Wednesday, September 4, 2013

Maryland Family Physicians Lead Health Care Efforts, Innovations

August 30, 2013 02:30 pm James Arvantes – Family physicians in Maryland practice and work in various settings and capacities, using their skills and expertise to deliver and improve health care for thousands of patients throughout the state. This diversity is one of the Maryland AFP's (MDAFP's) greatest attributes, enabling family physicians to forge alliances and common bonds across various agencies, commissions and practice modalities, thereby strengthening the chapter's commitment to public health and advocacy.
"We are a varied bunch," says Yvette Rooks, M.D., executive vice chair and residency program director in the Department of Family and Community Medicine at the University of Maryland School of Medicine in Baltimore and head team physician at the University of Maryland in College Park. "We have folks who practice concierge medicine and folks who are medical directors, and we also have folks who run accountable care organizations. We represent a variety of specialties within our specialty of family medicine."
Although the chapter has only 700 active members, its power and influence extend well beyond its actual membership, putting family physicians in a position to drive fundamental and enduring health system change.
"We are small, yet vocal," says Patricia Czapp, M.D., a member of the governor's subcommittee on health care delivery reform and chair of clinical integration at the Anne Arundel Medical Center in Annapolis. "And we are at the table where decisions are being made."
  • The Maryland AFP is one of the most diverse chapters in the country, enabling family physicians to forge alliances and common bonds across various agencies, commissions and practice modalities.
  • Within their various roles, family physicians in the state are leading health care reform and innovation efforts in both the public and private sectors.
  • By drawing on its diversity, the Maryland AFP is able to strengthen its commitment to public health and advocacy, resulting in improved health for thousands of state residents.

Encouraging Leadership

"I know the leaders of this chapter roll up their sleeves and get to work at placing our specialty of family medicine front and center in the most important role we play: improving the health of our state's patients, families and communities," says Yvette Oquendo, M.D., president of the MDAFP and a staff physician at Chase Brexton Health Services in Baltimore.
For example, family physician Niharika Khanna, M.D., serves as program director of the Maryland Learning Collaborative, which provides assistance to the state's multipayer patient-centered medical home (PCMH) initiative. The collaborative has helped 52 practices in the state achieve PCMH status during the past few years, effectively bringing about 250,000 patients into the PCMH model, according to Khanna, an associate professor of Family and Community Medicine, Pediatrics, and Psychiatry at the University of Maryland School of Medicine.
The collaborative has 339 physicians, and 266 of them are primary care physicians. Of that, 133 are family physicians, which gives family medicine a large stake in the learning collaborative.
State officials currently are in the process of expanding the PCMH model via a state innovation grant funded by CMS. Khanna, along with state officials, co-wrote the grant for the expansion.
Another family physician, Laura Herrera, M.D., deputy secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene, is leading the design of the state innovation model. In their respective roles, Khanna and Herrera are spearheading the state's PCMH efforts and planning for the spread of the state's innovation model.
The Maryland AFP (MDAFP) is one of the few AAFP chapters in the country with an accredited journal that enables family physicians to earn CME credit.
Each issue of the quarterly journal focuses on a clinical, policy or practice management theme and gives family physicians the opportunity to read the articles and take a quiz for CME credit.
"The Maryland chapter has its own credit requirement so that within the AAFP framework of mandating 150 credits every three years, with 75 being Prescribed, six Prescribed credits must be obtained from MDAFP CME," says Esther Rae Barr, C.A.E., executive director of the MDAFP.
Chapter-sponsored programming is offered via live conferences, journals with online quizzes and, new this year, online videos taped at live MDAFP conferences. The CME policy, initiated in 2000, has prompted the chapter "to hone its educational offerings so that members can acquire quality CME and, at the same time, meet the requirement," says Barr.
"We now are in a place where our journal and quizzes are online, allowing family physicians to earn over 12 credits a year from our chapter's website, which is significant."
Khanna is convinced that family physicians are best suited for the leadership role in the state innovation model because of their background and training. "We come in with the whole person orientation, the psychosocial model and a deep understanding of the patient as a partner in their health care," says Khanna. "Family physicians traditionally have been the go-to doctor, and (the) PCMH allows us to provide patient-centered care."
Family physician Donald Shell, M.D., M.A., director of the Cancer and Chronic Disease Bureau and interim director for the Center for Chronic Disease Prevention and Control at the Maryland Department of Health and Mental Hygiene, agrees with that assessment, saying that "family medicine really gives you a broad swath of medicine and health care," which makes family physicians natural leaders in the health care field.
In partnership with the Maryland Million Hearts program(, Shell works with Khanna to educate PCMH practices about state resources that are available to help patients achieve better health outcomes in cardiovascular and other chronic diseases. "I recently spoke to some PCMH practices about tobacco-related initiatives and making sure the physicians in the PCMH practices are aware of tobacco cessation resources," says Shell.
The work of Shell, Khanna and other family physicians in helping practices achieve PCMH recognition and better health outcomes for their patients has earned attention beyond the borders of Maryland, too. For example, CMS awarded multiple Maryland applicants accountable care organization (ACO) status as part of the Medicare Shared Savings Program. To quality for ACO status, entities are required to demonstrate a strong foundation of primary care physicians who are able to improve health outcomes and achieve savings, notes Czapp.
Family physicians in the state also have encouraged adoption of electronic health records and have played key roles in connecting primary care practices with the state's health information exchange. "We have many primary care practices that are well down the road of the patient-centered medical home and achieving meaningful use with electronic medical records," says Czapp, who chairs the board of one of the state's ACOs. "Those are the qualifications that allow us to say to CMS, 'We are confident enough in our ability to sign up for this program and demonstrate some savings that we can share among our doctors.'"

Looking to the Future

Czapp and other family physicians in the state are quick to acknowledge that Maryland is a progressive state in terms of health care delivery and innovation. That factor has allowed family physicians in the state to "step up," according to Czapp.
She says she is "shocked" that some states are struggling to initiate PCMH initiatives because officials in those states consider the PCMH experimental. "Light bulbs are experimental," she jokes.
Chapter executive director:Esther Rae Barr, C.A.E.
Date chapter was chartered:June 1948
Number of chapter members:1,200 total, 700 Active
Location of chapter headquarters: Catonsville
2014 annual conference:
 June 12-14, Holiday Inn, Frederick
In addition, the MDAFP, similar to other AAFP chapters, is experiencing a "generational shift," says Czapp. "We are seeing a lot of new energy coming in. This newer generation is excited about the future and what they see themselves doing as family physicians."
That applies to family physician Kisha Davis, M.D., M.P.H., president-elect of the MDAFP and one of its newer members.
Davis serves as the director of community health for the Casey Health Institute, an integrated primary care center that seeks to merge the best of east and west treatment modalities. "In addition to primary care, we also have an acupuncturist and a chiropractor, and we provide behavioral health, nutrition and wellness," says Davis. "We are not just trying to help people fix their diseases but really trying to address the preventive care and wellness piece and the lifestyle pieces that are a large part of health care and prevention."
In many ways, Davis's career is indicative of the versatility of family medicine. Before assuming her current position, Davis worked in a community health center in Columbia, Md., and served as a White House fellow from 2011-2012. As a White House fellow, Davis worked at the U.S. Department of Agriculture addressing food, nutrition and breastfeeding issues. In the process, she learned how the federal government really works.
"It was really eye-opening in terms of how few voices there are in government for medicine and seeing behind the scenes as to how things run -- where the right niches are to affect change," says Davis.
Similar to other MDAFP members, Davis cites the diversity of MDAFP members as one of the chapter's greatest strengths. But she also says that MDAFP members are "good at identifying potential talent and saying, "Why don't you come to this (MD)AFP meeting."
"A lot of people just need that little nudge," says Davis. 

Beth Israel Deaconess Medical Center Pays Over $5 Million for Allegedly Billing Medicare for Improper Inpatient Admissions

by ADMIN on AUGUST 23, 2013
When hospitals unnecessarily admit Medicare patients for short inpatient stays when the appropriate treatment would be outpatient or observation care, they improperly boost hospital profits at significant expense to taxpayers and patients. According to the Justice Department, Beth Israel Deaconess Medical Center (BIDMC) allegedly did just that, when it allegedly billed Medicare for inpatient admissions that should have been billed as lower reimbursed outpatient or observation services. These supposed false claims were submitted from June 1, 2004, through March 31, 2008.
Specifically, the government alleged that BIDMC inappropriately submitted claims to Medicare for one-day stay inpatient admissions for patients with congestive heart failure, chest pain, and certain digestive and nutritional disorders. These claims supposedly should have been billed as observation services, as the patients were briefly admitted for the limited purpose of observation and discharged the next day. In addition, the government alleged that BIDMC submitted claims to Medicare for less-than-one day (zero day) stays that should have been billed as outpatient or observation services.
Such improper inpatient admissions drain government dollars, for Medicare reimburses hospitals at significantly higher amounts for inpatient admissions compared to outpatient or observation services. When confronted by the government, BIDMC agreed to pay the United States $5.315 million to settle the alleged False Claims Act violations.
Of particular note, neither the government nor BIDMC credit a qui tamwhistleblower with raising these allegations. If this was a government-initiated False Claims Act case, this would be one of the few successful FCA cases that was not initiated by a whistleblower.