 and 3 in future articles as they become available.Stage 1 Highlights:➣ 80% of practice records must be on a

certified EHR;➣ Reporting of measures is through an at-

testation not electronic transfer of data;➣ 15/5/6 – 15 core objectives, 5 out of 10

objectives from a menu set and 6 Clini-cal Quality Measures – 3 core and 3 out of 38 from a menu set

Table 1 (page 5) lists the 15 Core Ob-jectives; Table 2 (page 5), the 10 Menu Objectives; Table 3 (page 6), the Clinical Quality Core Set and Alternate Clinical Quality Core Set; and Table 4 (page 6), the 38 Additional Quality Measures of which EPs much select 3.

The EHR Incentive Program reverts to a payment reduction in 2015 for EPs not adopting EHRs and demonstrating Mean-ingful Use. There is a temporary exemp-tion from the payment adjustment (details

Continued on page 5

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Continued on page 3

President’s Perspective

Patient Values and Evidence-Based Medicine:

Where is the Balance?John H. Robinson, MD, CPE President, NHMS

In the last newsletter column I discussed the balance between professional autonomy and teamwork in the delivery of optimal healthcare and described the importance of medical lead-ership in achieving that balance. The Patient Protection and Affordable Care Act (PPACA) addressed two other areas that might also be chal-lenging to balance in the interests of reform: 1) Patient Values and 2) Evidence-Based Medicine (EBM) practices along with associated Compara-tive Effectiveness Research (CER).

For several years now Patient Centered Medi-cal Homes (PCMH) have been operating with varying degrees of sophistication and success. The Joint Principles of PCMH in the domain of “Quality and Safety” encourage a) advocating for patients to support the attainment of patient-centered outcomes, b) using Evidence-Based Medicine decision support tools and c) encourag-ing active participation by patients in decision-making and eliciting patient-feedback to ensure that patient expectations are met. Assessments of patient values and preferences and of “readiness to change” in the direction of improved self-management capabilities are critical elements of this model. Tools such as motivational interview-

ing techniques and a more expansive assessment of Social History are useful means to enhance shared decision-making efforts in a practice. These principles, although not articulated as clearly in formal documents, are going to be an important element of Accountable Care Organiza-tion (ACO) operations as well. However, a recent article in the journal “Health Af-fairs” adds to a body of literature that suggests that balancing patient values and EBM might some-times be difficult. The article reports on the results of a survey of health care consumers concerning EBM. It identified significant gaps in knowledge and appreciation about EBM concepts and uncov-ered beliefs that “all medical care meets quality standards” and that “medical guidelines represent an inflexible, bargain-basement approach to treat-ing unique individuals”. If patients do not truly value EBM, then incorporating their values into treatment decisions may not yield optimal care as defined by EBM; if patients believe that “more is better” then convincing them that less is better might be a significant challenge. This finding perhaps should not be surprising. After all the PPACA included funding for CER but then rendered that research nearly meaningless by prohibiting the Centers for Medicare and Medicaid Services (CMS) from incorporating those findings into benefits coverage decisions; CMS is barred from disallowing coverage for drugs, treatments or devices based solely on CER findings that those items are ineffective. This mixed message was delivered by members of congress reflecting concerns of their constituents that are completely compatible with the results of this study.

In the distant past this conflict did not even ex-ist. Before the Karen Quinlan case the practice of medicine was nearly universally paternalistic and patient values seldom entered clinical decision equations. That legacy was never fully eliminated and explains why many patients in the study think that all medical care meets quality standards: “If my doctor recommends it then it must be good because I am not in a position to argue with him” without ever examining that assumption. The le-

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Continued from page 2gal finding of the Quinlan case that patients have a right to autonomy in medical decision-making has never been fully cultivated by the medical profes-sion as evidenced by poorly constructed informed consent forms and practices. It was not informed consent but rather the rise of direct to consumer advertising by pharmaceutical companies more than a decade ago that first truly challenged the physician attempting to provide proper clinical recommendations. Patients with limited knowledge of diagnosis and treatment options began to demand tests and prescriptions inappropriately. The busy practitioner operating in a fee for service environment which does not reward counter-education and academic detail-ing well, often submitted to patient demands thus driving up the costs of health care. Sometimes that physician would welcome the decision of a managed care medical director who would not permit coverage of a test or treatment that the patient demanded and that the doctor ordered only reluctantly; it unburdened the physician of the need to provide remedial education to the patient. And that experience underlies the other major finding of the study, that EBM represents bargain-basement medicine – if it was a managed care decision it must be bad. (In the interests of full disclosure, I have been a managed care medical director with responsibility for such prior authorization decisions.)

Clearly this has to change. Ideally the new reimbursement arrangements of PCMH and ACO practices will provide the necessary financial incentive to engage consumers in more thorough education about the implications of certain clini-cal decisions given the context of the patients’ own values. But those changes will not happen over night and will require significant modifica-tions in our approaches to the engagement of patients on their own terms. The medical profes-sion needs to continue and to perhaps accelerate its transition from a paternalistic mindset to one of educator and partner in the delivery of optimal care for individual patients. It would also do well to support more public education about the con-cepts, advantages and limitations of EBM.

No Time Like the Present to Increase Your Involvement

You may want to avoid TV and answering home phones until after the November 2, election, but YOU can make a difference by paying attention to the candidates running for NH State Senate and the NH House of Representatives. These local politicians do listen to their constituents and need your support.

As you encounter people running for state office, introduce yourself and ask for their position on is-sues important to you and your practice. If you are unsure about a candidate’s previous votes in Con-cord, contact Janet Monahan at the NH Medical Society for assistance: janet.monahan@nhms.org

We are fortunate here in the Granite State to have state legislators who are very accessible. Help candidates who have supported your views by of-fering to post a lawn sign or host a coffee to meet your neighbors. Get involved with the people who make the laws that impact your patients and your profession.

.~ Janet Monahan

Your patients may want to know... New Resource Helps Families Cope With Issues of Caregiving

A new comprehensive resource is now available to help family caregivers of older adults cope with the many issues they may face caring for a senior loved one.

The Home Instead Senior Care® network has launched Caring for Your Parents: Education for the Family CaregiverSM. This family caregiver support series addresses senior resistance to care and features 17 topics of interest to caregivers such as identifying the signs that care is needed, selecting an in-home care provider, communicat-ing with seniors and health care providers, and providing at-home care in a recession. Materials including workbooks and videos are available at www.caregiverstress.com

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EVP Corner

The Summer Heat is On!The summer of 2010 will likely go down in the history books as one of the hottest on record…not to mention the weather has been ferociously hot and humid! Of course my reference to the summer heat is the work NHMS has been doing in keeping abreast of key issues, preparing for the legislative session, monitoring one of the most important mid-term elections in over 15 years and prepar-ing for an exciting and eventful annual scientific conference.Over the summer months, NHMS Council and staff have been working hard on the following:ACA – The Affordable Care Act, or Healthcare Reform as we commonly refer to it, is the most significant healthcare legislation to be enacted in a generation. In addition to expanding coverage and encouraging efficiencies, there are numerous details which will impact you as a physician every day. Did you know…that beginning January 1, 2011, patients with Flexible Spending Accounts, Health Reimbursement Accounts, Medical Savings Accounts and Health Savings Accounts will need a written prescription from their physician to claim over-the-counter medications as eligible expense from these savings vehicles?There are many more provisions of the ACA and NHMS will continue to provide you with easy-to-digest information which will assist you in com-prehending this important piece of legislation.HITECH – Meaningful Use – As the article from page one illustrates, the HITECH Act contains many provisions which will impact the adoption

and use of electronic health records [“EHR”]. NHMS has been studying the details of the HI-TECH Act to better understand the implications for practicing physicians and will continue to fol-low its implementation. Did you know…that by 2015 all physicians ac-cepting Medicare will be required to use an EHR or they will face a reimbursement adjustment or reduction?Task Forces – NHMS has been actively working with its Public Health Task Force, Prescription Drug Task Force and Communications Task Force on important issues impacting the state. Did you know…that on September 25, 2010, the DEA will sponsor a national Take Back Day to encourage the collection of unused prescription medications from patients’ medicine cabinets? Watch for more information on this initiative.Annual Scientific Conference – NHMS staff under the direction of Dr. Robinson, has been planning a very exciting and informational Annual Scientific Conference in Kennebunkport, ME, the weekend of October 15 thru 17. Did you know…that this year’s meeting will have 12 CMEs at a cost of only $175 per NHMS member?Many more issues have been tracked and worked by staff such as participation in the rules mak-ing process for changes to the Board of Medicine rules, the JUA rules as well as participating in commissions and monitoring the work being done by the Legislature over the summer.As you can see, it’s been one of the hottest sum-mers in history and the staff at NHMS is not only up to the challenge of working these issues for you, but is honored to be able to do so. Invitation – Please let us know if there are any issues you would like us to track or if there is any information we can provide for you. We’re here for you.

~ Scott Colby

NHMS Annual Scientific Mtg.

October 15-17thThe Colony Hotel, Kennebunkport, ME

Mary.pyne@nhms.org

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Table 115 Core Objectives: 1.Computerized physician order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures to CMS/States4. Implement one clinical decision support rule5. Provide patients with an electronic copy of their health information, upon request6. Provide clinical summaries for patients for each office visit7. Drug-drug and drug-allergy interaction checks8. Record demographics9. Maintain an up-to-date problem list of current and active diagnoses10. Maintain active medication list11. Maintain active medication allergy list12. Record and chart changes in vital signs13. Record smoking status for patients 13 years or older14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically15. Protect electronic health information

Table 25 of 10 Menu Objectives:1. Drug-formulary checks2. Incorporate clinical lab test results as structured data3. Generate lists of patients by specific conditions4. Send reminders to patients per patient preference for preventive/follow up care5. Provide patients with timely electronic access to their health information6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate7. Medication reconciliation8. Summary of care record for each transition of care/referrals9. Capability to submit electronic data to immunization registries/systems*10. Capability to provide electronic syndromic surveillance data to public health agencies** At least 1 public health objective must be selected

yet to be finalized), which will be applied on a case-by-case basis determined annually, by the Secretary of HHS, with a five year limit.

In short, Meaningful Use is here to stay and the importance of adopting a certified EHR and using it in a “meaningful” way can not be overstated. To assist you in determining which EHR is best for you and your practice, NHMS has partnered with

Software Advice for a free assessment tool. The link for this tool may be found on the NHMS web-site www.nhms.org. Go to the Technology Center found under Practice Resources.

Please contact NHMS for additional information on the HITECH Act. We’re here to help!

~ Scott Colby

Continued from page 1

Continued on page 6

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Continued from page 5

Table 4Additional Clinical Quality Core Set – Must complete 3 of 38

1. Diabetes: Hemoglobin A1c Poor Control

2. Diabetes: Low Density Lipoprotein (LDL) Management and Control

3. Diabetes: Blood Pressure Management

4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

6. Pneumonia Vaccination Status for Older Adults

7. Breast Cancer Screening8. Colorectal Cancer Screening9. Coronary Artery Disease (CAD):

Oral Antiplatelet Therapy Prescribed for Patients with CAD

10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity ofRetinopathy

14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

15. Asthma Pharmacologic Therapy16. Asthma Assessment17. Appropriate Testing for Children

with Pharyngitis18. Oncology Breast Cancer:

Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

21. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

22. Diabetes: Eye Exam23. Diabetes: Urine Screening24. Diabetes: Foot Exam25. Coronary Artery Disease (CAD):

Drug Therapy for Lowering LDL-Cholesterol

26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

27. Ischemic Vascular Disease (IVD): Blood Pressure Management

28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement

30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

31. Prenatal Care: Anti-D Immune Globulin

32. Controlling High Blood Pressure33. Cervical Cancer Screening34. Chlamydia Screening for Women35. Use of Appropriate Medications

for Asthma36. Low Back Pain: Use of Imaging

Studies37. Ischemic Vascular Disease

(IVD): Complete Lipid Panel and LDL Control

38. Diabetes: Hemoglobin A1c Control (<8.0%)

Table 3Clinical Quality Core Set:

NQF 0013 Hypertension: Blood Pressure MeasurementNQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation

InterventionNQF 0421 PQRI 128 Adult Weight Screening and Follow-up

Alternate Clinical Quality Core Set:

NQF 0024 Weight Assessment and Counseling for Children and AdolescentsNQF 0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or OlderNQF 0038 Childhood Immunization Status

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The New Hampshire Medical Society Corporate Affiliates

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

Affinity Marketing Group

Anthem BCBS

Athenahealth

Cigna Healthcare

Crown Healthcare Apparel Service

Graduate Education Foundation

I C System

Kilbride & Harris

Maxim Healthcare Services

Medical Mutual Ins Co of Maine

NEEBCO

Northeast Delta Dental

Northeast Health Care Quality Foundation

ProMutual Group

Rath Young and Pignatelli PC

Risk Transfer Alliance, LLC

Sage Solon

Software Advice

Sulloway and Hollis

TD Insurance, Inc.

Pfizer

NHMS MembersThe New Hampshire Medical Society offices at 7 North State Street Concord, New Hampshire are your offices

You are welcome to stop by anytime to:

•• Catch•your•breath•when•in•Concord

•• Meet•with•colleagues••(call•ahead•to•reserve•meeting•space)

•• Use•wireless•to•check•your•email•or•search•the•net

•• Enjoy•a•cup•of•coffee,•use•the•microwave

•• Put•your•feet•up•and•read

Usual hours 8-5 M-F 603-224-1909

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CME & Meetings

NHMS Annual Scientific Mtg.,

October 15-17thThe Colony Hotel,

Kennebunkport, MEMary.pyne@nhms.org

The Vermont Cancer Center presents the 13th Annual Breast Cancer Conference on Friday, October 15, 2010, 8am-4pm at the Sheraton Burlington Hotel & Conference Center, Burlington, VT. The conference theme is “Breast Cancer, the Environment & You: Genetics, Toxins, Nutrition & Exposure.” This is a FREE community event with over 60 educational sessions and a full exhibits fair. The program has been submitted for AMA and AAFP credit, Nursing Contact Hours, and Social Worker, Pharmacy and Radiologic Technologist credit approval. For more information, visit www.VTBreastCancerConference.org or call 802-656-2292.

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Medical Mutual Insurance Company of Maine: Risk Management Practice TipAnticoagulation Management in the Physician Office

Management of the patient undergoing oral anticoagulation therapy, such as warfarin, requires the physician office to have an estab-lished system for test tracking and order man-agement. Diligence in following established processes is key in avoiding potential impact on patient care due to over or under anticoagu-lation. Systematic follow-up enhances patient care by decreasing the likelihood of significant complications.

Warfarin has a very narrow therapeutic win-dow. Failure to adequately monitor a patient or provide appropriate dosing could lead to serious, potentially life threatening complications. The patient may become supratherapeutic and have a serious bleeding event or subtherapeutic and be at risk for a clotting episode. An INR result that is outside the therapeutic range and becomes “lost in the shuffle” in a physician’s office can lead to life threatening complications.

Establishing a tracking system is the first step in effectively managing patients who are on warfarin for anticoagulation. A tracking system is implemented to assure that patient testing is completed when ordered, results are received and evaluated and adjustments are made to the patient’s medication regime (if necessary). In addition to a tracking system, protocols need to be developed to address the process for patients who fail to show for an appoint-ment/lab test. This process should include a review by the medical provider to determine what follow-up is necessary. Establish a pro-cess outlining how to manage a patient who cannot be contacted with results or who fails

to respond to attempts to contact. If a patient demonstrates repeated non-compliance with the recommended testing and follow-up, schedule an appointment to discuss the importance of close monitoring and the potential risks of non-compliance. Clear, timely documentation in the medical record is essential.

Beyond tracking of test results and appoint-ments, managing the patient’s INR effectively requires a knowledgeable, experienced practi-tioner to follow established guidelines in dose determination. Assessment of the patient to determine noncompliance, dietary impact or changes in medications needs to occur. Mak-ing warfarin dose adjustments based solely on “experience” or “history” with the patient can lead to challenges if the patient suffers a bad outcome due to anticoagulation management. Using an established algorithm is an objective, systematic way to manage warfarin therapy. If your patient has multiple providers, estab-lish and clearly document which provider will be responsible for prescribing, monitoring and adjusting the warfarin dose for the patient. For those patients receiving anticoagulation manage-ment in your practice, communicate the patient’s status with any other providers involved in their care. If you refer your patient to another provider, assure that information regarding the anticoagulation status is communicated.

Provide patients with clear, understandable educational material. Document patient educa-tion and understanding of their responsibilities regarding follow-up and ongoing monitoring as well as the expectation of compliance. Medical Mutual’s “Practice Tips” are offered as reference information only and are not intended to establish practice standards or serve as legal advice. MMIC recommends you obtain a legal opinion from a qualified attorney for any spe-cific application to your practice.

*MMCI is a NHMS Corporate Affiliate

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Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy CaseCompany agrees to substantial corrective action to safeguard consumer information

Rite Aid Corporation and its 40 affiliated entities have agreed to pay $1 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, the U.S. Department of Health and Human Services (HHS) announced today. In a coordi-nated action, Rite Aid also signed a consent order with the Federal Trade Commission (FTC) to settle potential violations of the FTC Act.

Rite Aid, one of the nation’s largest drug store chains, has also agreed to take corrective action to improve policies and procedures to safeguard the privacy of its customers when disposing of identifying information on pill bottle labels and other health information. The settlements apply to all of Rite Aid’s nearly 4,800 retail pharmacies and follow an extensive joint investigation by the HHS Office for Civil Rights (OCR) and the FTC.

OCR, which enforces the HIPAA Privacy and Security Rules, opened its investigation of Rite Aid after television media videotaped incidents in which pharmacies were shown to have disposed of prescriptions and labeled pill bottles containing individuals’ identifiable information in industrial trash containers that were accessible to the public. These incidents were reported as occurring in a variety of cities across the United States. Rite Aid pharmacy stores in several of the cities were highlighted in media reports.

Disposing of individuals’ health information in an industrial trash container accessible to unau-thorized persons is not compliant with several requirements of the HIPAA Privacy Rule and exposes the individuals’ information to the risk of identity theft and other crimes.

This is the second joint investigation and settle-ment conducted by OCR and FTC. OCR and FTC settled a similar case involving another

national drug store chain in February 2009.

The HIPAA Privacy Rule requires health plans, health care clearinghouses and most health care providers (covered entities), including most pharmacies, to safeguard the privacy of patient information, including such information during its disposal.

Among other issues, the reviews by OCR and the FTC indicated that:

• Rite Aid failed to implement adequate policies and procedures to appropriately safeguard patient information during the disposal process;

• Rite Aid failed to adequately train employ-ees on how to dispose of such information properly; and

• Rite Aid did not maintain a sanctions policy for members of its workforce who failed to properly dispose of patient information.

Under the HHS resolution agreement, Rite Aid agreed to pay a $1 million resolution amount to HHS and must implement a strong corrective action program that includes:

• Revising and distributing its policies and procedures regarding disposal of protected health information and sanctioning work-ers who do not follow them;

• Training workforce members on these new requirements;

• Conducting internal monitoring; and

• Engaging a qualified, independent third-party assessor to conduct compliance reviews and render reports to HHS.

Rite Aid has also agreed to external independent assessments of its pharmacy stores’ compliance with the FTC consent order. The HHS corrective action plan will be in place for three years; the FTC order will be in place for 20 years.

For additional information and to read the Resolution Agreement, visit www.hhs.gov/ocr/privacy.

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Q. Does NHMS offer dental insurance and are the rates competitive?

A. NHMS does offer dental insurance through NEEBCO and Delta Dental for member physicians, their families and employees. The rates are about 8% below market rate and there are several op-

tions. You can call NEEBCO or NHMS for a brochure.

Q. How do I know what my CME cycle is?

A. CME cycles are based on the year you received your license. If you received your license in an odd year you will always renew in an odd year. Therefore your CME cycle will be the two calendar

years before you renew your license. Your CME report will be due by February 28th of the year you renew your license. If you have further questions about CME contact Barbara.Brown@NHMS.org

Q. I got married and have a new name and address, who do I have to inform?

A. You are required to notify the NH Board of Medicine within 30 days of a change in home or busi-ness address. You can E-mail nichole.taylor@nhsa.state.nh.us or mail to 2 Industrial Park Dr

Concord NH 03301. Please let us know here at NHMS too, Joy.Potter@nhms.org

FAQ’s

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Health Care Reform: Grandfathered Plans The new health care reform law provides that certain provisions of the law will not apply to group health plans or health insurance coverage in which an individual was enrolled on as of March 23, 2010.

The regulations essentially state that plans will lose their grandfathered status if they choose to significantly cut benefits or increase out of pocket spending for consumers. Losing grandfathered status means that a plan would have to comply with additional health care reform requirements, such as first-dollar coverage of recommended prevention services and patient protections such as guaranteed access to OB-GYN’s and pediatricians.

Permitted Changes: Grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with state or other federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.

Prohibited Changes: Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. Specifically, making the following changes would cause a plan to lose its grandfathered status:

• Significantly cutting or reducing benefits;

• Raising co-insurance charges;

• Significantly raising co-payment charges;

• Significantly raising deductibles;

• Significantly reducing employer contributions;

• Adding or tightening an annual limit on what the insurer pays;

• Changing insurance carriers.

The regulations also contain additional requirements to keep health plans from using the grandfather rule to avoid providing important consumer protections.

To promote transparency, the regulations require a plan to disclose to consumers, every time it distributes material, whether the plan believes that it is a grandfathered plan and therefore is not subject to some of the additional consumer protections of the health care reform law.

For more detailed information on Grandfathered Health Plans please contact your NEEBCo service representative at 603-228-1133

Benefits Corner – Brought to you by New England Employee Benefits Company, Inc. Your Employee Benefit Source

*NEEBCO is a NHMS Corporate Affiliate

New Hampshire Medical Society7 North State StreetConcord, New Hampshire 03301-4018

ADDRESS SERVICE REQUESTED

Prsrt Std.U.S. Postage

PAIDConcord, NH

Permit No. 1584

NH Medical Society wishes to extend condolences to the family of Barry Stern, MD. Past President of NHMS and NHAFP.

9/13/1945– 7/29/2010