VIRGINIA MEDICAL NEWSMAY 2015

Permanent SGR fix—At last!

IN THIS ISSUE

After years of uncertainty and 17 last-minute temporary fixes, Medicare’s

flawed sustainable growth rate (SGR) formula no longer exists. On April 16, Pres. Barack Obama signed a $200 billion Medicare reform package to permanently end the automatic Medicare payment cuts to physicians and immediately block the 21 percent cut that was scheduled to take effect in April.

The Medical Society of Virginia (MSV) thanks members for sending 1,469 e-mail messages to our Virginia delegation to ask them for support of SGR repeal. These efforts would not have been successful without the urging of our members to encourage Congress to repeal the SGR formula and design a new Medicare physician payment system. MSV has worked for years to find a more permanent solution, teaming up with the American Medical Association (AMA) at events like its advocacy conference where President William C. Reha, M.D., M.B.A., Executive Vice President Melina Davis-Martin, Randolph Gould, M.D., FACS, Josh Lesko and

Taylor DesRosiers met with members of Congress to discuss SGR.

“This is another example of the strides that organized medicine can make when physicians join together for a common cause and make their voices heard,” Dr. Reha said. “I extend a sincere thank you to all of you that wrote or called your legislators. Not all of the members of our delegation knew how they would vote on the bill initially, and I know your activism is what helped make a difference.”

Hailed as a “significant bipartisan achievement”, the new law overhauls older legislation that aimed to slow Medicare’s growth by limiting reimbursements to physicians. It revamps how physicians will be paid in the future, including annual payment updates of 0.5 percent starting on July 1 and lasting through 2019. It also provides financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits.

Other benefits to physicians include:

• Simplified quality reporting programs;

• Protections so medical liability cases

cannot use Medicare quality program standards and measures as a standard or duty of care; and

• Technical support to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.

MSV sent thank you letters to legislators who supported SGR reform: Reps. Robert Wittman, Scott Rigell, Bobby Scott, Randy Forbes, Robert Hurt, Bob Goodlatte, Donald Beyer, Morgan Griffith, Barbara Comstock and Gerald Connolly, as well as Sens. Mark Warner and Tim Kaine.

If you receive an award or honor that you would like your physician colleagues to know about, please share it with us! The Medical Society of Virginia (MSV) is happy to feature your good news in an upcoming E-News or publication. Simply send your good news with your headshot to us at newsdesk@msv.org.

Share your good news

02 Legislative Summit Update

04 Siobhan Dunnavant, M.D. runs for Virginia Senate

05 The countdown to ICD-10 is on!

08 Tackling the opioid addiction problem

11 Congratulations Ken Tuck, M.D., Doctor’s Day winner

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Advocate for my profession

Looking to 2016 and beyondApproximately 60 physicians, medical society staff and

specialty society lobbyists gathered on May 1 for the Medical Society of Virginia’s (MSV) annual Legislative Summit. Members submitted 10 proposals that they believed should be a part of MSV’s legislative agenda in 2016, and the summit provided an opportunity to present and discuss these initiatives. The proposals will now go before the Legislative Committee on June 24, when they will make recommendations to the Board of Directors on what actions should be taken.

MSV staff Matt Mansell and Robin Cummings presented initiatives the society is already undertaking, including:

• Opioid Misuse Work Group, which was assembled after this year’s General Assembly session in response to growing concern over the growth in prescription drug abuse in Virginia

• Gathering data on procedural and imaging pre-authorization

• MCHIP credentialing regulations

• Virtual credit card payments from health plans

• Advanced directive registry

• Truth in Advertising Work Group

• External activities of MSV include:

• Prescription Prior Authorization Work Group

• Board of Pharmacy’s pharmacy benefit manager review

• Workers’ Compensation Group

• The study on involuntary civil admission evaluations

• Scope of practice talks

• Mixing, Diluting and Reconstituting Work Group

• State studies on certificate of public need and graduate medical education funding

MSV President William C. Reha M.D., M.B.A. presented a proposal on virtual credit card transaction fees for physician reimbursement while MSV President-Elect Edward Koch, M.D. followed with a proposal on developing legislation to provide

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Advocate for my profession

safeguards in physician employment contracts. Two proposals were submitted by medical students—one asking that MSV make graduate medical education funding a priority in the 2016 General Assembly session and the other calling for legislation to decriminalize needle possession and legalize sterile needle exchanges to promote the prevention of HIV/AIDS and hepatitis C transmission. There was also much discussion of Marcella F. Fierro, M.D.’s proposal to require video recording of forensic psychiatric assessment of defendants on trial.

COPN reform stood out as a popular subject, with the Virginia Orthopaedic Society and the Medical Society of Northern Virginia both asking that MSV make it a legislative priority. The Virginia Society of Otolaryngology asked that MSV submit legislation next year which would prohibit anyone from using the title “physician” unless they have been awarded a degree as a doctor of medicine or osteopathy. Mental health continues to be at the forefront of health care discussion, and the Psychiatric Society of Virginia put forward a proposal requesting that, if the recommendations from a recently convened work group of stakeholders are appropriate, MSV should back legislation to allow emergency room physicians and psychiatrists to evaluate individuals for involuntary civil admission. Finally, the Richmond Academy of Medicine suggested MSV support a study examining innovative programs that exist in other states to reduce unopened, unexpired prescription medication waste by allowing those medicines to be donated to patients in need.

A special thank you goes out to Dr. Koch and Dr. Reha for moderating the discussion, members who submitted proposals and everyone who attended the summit. MSV is excited by our recent legislative victories and looks forward to another productive General Assembly session in 2016.

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Advocate for my profession

Siobhan Dunnavant, M.D. runs for Virginia Senate

Hoping to expand her scope as a physician leader, Siobhan Dunnavant, M.D. is running in the June 9 primary for a

seat in the Virginia Senate as a Republican in the 12th District (Henrico and Hanover).

After spending years as an active leader within the Medical Society of Virginia (MSV) including roles on the Board of Directors and legislative committee, Dr. Dunnavant decided to run for Senate to help solve the problems she experienced as a physician running a small OB/GYN private practice for 15 years. The many health care reform changes made it difficult to maintain autonomy and survive as a small practice. After selling her practice to the hospital and becoming an employed physician, she decided to take action and focus her efforts to give back as a public servant.

“Mom always said, ‘It’s not enough to identify a problem, you have to be part of the solution,’” professed Dr. Dunnavant. “After careful consideration, I decided the best opportunity for me to be part of the solution to these problems was in the state

Senate—where there isn’t a single physician.”As a physician accustomed to prioritizing and making

difficult decisions, Dr. Dunnavant hopes to leverage her professional experience to help her as senator. If elected, she intends to first concentrate on helping the General Assembly reduce spending and then pursue more efficiency and accountability in government. Currently, between the House and Senate, there are 2,500 pieces of legislation introduced annually. “I would like to see less legislation and a structured process to review and redact laws and regulations that are negatively impacting our lives,” she said.

Dr. Dunnavant encourages physicians to get involved in the legislative process by volunteering in their communities to effect positive change. She believes physicians are uniquely suited for public service and statesmanship because they:

interact with other constituents in a very intimate way, often hearing about the challenges, successes and burdens they and their families face;

• possess unique problem solving skills;

• investigate problems, tease out pertinent components, make assessments and collaborate to find a solution;

• review data and information to sort out what is important and what is frivolous; and

• motivate, educate and empower other people, even about very sensitive and personal subjects.

To learn more about Dr. Dunnavant and her stance on the issues, please visit www.dunnavantdelivers.gop.

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The Oct. 1, 2015 ICD-10 implementation date will be here before you know it. On this date, all health care providers,

health plans and health care clearinghouses must transition to ICD-10, the tenth revision of the International Classification of Diseases. Is your practice prepared to make the required changes in clinical documentation?

If not, the Medical Society of Virginia (MSV) has many resources available to help you get prepared for the implementation—a free webinar, two-day boot camps and one-day refreshers. Learn more about these offerings below.

NEW! One-day refresher course This valuable course is intended to refresh individuals on ICD-10 basics with instructor-led exercises to build your skills. Oct. 1 will be here before you know it so take advantage of this training to help make a smooth transition. Click here to register for a class in your area.

Free ICD-10 webinar from MSV and AHIMA Join MSV and AHIMA on June 16 at 12:00 p.m. for a 45 minute presentation from industry experts on coding and documentation education for ICD-10 CM and procedure coding system (PCS). Attendees will also learn about additional resources. Click here for more information or to register.

Two-day boot camp This two-day seminar is for coders, care providers and office staff interested in becoming proficient in ICD-10. This comprehensive code set training includes an overview of the ICD-10 format and structure, an in-depth study of ICD-10 guidelines, valuable coding tips and hands-on ICD-10 coding exercises to prepare individuals for ICD-10CM proficiency exams required to maintain coding certification. This boot camp will be led by MSV’s own AAPC certified ICD-10CM instructor. Click here to register for a class in your area.

Online trainingMSV has partnered with the American Health Information Management Association (AHIMA) to provide online ICD-10 training at special rates for MSV members. AHIMA’s clinical documentation for ICD-10 training provides interactive, online training on the documentation needed by physicians and clinicians to meet ICD-10-CM requirements. Click here to register.

Manage my practice

The countdown to ICD-10 is on!

FINAL RULE FOR

ADOPTIONM19.22

SEVENTHCHARACTEREXTENSION

F63.0

CODE STRUCTURE

N18.5INTERNATAA IONAL

CLASSIFICATAA ION

OF DISEASES

INCLUSION TERMS

AAPC

ICD-10CC18 6

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Practice owners know how difficult it can be to find the opportunity to get

away and take time off. Have you ever considered, however, what would happen if you became disabled and couldn’t go back to work at all? Is your practice equipped to keep running? Are your colleagues and staff able to cover the expenses to keep the doors open and lights on while you are unable to work?

Peace of mindThanks to business overhead expense (BOE) disability insurance, your practice does not have to stop running just because you can’t work. The expenses won’t stop so this type of disability insurance offers

protection by reimbursing normal and customary expenses like rent, utilities, employee salaries, etc. so you are able to maintain your practice in the event of a disability.

BenefitsOne of the main benefits of BOE coverage is that your insurance company will reimburse your practice each month that you’re unable to work to help pay the everyday bills so you don’t have to dip into your hard-earned assets.

Partner with usThe Medical Society of Virginia Insurance Agency (MSVIA) understands the

importance of finding the right protection for not only you but also your practice. Through a special arrangement between our strategic partner 1752 Financial as well as with Principal Life Insurance Company and Ameritas, you can purchase discounted BOE insurance so you can help protect your practice.

For more information and to see the special pricing for business overhead expense insurance, please contact Dustin Beekman, MSVIA director of life and health, at 877 | 226-9357 ext. 1006 or dbeekman@msvia.org.

The MSV Insurance Agency (MSVIA) is here for you when you need it most. As a physician, it is vital for you

to protect your most valuable asset—your ability to earn an income. MSVIA is offering a high-limit disability program that is discounted exclusively for MSV members so you can protect your income and have peace of mind. Enrollment for this coverage is only open for another two weeks so be sure to contact MSVIA before it’s too late!

Why do you need a high-limit disability program? Some insurance options do not provide enough disability insurance so it’s important that your disability coverage have high enough limits to replace your lost income. The benefits of MSVIA’s exclusive disability program include:

• Guaranteed coverage - Coverage is offered to MSV members on a guaranteed basis without any exclusion other than the standard policy exclusions.

• High limit - You can qualify for up to $25,000 in monthly disability benefits.

• Premium discount and guarantee - A premium discount of up to 20 percent to all eligible members. Premiums are guaranteed during the policy term.

• Own occupation - If you are unable to work in your specialty, full benefits are payable even if you are working in a different occupation.

• Transferability - Ability to take the policy with you if there is a change in employment.

Contact Dustin Beekman, MSVIA director of life and health, at dbeekman@msvia.org or 877 | 226-9357 ext. 1006 to find the right product for your needs.

Manage my practice

Keeping your doors open and lights on

Protect your income when you need it most

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Take advantage of the high-limit supplemental disability program created exclusively for Medical Society of Virginia (MSV) members.

THE BENEFITSGuaranteed Coverage Coverage is offered to MSV members on a guaranteed basis without any exclusion other than the standard policy exclusions.

High Limit You can qualify for up to $25,000 in monthly disability benefits.

Premium Discount & Guarantee A premium discount of up to 20% to all eligible members. Premiums are guaranteed during the policy term.

Own Occupation If you are unable to work in your specialty, full benefits are payable even if you are working in a different occupation.

Transferability Ability to take the policy with you if there is a change in employment.

For more information, contact Dustin Beekman, MSVIA director of life and health, at 877 | 226-9357 or dbeekman@msvia.org.

Exclusive program is brought to you by:

PEACE OF MINDPROTECTING ALL OF YOUR INCOME HAS NEVER BEEN THIS EASY.

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Care for my patients

Tackling the opioid addiction problemThe Medical Society of Virginia Foundation (MSVF) through

a grant from the Physicians Institute for Excellence in Medicine has partnered with other organizations to once again host educational seminars on the safe and effective use of Extended Release/Long Acting (ER/LA) opioids in an attempt to tackle the growing opioid addiction problem. Approximately 40 physicians and health care professionals attended the first session at Bon Secours Maryview Medical Center in Portsmouth on May 9th.

Led by Mary McMasters, M.D., FASAM and Sarah Melton, PharmD, BCPP, CGP, FASCP, this seminar provided Continuing Medical Education (CME)/Contintuing Education (CE) credit on the appropriate prescribing and safe use of ER/LA opioid analgesics, as specified in the U.S. Food & Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) blueprint. The seminar included informational tools for patient assessment, risk evaluation, prescribing best practices, ongoing therapy

management, patient and caregiver counseling methods, and general and product-specific drug information concerning ER/LA opioid analgesics including identification of adverse effects.

Dr. McMasters, an addiction specialist, urged opioid prescribers to practice to the standard of care, which includes checking the Virginia prescription monitoring program (PMP), conducting urine drug testing (UDT), monitoring a patient’s adherence to the treatment protocol and addressing aberrant behavior.

MSVF will continue to hold additional sessions, including one at Sentara Northern Virginia Medical Center on Sept. 12.

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MSV photo library - We need you!The Medical Society of Virginia (MSV) is creating a photo library so we can have photos on hand to use in our publications and marketing materials. Our goal is to use photos of actual physisicans, rather than use stock photography. Who better to represent our members than our actual members? We would love to have an all-encompassing representation of our membership, but we need your help. Examples of photos include: practice settings, physicians and staff working, technology, etc. Send photos to newsdesk@msv.org along with any descriptions of what it is in the photograph.

May 2015 9

MSV news

As MSV President, I am blessed to travel throughout all of Virginia

to give presentations and meet with other physicians at their component and specialty medical societies. While I was in Danville giving the legislative update at its county medical society meeting, I had the pleasure to talk to Dr. Edwin Harvie Jr. He informed me of the rich legacy of his family in the Danville area, he relayed to me that his grandfather, Lewis Edwin Harvie, M.D., served as president of MSV in 1898. Dr. Harvie said he had a copy of his grandfather’s

presidential address from that time and asked if I would have any interest in reading it.

Needless to say, I was extremely interested and have excerpted several parts of it for you to read. If you are interested in reading the entire speech, please click here.

Late 19th century was a fascinating time for medicine. It was during this time that the practice of modern medicine arose, including:

• the development of anesthesia;

• improvements were made in public health, including the need to wash hands and sterilize equipment;

• the development of cell theory and discovering that all living things are composed of cells;

• the development of germ theory and bacteriology;

• the emergence of women as nurses; and

• the advancement of psychiatry.

In Dr. Harvie’s inaugural address, given in Hot Springs in 1898, some snippets that I found particularly interesting include when he gives advice to young physicians and says, “The art of practical medicine is learned, only by accurate observation and knowledge. Success will come to you, only by your own personal exertions, tact, and the study of the fast advancing science of medicine, of surgery its handmaid, and of the cognate sciences. . . . A college Diploma simply certifies that you are prepared to enter the practice of medicine, not that you are a full-fledged Doctor. Have confidence in yourselves, but do not conclude you know it all. Your success will in no small degree depend on what you will learn from the old Doctors with whom you come in contact. Treat them with all

the courtesy and deference, which is so becoming from youth to age, from inexperience to knowledge.”

He advises the young physicians to keep their office space neat and presentable so that they can stay on top of the details and be available to those requiring their services, as patients require prompt responses. He also advises them to remember that the practice of medicine is as much of a business as any other profession in that it helps them provide for their lifestyles

and families, but that it differs in a big way: the success of physicians depends on their “knowledge, faithfulness and skill” and that the “lives of our fellow beings” depend on them.

Overall, I found it interesting to see how Dr. Harvie’s words still resonated with today’s physician and shared common threads that we still speak on today. MSV, as an association of

physicians, continues its work to help physicians succeed in an evolving business environment while still providing quality care to patients. We still look for opportunities to convene more experienced physicians with our medical students and residents so we can be a unifying community for all physicians in Virginia. We have continuously evolved to best fit the needs of our constituency, which has helped us serve our members since 1820.

President’s message – A look back at MSV and 19th century medicine

Regards,

William C. Reha, M.D., M.B.A.President, Medical Society of Virginia

William C. Reha, M.D., M.B.A., President, Medical Society of Virginia

Lewis Edwin Harvie, M.D.

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MSV news

Abingdon Pamela Ann Myers, MD

Alexandria Lisa C. Rainey, MD

Charlottesville Jacob Conrad Meyer, MD

Chesapeake Douglas R. Knittel, MD

Danville Curtis Merritt, DO

Gloucester Elizabeth R. Lunsford, MD

Lexington Ayesha Jone Kelly, MD

Lynchburg Clinton Steven Beverly, MD Lucius D. Clay, III, MD John Louis Guglielmetti, MD Amanda B. McClung, MD

Manassas Park Jamal Uddin Zia, MD

Pearisburg Russell W. Melton, MD

Rockville Shona Sanchita Pendse, MD

Suffolk Muna Ahmed Jama, MD

Vienna Patricia Maria Ladisa, MD

Vinton Randall R. Rhea, MD

Virginia Beach David Henry Adler, MD Ramon Deguzman Matawaran, MD

Williamsburg Amna Hamid Feroze, MD

Winchester Christine Catherine Pletkova, MD

MSV welcomes new members

For the third year, the Medical Society of Virginia (MSV) gave patients and physicians across Virginia the chance to honor their favorite physicians in its

Doctors’ Day Facebook campaign. Although it was a close race, MSV awarded Kenneth Tuck, M.D. with the honor of being the 2015 Doctors’ Day winner with 82 “likes”. Dr. Tuck’s nomination came in from MSV President William C. Reha, M.D., M.B.A.

“Dr. Tuck is widely known and respected in Virginia and the nation,” Dr. Reha said. “He has served as president of the Medical Society of Virginia and the American Academy of Opthamology during his professional career spanning more than 50 years, which is an incredible testament to his dedication to our profession.”

Dr. Tuck has worked as an ophthalmologist in Roanoke and recently announced his retirement at the age of 82. He graduated from the University of Virginia School of Medicine and completed his residency at the Mayo Clinic in Rochester, Minnesota.

“I appreciate the confidence of my colleagues and friends, especially at this time as I leave my practice and search for a new way to serve.” Dr. Tuck said. “It has been a huge honor and privilege to practice medicine for the number of years that I have practiced. There is no service that has been more fulfilling than helping our patients. I wish I could do it another 50 years.”

Congratulations, Ken Tuck, M.D., Doctors’ Day winner

MSVIA partners with Digital Benefit Advisors to offer Virginia physicians access to a range of employee benefit products for groups and individuals including medical, dental, vision, life, disability and more. Click here to view the Digital Benefit Advisors newsletters to learn more.