physicians’ bi-monthly septemeroctoer 13 n.h. … newsletter...physicians’ bi-monthly...

Physicians’ Bi-Monthly September/October 2013

This summer, the final checks from the N.H. Medical Mal-practice Joint Underwriters As-sociation (JUA) settlement dis-tribution were sent to providers who held policies at any time since 1986. If you believe you qualify and have not received any distribution, please contact the JUA at 800-221-2503 or the Claims Administrator at 888-714-2403.

DO NOT DELAY!

JUA $$ LAST CHANCE!

Often referred to as Medicaid Managed Care, MCM will go live December 1, 2013

On Aug. 14, 2013, the State of N.H. Department of Health and Human Services [“DHHS”] issued a press release affirming that the three (3) managed-care plans [“MCOs”] under contract with the state for the Medicaid Care Management Program [“MCM”] had developed provider networks adequate to meet the needs of the first phase of the program launch (Important re-

imbursement changes are further down in this article).

As such, Phase 1, or “Step 1,” will commence on Dec. 1, 2013, when Medicaid beneficiaries will be en-rolled and accessing care through one of the three (3) MCOs. The press release identified an aggres-sive effort to reach full implemen-tation by this date and outlined some of the activities that would be undertaken over the coming weeks and months, including:

• Outreach to current Medicaid beneficiaries to assist them in selecting an MCO for their cov-erage;

• Outreach to current Medicaid providers about how to make

N.H. Prepares for Medicaid Care Management

Medicaid, cont. on page 4

Citizens Health Initiative work

supports Million Hearts Submitted by Holly Tutko, MS, N.H. Institute for Health Policy and Practice

The N.H. Citizens Health Initia-tive (NH CHI) is a multi-sector collaboration of citizens, business leaders, medical providers, in-

Million Hearts, cont. on page 6

On October 25, 2013, the Medicare Part B claims processing will be tran-sitioned from NHIC Corp. to the new National Government Services Juris-diction K (JK) A/B MAC.

What does this mean for you? All Medicare providers must re-enroll!

A new password is needed to access the EDI Gateway to submit claims. All connectivity to the Gateway MUST be obtained via a Network Service Ven-dor (NSV). You can view VSN pro-files at: http://www.ngsmedicare.com/wps/portal/ngsmedicare/jktransition.

To ensure a seamless transition, there

is an Early Boarding opportunity now available with National Government Electronic Data Interchange (EDI). This means you can pre-enroll with National Government Services (NGS), and the claim will be automatically re-routed back to NHIC Corp. until the October cutoff date. Questions can be directed to 888-379-9132.

NHMS met with a representative from NGS and will continue to disseminate information as it becomes available.

NGS recommends joining the List-serv/Email updates program at htpp://www.NGSMedicare.com. �

Medicare Providers MUST RE-ENROLL


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New Hamphire Medical Society7 North State Street Concord, NH 03301 603 224 1909603 226 2432 [email protected] www.nhms.org Travis Harker, MD ..................... PresidentScott Colby ........................................ EVPCatrina Watson ............................... Editor

Coming Together to Prevent Suicides in New Hampshire ....................................3

Before You Hit Delete … .......................3EVP Corner ............................................52013 NHMS Council ...............................7

Mission: Our role as an organization in creating the world we envision.

The mission of the New Hampshire Medical Society is to bring together physicians to advocate for the well-being of our patients, for our profession and for the betterment of the public health.

Vision: The world we hope to create through our work together.

The New Hampshire Medical Society envisions a State in which personal and public health are high priorities, all people have access to quality healthcare, and physicians experience deep satisfaction in the practice of medicine.

Do you or a colleague need help?The New Hampshire Professionals’ Health Program (N.H. PHP) is here to help!

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

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

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Last Friday I had a frustrat-ing day in clinic. About half of my patients showed up late, the other half showed up on time or early, but not early enough for the schedule to sort itself out and keep me on time. I was having some computer problems with login errors. I learned, as I was about to see my first patient, that I would be shadowed by a stu-dent, which typically is great, but I was feeling stressed because of a late arrival. I was already behind schedule before even starting. It was the kind of day that cumula-tively results in emotional exhaus-tion, detachment and a low sense of accomplishment, leading to burnout. I’m guessing you have all been there at least once.

Add to this the myriad changes that seem to be happening all at once. My clinical team changed recently; I’m working with a dif-ferent medical assistant, nurse and integrated care manager (like a hybrid between a social worker and therapist). They are all top-notch, but we haven’t worked to-gether previously and don’t know each other’s rhythms and work-

flows yet. I’m seeing patients in different rooms with different layouts than previously. At the same time, the system is changing all around us. We have Mean-ingful Use, ACOs and Medicare Shared Saving quality metrics, all of which hold great promise but require us to change how we do things. My rough day in clinic working with my new team re-minded me how easily we fall into routines and how difficult it is to change them.

Last year a survey of 7,288 phy-sicians published in the Archives of Internal Medicine showed that nearly 50% experienced symp-toms of burnout like emotional exhaustion, depersonalization and depression. This is certain-ly troubling but not unexpected given the intense nature of our work, the high standards of care to which we hold ourselves and a rapidly changing environment. It is often impossible to be “per-fect” while working on a not-so-straightforward clinical issue in a system in which you are learning how to do new things like harness the power of your EMR to im-prove population health. Throw in worry about malpractice and it becomes very clear why the rate of burnout is so high and why some choose to leave our profession.

The good news in all of this is that we don’t have to experience burnout. Much of what burns us out is a matter of perspective, and we can decide how we respond to the pressures on us. Think-ing differently about what makes our work difficult with a new lens can be liberating and allow what

President’s PerspectiveReframing

P. Travis Harker, MD, MPH

President’s Perspective, cont. on page 8


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Every Wednesday, NHMS sends members the eNews Update. The purpose of the eNews is to provide members with quick access to time-sensitive updates and information. For instance, the eNews provides hyperlinks to important legislative information; contacts and updates on the JUA settlement funds; and the latest from CMS, DHHS or AMA on Medicare, Medicaid, disease outbreaks and other practice matters. The eNews offers links to special member services and CME conferences. The NHMS president writes a blog with thoughtful, sometimes provocative, personal in-sight into current issues with a quick link for your own feedback. There is a monthly poll question to also gain insight from readers.

So, please, before you hit delete, take a moment to see what you are missing.

If you are not receiving the weekly eNews, please send your email address to [email protected]. �

Before You Hit Delete …

The N.H. Suicide Prevention Council recently teamed up with medical, law enforcement, military, corrections and school per-sonnel in hopes of raising awareness about suicide, including: the resources available in New Hampshire, educating the community on warning signs of those who may be at risk, and highlighting current initiatives in prevention, such as the State Police Peer-to-Peer program.

Speaking on behalf of the New Hampshire Medical Society, Dr. Stuart Glassman stressed the importance of providers asking the right questions and taking the time to check for warning signs and the collaborative efforts of those striving to prevent suicide.

“As healthcare providers, as physicians, the medical society is re-ally focused on trying to get the message out that we play a role at identifying at-risk patients,” said Glassman. “We’re helping to be a part of the culture of change to really discuss these issues openly with no judgment and try to provide the best care that we can.”

The press event was covered by WMUR. http://www.wmur.com/news/health/Officials-say-awareness-of-suicide-prevention- resources-growing/-/9857712/21855652/-/5blhl9/-/index.html.” �

Coming Together to Prevent Suicides in New Hampshire


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the most of their relationship with the MCOs;

• Open enrollment in the MCOs for Medicaid beneficiaries is expected to begin in Septem-ber; and

• The state’s assessment of the plans’ readiness to handle member enrollment, complex care coordination, provider payment and other essential functions in compliance with the state’s contract.

Provider Communications:

DHHS is committed to a commu-nication plan that includes regular provider updates. NHMS is re-ceiving those updates and has be-gun posting them on the NHMS website, www.nhms.org (go to the News Blog, N.H. Managed Care Medicaid Moves Forward); for the latest updates and links go to the DHHS website, http://www.dhhs.nh.gov/ombp/caremgt/index.htm.

Important Updates:

DHHS will offer training for pro-viders in October (following Sep-tember sessions).

Medicaid beneficiaries should have received a letter in August announcing the move to MCM. It was sent as an informational piece only with no action required by them at that time.

The three MCOs are:

Well Sense Health Plan (Boston Medical Center Health Net Plan) – Kristina Griffin, 603.263.3043, [email protected]

N.H. Healthy Families (Cen-tene) – Provider Relations Office (no individual was identified at

the time this article was written), 866.769.3085

Meridian Health Plan (Meridian) – Mark Simpson, 603.263.7000, Ext. 6521, [email protected]

In addition, DHHS has assigned staff to manage the MCO rela-tionships:

Well Sense Health Plan – DHHS Contact, Mary Gaye Grizwin, [email protected]

N.H. Healthy Families – DHHS Contact, Patrick McGowan, patrick.

[email protected]

Meridian Health Plan – DHHS Contact, Laura Ford, [email protected]

Important Reimbursement Changes:

Taken directly from the Aug. 21, 2013, Regular Update #2:

On Dec. 1, 2013, the MCM pro-gram start date, DHHS is pre-cluded by federal law from pay-ing Fee-for-Service (FFS) rates to providers who serve clients en-rolled in Care Management.

Providers who are enrolled in a member’s health plan will receive payment directly from the Man-aged Care Organization. Provid-ers must enroll with an MCO(s) in order to continue seeing Medicaid clients and to be reimbursed. The Health Enterprise Medicaid Man-agement Information Systems (MMIS) will not pay claims for health-plan-covered services ren-dered to a member of an MCO.

Not all Medicaid services will be covered by the MCM program at this time. Long-term care and waiver services, specialized ser-vices offered by the Division of Children, Youth and Families (DCYF) and dental services will continue to be covered by the FFS plan, even when the member is enrolled in a health plan.

In addition to changes in how you will bill and be reimbursed for services delivered to N.H. Medic-aid recipients, you will also need to follow instructions for these other processes for each individ-ual health plan:

• Prior Authorizations

• Referrals

• Appeals

• Non-Emergent Transportation

For more information as the program is rolled out, watch the DHHS website, http://www.dhhs.nh.gov/ombp/caremgt/index.htm, and the NHMS website, www.nhms.org, or contact the NHMS offices and speak with Scott Colby at 603.224.1909 or [email protected]. �

Medicaid, cont. from page 1

On Dec. 1, 2013, the MCM program start date, DHHS is precluded by federal

law from paying Fee-for-Service (FFS) rates to providers who serve clients enrolled in Care

Management.


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More than just a tradition; More than just a CME Program

The mission of the New Hamp-shire 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.

The New Hampshire Medical Society’s Annual Scientific Con-ference has become more than just a tradition of education, net-working and camaraderie over the years. It actually stands as a real and visible demonstration of the mission of NHMS – bringing together physicians for the pur-poses cited above.

Over the years, the Annual Scien-tific Conference has been attend-ed by many faithful, interested and dedicated “regulars.” In re-cent years we have seen many new faces, which supports the premise that this meeting is more than just a tradition. These physicians come for many reasons, but what-ever the reason, they come in ful-fillment of the mission. Perhaps they never thought about it in this context, but I have.

Watching the interaction of new-comers and veterans, primary care physicians and specialists, younger and older physicians, students and residents has been an eye-opening experience for me and is what compelled me to write this piece. Seeing the inter-action, listening to the sharing of personal and professional expe-riences and creating new shared moments are all part of what your society should encourage.

While I am aware of the day-to-day grind many feel, I can’t pre-tend to know the pressure you must feel at times in caring for your patients. This conference allows you the chance to “blow-off some steam,” if you will.

Sure, CMEs can be earned on-line, at all hours of the day and, in many cases, free of charge. Cer-tainly we’re all busy and when the glossy brochure reaches your desk in June, for a November meeting, it sounds great (until you have to take precious personal time away from home and actually drive to the re-sort). But in the end, a new atmo-sphere among new and familiar faces in a shared experience is the hidden benefit of the conference.

Mountain View Grand Hotel & Spa, Whitefield, N.H.

Location of the 2013 Annual Scientific Conference

November 8-10, 2013*

Two years ago, the NHMS Coun-cil, under recommendation of staff, approved a consolidation of several annual events into one weekend program. Last fall, un-der Dr. Cindy Cooper’s leader-ship, NHMS held a very success-ful meeting in Portsmouth, N.H. which included the NHMS annual general session, annual presiden-tial inaugural and gala and annual scientific conference – addressing the issue of obesity.

The 2012 event was hugely suc-cessful with attendance at levels not seen in more than 13 years!

So in the end, I would ask you to consider this event more than just a CME program over a weekend in the late fall. Consider it a liv-ing and dynamic demonstration of the NHMS mission to bring together physicians.

*NOTE: This year’s Annual Scien-tific Conference in Whitefield, N.H., will include the general session, presi-dential inaugural and gala, education programs addressing what all special-ties need to know about mental illness and, of course, fellowship and cama-raderie. Join us November 8-10 in Whitefield. �

EVP CornerThe NHMS Annual Scientific Conference

Scott G. Colby

Our Mission:

To bring together physicians to advocate for the well being of our patients, for our profession and for the

betterment of the public health.


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surers and government/commu-nity agency representatives work-ing together to create a healthcare environment that promotes better health, better care and lower costs for all New Hampshire residents.

The NH CHI performs its work using formal working groups known as Pillar Projects. Since the inception of the NH CHI in 2006, the Health Promotion Dis-ease Prevention (HPDP) Pillar Group has focused on decreasing the leading preventable causes of illness and death (unhealthy eat-ing, sedentary lifestyle, tobacco use and excessive alcohol use) for New Hampshire citizens. Obvi-ously, these modifiable factors impact cardiovascular risk and di-rectly relate to the Million Hearts Initiative.

Recognizing that both public health and clinical care play criti-cal roles in reducing the bur-den of preventable disease, the HPDP began in 2009 investigat-ing N.H.-based health promotion and disease prevention projects/programs involving both sectors. This investigation culminated in the development of a comprehen-sive report describing lessons that were learned about how to effec-

tively link the public health and clinical care systems. The HPDP then developed a “State Integra-tion Plan” containing six recom-mendations with supporting ac-tivities to promote the adoption of integration approaches to im-prove the health of N.H. citizens.

NH CHI’s promotion of inte-gration parallels the strategy of the NHMS Medicine and Public Health Task Force to bring to-gether partners from medicine and public health to address the goals of the Million Hearts Cam-paign in a collaborative fashion.

Currently, the HPDP is co-chaired by Dr. Jose Montero, N.H. pub-lic health director, and Sharon Beaty, CEO of Mid-State Health Center, and is focused on encour-

aging integrated efforts to reduce tobacco use in New Hampshire. Workplan objectives include building knowledge and skills re-quired for integration; catalyzing the use of integrated, evidence-based interventions; promoting integration best practices; and securing resources to sustain inte-gration work. In support of these objectives, the HPDP authored the “Clinician’s Role in Integrat-ing Medicine and Public Health to Improve Individual and Popu-lation Health: A Primer and Call to Action.” This short primer describes the concept and value of public health and clinical care integration and provides practical ways that clinicians can reduce the burden of tobacco both “inside” and “outside” the clinic walls.

To see the “Clinician Primer” and other relevant CHI reports or to connect to the work of the HPDP Pillar Group, go to the HPDP sec-tion of the NH CHI website (www.citizenshealthiniative.org).

Those interested in the NHMS Medicine and Public Health Task Force and the Million Hearts Ini-tiative can contact Rudy Fedrizzi, MD, at [email protected]. �

Million Hearts, cont. from page 1

Since the inception of the NH CHI in 2006, the Health Promotion Disease Prevention

(HPDP) Pillar Group has focused on decreasing the leading preventable causes of

illness and death.

Family Physician Career Opportunity in VermontWhite River Family Practice is a well-established, progressive, primary care private practice with 6 FPs & 3 ARNPs located in White River Junction, VT, seeking an energetic, full-time, board-certified physician for partnership track. We are a training site for the Geisel School of Medicine at Dartmouth and have strong clinical ties to Dartmouth Hitchcock Medical Center. We are leaders in Vermont as a Level III Patient Centered Medical Home, committed to both quality individual patient care and to improving population health. We are recruiting a physician desiring to practice in beautiful Vermont, to contribute to our vision of innovation in primary care, yet wanting to maintain a healthy work/life balance. No OB or inpatient work, fully integrated EHR. Dedication to teaching, strong clinical skills and leadership strongly desired. Clinical academic appointment commensurate with experience possible.

Please contact Dr. Michael Lyons at [email protected] or call (802)295-1765 ext 122.


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2013 NHMS Council President P. Travis Harker, MD, MPH

President-Elect Stuart J. Glassman, MD

Immediate Past President Cynthia S. Cooper, MD

Penultimate Past President William J. Kassler, MD, MPH

Vice President Beth R. Smith, MD

Secretary Seddon R. Savage, MD

Treasurer Paul P. Bergeron, MD

Speaker Richard P. LaFleur, MD

Vice Speaker Tessa J. Lafortune-Greenberg, MD

AMA Delegate Gary L. Woods, MD

AMA Alternate Delegate William J. Kassler, MD, MPH

Chair, Board of Trustees Gary A. Sobelson, MD

Medical Student Ben J. Dewey

Physician Assistant Mark H. Rescino, PA-C

Osteopathic Assn. Rep. Robert G. Soucy, DO

Young Physician Rep. Lora L. Council, MD

Young Physician Rep. Heidi Hallonquist, MD

Member-at-large Barry D. Smith, MD

Member-at-large Lukas R. Kolm, MD

Member-at-large Tina C. Foster, MD

Member-at-large Ed Schiavoni, MD

Member-at-large Ted T. Brooks, MD

Member-at-large John R. Butterly, MD

Physician Member of N.H. Board of Medicine Robert C. Vidaver, MD

Lay Person Martin Gross, Esq.

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

Specialty Society Reps.

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

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

· N.H. Chapter of Emergency Physicians John J. Seidner, MD/Paul F. Racicot, MD

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

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

· N.H. Psychiatric Society Len Korn, MD

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

· N.H. ACOG Oge H. Young, MD

· N.H. Orthopaedic Society Anthony V. Mollano, MD

Trustee David C. Charlesworth, MD

Trustee Charles M. Blitzer, MD

Trustee Gary A. Sobelson, MD

Invited Guest: MGMA Rep. Dave Hutton

Elliot Health System seeks an additional BC/BE Emergency Medicine trained physicians.

The combined volume is over 90,000 visits annually.

Join our premier group of 28 physicians and 21 mid-level providers dedicated to caring, quality patient care for the adult and pediatric patients.

Elliot offers an outstanding compensation and benefits package as well as sign-on bonus potential.

•Elliot Hospital (295-bed, acute care facility and Level II Trauma Center)

•New Hampshire’s Hospital for Children

•Elliot’s Urgent Care Center in Londonderry

•The Elliot at River’s Edge

Manchester, New Hampshire

Molly Alderson 800-678-7858 xx64507 [email protected]

ID#151006C89 www.elliothospital.org

New Hampshire Medical Society NewsletterSeptember/October 20131 x 1/2 pageKRM 151006 EM

WANTEDInternal Medicine, Orthopedic, Neurologic, General or Family Practice Physicians interested in providing part-time or full-time staff medical consultant services or are interested in performing consultative examinations in your office for the Social Security Disability program, under contract at the state Disability Determination Services office in Concord NH, should email a current CV to [email protected] to begin the process. The medical contractor must be licensed in the state of New Hampshire. Staff Work involves performing medical reviews of disability claims and requires no patient contact.


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is central to our profession, the doctor-patient relationship, to be that what supports us rather than burns us out. Dr. Rachel Naomi Remen, a pediatrician and clinical professor of family and commu-nity medicine at UCSF School of Medicine, writes:

“Even on the most stressful and pressured of days there are moments in which we can experience something else, moments in which we connect to people on a very intimate level and make a difference to them and they to us. Times when, despite everything, we experience compassion, give and receive love, ease suffering and fear and are profoundly trusted. Instances when the greatness and courage of an ordinary person is suddenly revealed and we know our-selves to be in the presence of a hero. Or we recognize that we ourselves are heroes. No ques-tion that these experiences are brief, but they happen daily. And often they are life-giving – like taking single breathes of pure oxygen in the middle of a deep-water dive.

There is a deep river of mean-ing that runs through the work of every health professional. It can sustain us in difficult times. Tapping into it usually requires the capacity to see fa-miliar things in new ways.

It is so easy to become blinded by routine, numbed by mind-less paperwork and let some-thing meaningful and inspir-ing pass us by unnoticed. So look for those moments when you catch a glimpse of some-thing that has been present in this work and its relationships for thousands of years …”

The late American author David Foster Wallace gave a truly inspir-ing commencement speech at Ke-nyon College in 2005 (search for it and listen to it online) encour-aging graduates to choose how they see the tedium or stressors of daily adult life.

“If you’re automatically sure that you know what reality is, and you are operating on your default setting, then you, like me, probably won’t consider possibilities that aren’t annoy-ing and miserable. But if you really learn how to pay atten-tion, then you will know there are other options. It will actu-ally be within your power to ex-perience a crowded, hot, slow, consumer-hell type situation as not only meaningful, but sacred, on fire with the same force that made the stars: love, fellowship, the mystical one-ness of all things deep down.

Not that that mystical stuff is necessarily true. The only thing that’s capital-T True is that you get to decide how you’re gon-na try to see it… It is unimag-inably hard to do this, to stay conscious and alive in the adult world day in and day out.”

One of the things that helps me see my daily routine differently is getting out of it and spending time in fellowship with other phy-sicians. I believe we can learn to-gether, share our experiences and grow our inspiration and joy in

our work. We can help each other see the daily grind in a different way by looking for those truly ful-filling moments and experiences. Through the NHMS, I have met an incredible number of inspiring physicians who do incredible work and I am a better, happier doc-tor because of you. I hope you’ll choose to join us November 8-10 at our annual meeting. You’ll learn about mental illness and how it pertains to your specialty; but perhaps more importantly, spend-ing time in fellowship with your peers may help you see your work a little differently.

Looking back at that rough day in clinic I can see that I really did help some people who were struggling with their illness and there were clearly moments when I was touched and inspired by my patients – looking at that differ-ently starts to make that day feel a little better. �

President’s Perspective, cont. from page 2

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liability claim when it’s deemed a less expensive alternativeto defending it — sometimes even when the case is with-out merit. We’ve even heard of cases where the decision tosettle was made without consulting the physician who hadbeen sued. Is that the kind of “coverage” you have?

With Medical Mutual you can be sure that if you’re everthe subject of a significant claim, our Claims Committee, comprised of practicing physicians like you, will review the details of your case. Then they — not businesspeople— determine whether it’s best to settle or defend, based onthe medical facts. And in the end, we believe that since it’syour reputation and record that are on the line, the decisionto settle or defend is your call.

If you prefer that kind of respectful, peer-directed coverage,make it your call to say so. Talk to your practice or hospitaladministrator about making sure you’re insured byMedical Mutual. For more information, contact JohnDoyle toll-free at (800) 942-2791, or via email [email protected].

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

ADDRESS SERVICE REQUESTED

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PAIDConcord, NH

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Gov. Maggie Hassan signs HB 242, which increases the height exception to the child-restraint requirement for motor vehicle operation and adds

7-year-old children to the requirement. Gov. Maggie Hassan signs SB 170, a bill sponsored by state Sen. Peggy Gilmour (in

blue) that amends the definition of life-sustaining treatment in New Hampshire’s

living will law to include medically administered nutrition and hydration for

purposes of an advanced directive.

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