BORIM new regulatory changes; September Vital Signs now available

News and announcements

Board of Registration in Medicine (BORIM) new regulatory changes - FAQs released 

The Board of Registration in Medicine (BORIM) released on Thursday, September 5, 2019 a set of FAQs to further clarify the 70 pages of regulatory changes they promulgated in July of this year, which were in large part opposed by the Massachusetts Medical Society (MMS) and other key stakeholders across the health care system.

We encourage all physicians to review this document carefully to understand the implications that these new regulations will have on clinical practice. While some clarification in the FAQ document was helpful, we remain concerned about several provisions, including fundamental changes to the informed consent process which BORIM has confirmed will require all informed consent conversations to be reduced to written, signed form.

The MMS has gone to great lengths to have these regulations clarified, delayed, or reversed altogether. It has been our near singular focus since the Board vote this summer.

The medical society will continue to explore all legal and legislative avenues to achieve a result that is in the best interests of patients and physicians. Until that time, we urge you to review the FAQ document and the regulations, and we will work to provide further guidance about what you can do to adjust your clinical practice appropriately.

We will update you as we have additional information.

September Vital Signs now available: Women Physicians Leading the Way

Jessie Gaeta, MD, remembers the moment she realized that she wanted to use her skills and experiences on a broader stage — to help not just the patient in front of her, but the countless patients she and her colleagues cared for every day at Boston Health Care for the Homeless Program (BHCHP).

"I remember thinking that I could write a prescription for insulin, but half the time the patient couldn’t take it the way it was intended because they didn’t have a home and they had nowhere to store it," says Dr. Gaeta, chief medical officer at BHCHP. "I thought that I could bring about more change for my patients on a broader scale and that there was a place for doctors doing that. I understood the health consequence of policies on people’s lives in a different way, and this seemed to be missing from a lot of conversations."

In honor of Women in Medicine Month, Vital Signs spoke to six women physicians who have driven institutional and state policy changes that promote healthier outcomes among Massachusetts residents. The common threads in their stories include an understanding of the respect the initials MD garner, a passion for addressing complex social problems, and a unique perspective on those problems.

To read the full story, and the rest of September Vital Signs, click the button below.

Students, residents – could you use $5,000? 

The MMS awards two Medical Information Technology prizes annually for functioning projects substantially completed in the past year that use technology to assist physicians in the practice of medicine, the teaching of medicine, or the pursuit of clinical research. The winning applicants in each category are awarded a prize of $5,000 in the spring of 2020.

Applicant must be a student, resident, or fellow at the time of submission and be enrolled in one of the four Massachusetts medical schools or a Massachusetts hospital or training program. Initial expressions of interest are accepted through October 28, 2019, with full applications due by November 24, 2019.

For more info and application, click the button below.

September is National Preparedness Month! 

National Preparedness Month provides an opportunity to raise awareness of the important work we all do to ensure our communities are safe, healthy, and ready for emergencies. The Massachusetts Department of Public Health (DPH) Office of Preparedness and Emergency Management (OPEM) is sponsoring a statewide campaign to encourage Massachusetts residents, families and communities to make plans and prepare for public health and medical emergencies, threats, and disasters.

This year’s Know Plan Prepare campaign emphasizes being informed, planning ahead and being prepared; a prepared community is a resilient community.

OPEM offers a number of preparedness materials available to order including tote bags and a secure document bag. Whether it’s through your own volunteerism or within your practice, encouraging community members and your patients to assemble a preparedness kit is fundamental for emergency preparedness. Key things to include in a kit are copies of important papers like insurance documents, Social Security cards, and prescriptions; being prepared is essential in order to grab and go when there are weather emergencies, power outages, and other events.

Also available is A Personal Planning Tool for Individuals Who Have Access and Functional Needs; an 8-page booklet that provides space for people to record their personal needs in the categories of communication, medical needs/maintaining health, independence, service/support, and transportation. This resource is available in print and as fillable pdf.

DPH maintains one central web page at http://www.mass.gov/knowplanprepare to provide information, tips, and links for the public. The web page also provides resources to support local, regional and state preparedness initiatives for you to use with your community or organization. DPH will also be tweeting daily using the Department’s Twitter page.

Provider directory updates: CAQH Direct Assure process launched

Harvard Pilgrim, in collaboration with HealthCare Administrative Solutions, has begun piloting CAQH’s DirectAssure® with a user group of providers.

This approach will enable providers to update their demographic and practice information in one place and share it simultaneously with multiple health plans. Because DirectAssure® works in concert with CAQH ProView, an online database that most providers already use to regularly review and attest to professional and practice information, this approach capitalizes on an existing workflow and will streamline the process of keeping directory information up to date. To learn more, please click here .

For more information about the DirectAssure® project, please refer to these resources:

• HCAS Provider Directory website
• CAQH Fact Sheet and CAQH Direct Assure website

If you have any questions, and for all your payer updates, contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.

Payer watch

MassHealth Important Update

Ensure you are complaint with the Ordering, Referring and Prescribing (ORP) Requirements*

With the new Ordering, Referring and Prescribing (ORP) Requirements, it is imperative that all your claims include the information as specified in All Provider Bulletin 274 to prevent future denials.

The information in this bulletin is intended to continue to help billing providers prepare their processes and systems for compliance with ORP requirements and reduce the serious financial impact on their practices once claim denials take effect.

To better understand where changes need to be made providers can reference their 835 electronic remittance advices for their CARCs and RARCs edits related to ORP.

If you are not the person in your practice responsible for claims billing, please get this message to those responsible before the edits are turned on and claims are denied.

Below are reasons for denials:

• POSC version of the remittance advice 1080 Ordering Provider Required 1081- NPI required for Ordering

• Provider 1200 – Referring Provider Required 1201 – NPI of Provider Required - HDR

• 1202—NPI of Referring Provider Required 2—HDR²

• 1204—NPI of Referring Provider Required 2—DTL²

*Ordering, Referring, and Prescribing Requirements

Section 6401(b) of the Affordable Care Act includes requirements related to ordering, referring, and prescribing (ORP) providers. If MassHealth requires a service to be ordered, referred, or prescribed, then ACA Section 6401(b) requires that

1. The billing provider include the ORP provider’s NPI on the claim; and
2. The ORP provider be actively enrolled with MassHealth as a fully participating provider or as a nonbilling provider and be an authorized ORP provider, as described on page 2 of this bulletin.

Section 6401(b) applies to all claims submitted by providers for payment by the MassHealth agency, including claims for secondary coverage and Medicare Crossover claims. It does not apply to claims submitted to managed care entities.

To learn more about the ORP requirements please visit:
https://www.mass.gov/the-aca-orp-requirements-for-masshealth-providers

MassHealth All Provider Bulletin 274 can be found at: https://www.mass.gov/files/documents/2018/02/08/all-274.pdf

If you have any questions, and for all your payers update, contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.

Benefit buzz

Legal Advisory Plan - Why you should enroll

When you receive a Board of Registration in Medicine (Board) investigation or complaint, it is recommended that an attorney delivers a well-crafted response to the Board. If you have to attend an informal Board conference about your situation, it is advised that an attorney represents you in person.

Your malpractice insurance may not cover these legal activities or perhaps only a portion. Your out-of-pocket expenses could cost you thousands of dollars.

Take advantage of the MMS Legal Advisory Plan, a members-only affordable legal service, for a nominal fee of $70/year – a fraction of typical legal fees. Enroll or renew for coverage through July 2020 now. Additional discounts for groups of five or more. Questions? Email lap@massmed.org or call (781) 434-7311.

Member verdicts: 

"The Plan is a bargain. Our practice has contacted the attorneys a few times and resolved the Board matters quickly."   

"The LAP newsletters were very helpful in helping me be aware of situations to avoid that could impact my medical practice and license."

The PHYSICIAN PRACTICE RESOURCE CENTER (PPRC) serves individual physicians and group practices of all sizes by providing expert knowledge and resources, advocacy, timely and critical information, and ongoing practice support. Our goal is to ensure that you have the information and resources you need to maintain a thriving practice of any size. In today’s challenging environment, practicing medicine is complicated. We make it easier. We provide physician practices a powerful support and resource network so that you can operate successfully and focus on what matters most.

Feel free to contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.
 

The Massachusetts Medical Society is hosting in-person Insurance Claims Consultation Days (ICC). ICC days are designed to allow MMS member physicians and/or their practice staff to schedule 30-minute appointments with health plans to focus on adjudication of troublesome claims.

Available:

• Lakeville ICC Day September 19, 2019

Representatives from health plans will be on-site to review claims with you to facilitate claims processing.  Schedule your appointment at massmed.org/ICC2019.       

The following health plans are participating: Allways Health Partners, Blue Cross Blue Shield of Massachusetts, Fallonhealth, Harvard Pilgrim HealthCare, Health New England, MassHealth, Medicare, Tufts Health Plan, UnitedHealthcare, and Unicare.

Educational programs and events

CME education programs & events  

Featured Online Physician Burnout CME Courses

• Restoring the Art of Medicine: The Power of Physician Wellness – The 2019 Annual Education Program
• Future of Care: A Call to Collaboration – The 2019 Shattuck Lecture
• MedPEP, Medical Professionals Empowerment Program (20 episodes)
• Restoring Well-Being to the Medical Profession
• Running on Empty? Physicians’ Path to Enjoying Life and Medicine More

Featuring Live CME Activities

CME Essentials Workshop 
Thursday, October 3, 2019 from 9:30 a.m. – 2:30 p.m. 

16th Annual Public Health Leadership Forum: Maximizing the Political Determinants of Health
Thursday, October 24, 2019 from 1:00 p.m. – 5:00 p.m.

Upcoming events and trainings

September 17: New England HIMSS- September Educational Event - Social Determinants of Health: Current State and the Opportunity Impact of Health Information Technology (The Inn at Longwood Medical)
Please join New England HIMSS for an education session on September 17 from 6-9 p.m. Learning objectives include (1) increase knowledge of social determinants of health (SDOH) and their impact on community and patient health and wellbeing, (2) increase understanding of the clinical and business drivers associated with SDOH, and (3) understand information technology barriers and emerging solutions to support clinicians in managing SDOH. Speakers are MMS President Dr. Maryanne Bombaugh and Dr. Tonya Hongsermeier of Leahy Health.

September 24: Tobacco Free Mass Policy Forum (MMS Headquarters)
What’s all the fuss about flavors? What makes menthol so special? At this year's Policy Forum, Tobacco Free Mass will bring together national experts to examine the way the tobacco industry has used flavors, especially menthol, to target people of color and young people. We'll look at the history and the impact of flavored tobacco and consider options for policy change. Event hours: 9:30- noon.

September 26: 18th Annual Women Leaders in Healthcare Conference (Sheraton Framingham)
This event, organized by the Massachusetts Health & Hospital Association, will feature prominent women leaders in the healthcare space and others conducting exciting research. Lois Cornell, Executive Vice President of the MMS, will be a panelist on the topic, "Disruption, Innovation & Uncertainty: What’s Keeping Healthcare Leaders up at Night?" Event hours: 8:30 a.m. - 2:15 p.m.

September 27: Worcester District Medical Society 225th Anniversary Gala (Mechanics Hall)
Join the Worcester District Medical Society on Friday, September 27 as they celebrate their 225th anniversary at Mechanics Hall in Worcester. Cocktails, hors d'oeuvres, and dinner will be served. Dr. Sahdev Passey, Dr. Michael Hirsh, Mayor Joseph Petty, and Dr. Dale Magee will be delivering remarks. Event hours: 5:30 - 10:30 p.m.

October 16: Forum about Giving Back: A Pathway to Happiness, Purpose and Fulfillment (MMS Headquarters)
The keynote speaker, Sanjiv Chopra, MD, an internationally known thought leader, author, and speaker will share the “Happiness Formula” and the traits of happy individuals when living with purpose. Maryanne Bombaugh, MD, president of the MMS, will discuss the rewards of improving the lives of patients when optimizing their social determinants of health. This free unique event is on October 16, 2019 at the MMS headquarters in Waltham. It is hosted by the MMS Committee on Senior Volunteer Physicians.

Questions? Email ckoh@mms.org or call (781) 434-7312. 

What’s new in health care

Check out the most clicked-on stories from this week's MMS Media Watch. Sign up for daily Massachusetts media roundups by email. Some publications are fully accessible only to their subscribers.

Tobey Hospital maternity to close; nurses' union denounces decision (Southcoast Today)

The maternity unit at Tobey Hospital will close on Dec. 31 as Southcoast Health expands maternity services at St. Luke's Hospital in New Bedford, the nonprofit hospital corporation announced Thursday. The number of births has been declining at Tobey, which now sees about 375 babies born each year. St. Luke's sees 1,500. Southcoast Health said its staff will contact expectant mothers who planned to give birth at Tobey in 2020 and guide them to another location of their choice. Obstetrics and gynecology, including childbirth education and breastfeeding support groups, will remain in Wareham. The hospital corporation said it plans to dedicate the entire third floor at St. Luke's Hospital to mothers, newborns and children.

Mass. men charged in alleged diversion of 23 million opioid pills (MassLive)

The DOJ said in a statement those charged include medical providers, clinic owners and managers, pharmacists, pharmacy owners and managers as well as drug dealers and traffickers and that their actions allegedly resulted in the diversion of approximately 23 million oxycodone, hydrocodone and carisoprodol pills. The charges allege participating doctors, medical professionals and pharmacies knew the prescriptions had no legitimate medical purpose and were outside the usual course of professional practice. Most of the charges, including those brought against pharmacists, doctors and other medical professionals, were made by Strike Force attorneys in the Southern District of Texas.

Migrants in Boston hospitals are cautiously hopeful (WBUR)

"M.K. says he's been in Boston since 2017, when he entered the country on a tourist and medical visa. After extending as many times as he could, he applied for medical deferred action through U.S. Customs and Immigration Services (USCIS) -- the agency that has for decades reviewed these applications — knowing it was likely his last option. Ten months later — as WBUR first published news about a decision by USCIS to stop taking medical deferral applications — M.K. got his answer. "What happen[ed] is I read your article before I even saw the letter, and I called a family member to check out the mail and surprise, surprise, there's the letter," he explains.

Mass. weighs bringing in drug-sniffing dogs to its psychiatric hospitals (WBUR)

The Department of Mental Health is also weighing a controversial proposal: whether to place drug-sniffing dogs in all of its psychiatric facilities. The idea has sparked criticism from some mental health advocates, including the National Alliance on Mental Illness in Massachusetts. NAMI Executive Director Deborah Shields said research shows that drug-sniffing dogs steps are not effective, and that such a move could make psychiatric hospitals feel like prisons. "We're very concerned that having drug-sniffing dogs in a psychiatric hospital could greatly undermine the therapeutic environment and could greatly scare and traumatize the people in there seeking treatment," she said.