Wednesday, March 29, 2017

OCMA Blog

AMA Code of Medical Ethics

In 1847, physicians representing 22 states and the District of Columbia came together to establish America’s first national professional association for physicians, the American Medical Association (AMA).

As one of its first acts, the AMA created the first national codification of ethics for any profession anywhere in the world. As the first of its kind, the 1847 AMA Code was reprinted by medical societies in Berlin, London, Paris, Vienna, and around the world. Throughout the rest of the 19th century, it was the most commonly printed medical document in the English language. Today, the AMA Code remains the only codification of professional conduct for all US physicians regardless of their medical specialty, practice type or location.

Ethics guidance is regularly added or amended in the AMA Code to reflect changes in medical science and societal expectations. As with any “living” document that is authored by different individuals over many decades, the AMA Code became fragmented and unwieldy. 

To address these issues, the AMA embarked on a multi-year “modernization” project to comprehensively review and update the AMA Code. After much deliberation and debate, the AMA House of Delegates adopted the modernized AMA Code last June.

“The modernization project ensures that the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” AMA Immediate Past President, Steven J. Stack, MD, said.

A commemorative, leather-bound edition of the modernized AMA Code is available.


March 28 is Diabetes Alert Day: Diabetes prevention programs reduce costs, improve patient outcomes

Sugar. It’s the sweet, grainy staple surging through the foods so many of your patients love but can’t entirely kick. Yet the effect of these seemingly innocuous treats has become as deeply rooted as a cavity in the lives of sick patients and the U.S. health care system, according to a recent study on prediabetes and medical expenditures.

Published in Population Health Management, the study demonstrates how preventing the onset of type 2 diabetes can reduce annual health care costs by thousands of dollars per patient and generate large positive returns on investment (ROI) for health systems, insurers and employers.

Researchers in the study used individual-level claims data from more than 8,000 commercially insured adults to estimate medical expenditures among individuals with prediabetes. Data on expenditures were combined with findings from previous studies to estimate net savings and ROI if they were to participate in a Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention program (DPP). 

Based on an analysis of the data, researchers found that: 

Patients who develop diabetes are very costly. Expenditures during the one-to-three-year period following HbA1c screening are one-third higher for those who develop diabetes. That amounts to an annual average of $2,671 per patient. 

Preventing diabetes is more than a vital public health solution—it’s an effective financial strategy. Because the annual cost differential for patients who develop diabetes is significant, “The three-year ROI for a National DPP is estimated to be as high as 42 percent,” wrote the study’s authors, Tamkeen Khan, Ph.D., Stavros Tsipas and Gregory Wozniak, Ph.D., all of the American Medical Association (AMA).

Diabetes prevention programs are still one of the best solutions for improving health outcomes and reducing burdensome medical expenditures. In fact, patient participation in a CDC-recognized DPP in a community-based or primary care setting costs between $400 and $500 per person—far less than the average annual medical care expenditure savings. Not to mention previous research confirms that the impact of these programs extends beyond dollar signs: People who complete DPPs are one-third less likely to develop type 2 diabetes after 10 years.

Using results from this analysis and findings in previous studies, the study authors estimated just 14 percent of patients who complete a DPP will be diagnosed with diabetes within three years, compared with 29 percent of those who do not participate.
DPPs in California: The California Medical Association's plan to prevent diabetes 

These recent findings underscore precisely why AMA and the California Medical Association (CMA) have partnered to advance patient participation in DPPs throughout our state and galvanize support for community-based interventions. 

More than 86 million Americans are living with prediabetes, but most of them are unaware. In California alone, an estimated 13 million adults  have the condition, putting them at high risk of developing type 2 diabetes without intervention.

"The diabetes epidemic is out of control and getting worse. In California, diabetes rates have increased by 35 percent since 2001," says CMA President Ruth Haskins, M.D. "In partnership with AMA we are working hands-on with California's physicians to implement meaningful diabetes prevention efforts to improve the health of Californian's  and ultimately improve the health of people across the country.” 

The partnership is part of Prevent Diabetes STAT, a strategic effort launched by AMA in collaboration with the CDC in 2015 to engage more Americans with prediabetes and slow the progression of type 2 diabetes. 

"The goal of this partnership is to get patients with prediabetes into proven lifestyle change programs that have been shown to cut the risk in half of progressing to type 2 diabetes," said AMA President Andrew W. Gurman, M.D. "By working with a variety of practices and health systems within California, we are learning the best ways to implement processes for screening, testing and referring across different clinical settings. We will use these models in the future to support other states as they adopt a similar process—helping even more Americans stave off or delay type 2 diabetes to improve health outcomes." 
Calculate DPP savings for your patient population

 An online tool from AMA helps employers, insurers, health systems and others to calculate net savings and ROI for their sample populations. Play with this calculator to see how upping the share of your patients who enroll in a DPP can have a sizeable effect on the number who develop diabetes and how much money can be saved through prevention.

To find a CDC-recognized program near you or online, visit https://nccd.cdc.gov/DDT_DPRP/Programs.aspx.
For more diabetes prevention resources from AMA and CMA, visit http://www.cmanet.org/issues-and-advocacy/cmas-top-issues/public-health/diabetes-prevention/



Amended OCMA Bylaws

The Bylaws Committee of the Orange County Medical Association has reviewed and updated the organization's bylaws. The revisions have been approved by the Board of Directors and will be approved at the General Membership Meeting in May.   The revised Bylaws can be found by clicking here

Paul B. Yost, M.D. Elected Chair of CalOptima Board of Directors

During its March 2, 2017 meeting, the CalOptima Board of Directors elected Paul B. Yost, M.D. to serve the remainder of Mark Refowitz’s term as chair of the CalOptima Board of Directors.  Mr. Refowitz previously announced his retirement as Director of the Orange County Health Care Agency, effective March 30, 2017.  He also announced he would be stepping down from the CalOptima Board subsequent to the March 2 regular meeting.  Dr. Yost’s current term as chair will conclude at the end of 4 months, when the next election is scheduled.

Congratulations to Dr. Yost on this tremendous accomplishment.


CHOC was named a 2016 Healthcare Information and Management Systems Society (HIMSS) Enterprise Davies Award recipient

Children’s Hospital of Orange County (CHOC) was named a 2016 Healthcare Information and Management Systems Society (HIMSS) Enterprise Davies Award recipient for achieving improvements in patient care through the use of health information technology. CHOC is the only children’s hospital on the West Coast— and third in the country— to be honored with the award since its inception.
 
Since 1994, the HIMSS Nicholas E. Davies Award of Excellence has recognized the outstanding achievements of organizations that use health information technology to improve patient care while achieving cost savings. As an award recipient, CHOC will share case studies and lessons learned with other health care organizations across the nation.
 
“CHOC has made significant investments in health information technology designed to enhance quality and patient safety – our highest priorities.  We designed and implemented our electronic health record (EHR) with a focus on improving care.  Because building and using an effective EHR is not always easy, and is certainly expensive, it’s gratifying to see measurable improvement from our efforts and investments.  Making kids’ care better— making kids’ lives better—is the ultimate outcome, and proves the value,” says Dr. James Cappon, chief quality officer, CHOC.
 
CHOC received the award from HIMSS based on four case studies that detailed how the use of health information technology and standardized clinical processes has improved patient care. The case studies included: 
 
•       Through education, a standardized care bundle, and EHR-enabled best practice guidance to minimize urinary catheter use and duration, CHOC significantly reduced catheter-associated infections and urinary catheter use. 

•       Using embedded, evidence-based care guidelines to control asthma and an alert system that triggered when patients were about to be discharged before a home management plan was created, CHOC drove down the average length of stay for asthma patients from 2.14 days to 1.72 days. Asthma readmissions within 30 days also fell from an average of 1.7 per quarter to 0.7 per quarter.
  

•      CHOC implemented an EHR-enabled Pediatric Early Warning System (PEWS) to trigger a rapid response team for deteriorating patients. As result, approximately 369 children have avoided resuscitation, with potentially as many lives saved.
 
•       CHOC implemented centralized breast milk preparation including barcoding to effectively eliminate feedings of the wrong breast milk. Efficiencies associated with the centralized processes for breast milk preparation resulted in significant annual savings. 
 
“CHOC demonstrates an enterprise-wide approach to collaboratively identifying clinical challenges, selecting IT interventions and developing workflows to address those challenges,” said Jonathan French, senior director of quality and patient safety and Davies program director with HIMSS. “Through using information technology to standardize care and continually look to improve care delivery and outcomes, CHOC has significantly improved the quality and patient safety outcomes for their patients. HIMSS is proud to recognize CHOC as a 2016 Davies Enterprise Award winner.”
 
Named one of the best children’s hospitals by U.S. News & World Report (2016-17) and a 2016 Leapfrog Top Hospital for safe, quality care, CHOC has achieved recognition as a HIMSS Stage 7 EMR (electronic medical record) adoption hospital. CHOC is also a leader in the adoption of population health technologies, and is a recipient of a $17.7 million grant from the Centers for Medicare & Medicaid to help Southern California pediatricians expand their quality improvement capacity, learn from one another and achieve common goals of improved care.
 
“These examples of our institutional quality and safety initiatives are an important part of our mission to nurture, advance and protect the health and well-being of children.  As we now reach out to the larger community with our population health efforts, our focus extends to keeping well children well,  in addition to keeping those who are ill as well as they are able to be,” explains Dr. William Feaster, chief medical information officer, CHOC.
 
CHOC will be recognized as a HIMSS Davies Award recipient at the 2017 HIMSS Conference & Exhibition, Feb. 19-23, in Orlando, Fla.  For more information on the awards program, visit the HIMSS Davies Award website.


CHOC Named One of the Safest Hospitals in the Nation by The Leapfrog Group

CHOC Children’s Hospital has once again been named a “Top Hospital” by The Leapfrog Group for providing the safest and highest quality health care services to patients.  CHOC is one of only nine children's hospitals in the nation—and the only one on the West Coast— to earn the prestigious distinction.  

"CHOC is committed to becoming the world's safest children's hospital. While this is a never-ending journey, being named as a Top Children's Hospital for the eighth time by the Leapfrog Group suggests we are on the right track. Leapfrog has always emphasized patient safety as the top priority, one with which our patients, families and partners would no doubt agree. It's a humbling honor, and serves as both encouragement and motivation to continue our efforts to provide the safest, highest quality care possible,” said Dr. James Cappon, chief quality officer, CHOC.

The selection of Top Hospitals is based on the results of the 2016 Leapfrog Hospital Survey. Performance across many areas of hospital care is considered in establishing the qualifications for the award, including infection rates and a hospital’s ability to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology

“Being acknowledged as a Top Hospital is an incredible feat achieved by less than three percent of hospitals nationwide,” said Leah Binder, president and CEO of The Leapfrog Group. “With this honor, CHOC has established its commitment to safer and higher quality care. Providing this level of care to patients requires motivation and drive from every team member. I congratulate CHOC’s board, staff and clinicians, whose efforts made this honor possible.”

To see the full list of institutions honored as 2016 Top Hospitals, please visit www.leapfroggroup.org/tophospitals.



6 OC Hospitals Receive "A" Rating for Safety

Six hospitals in the Orange County area, including Hoag Hospital Irvine, Hoag Memorial Hospital Presbyterian, Orange Coast Memorial Medical Center, Kaiser Foundation Hospital - Anaheim and Irvine, and UC Irvine, received an A rating from the Leapfrog Group, a national hospital safety organization, which recently released its annual safety ratings for 2016. 

Of the 2,633 hospitals evaluated nationally, 267 were in California. Eighty-one California hospitals received an A rating overall, and the state ranked 26 among the 47 states included in the rating.

Kaiser Permanente hospitals consistently post some of the highest scores.

“Kaiser Permanente is committed to patient safety. The ratings by the Leapfrog Group demonstrate that commitment and the trust we have earned from our patients and members, affirming that they are receiving the right care from a team of compassionate physicians, nurses, and care providers,” said Edward M. Ellison, MD, executive medical director, Southern California Permanente Medical Group. “Our emphasis on infection control and adherence to the safest surgical standards makes Kaiser Permanente hospitals in Southern California among the safest in the nation. 

“In the fast-changing healthcare landscape, patients should be aware that hospitals are not all equally competent at protecting them from injuries and infections. We believe everyone has the right to know which hospitals are the safest and encourage community members to call on their local hospitals to change, and on their elected officials to spur them to action. States that put a priority on safety have shown remarkable improvements.” said Leapfrog President and CEO Leah Binder in a statement.

The Leapfrog Group's safety assessments factor in several criteria from 30 categories, pooled together from various performance measures from sources such as the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. These include rates of errors, injuries, accidents, and infections, according to the LA Times.

The Leapfrog Hospital Safety Grade is calculated by top patient safety experts and is peer reviewed, fully transparent and free to the public. A full description of the data and methodology used in determining grades is available at www.hospitalsafetygrade.org.

MACRA Implementation: A Review of CMS’ Final Rule

WEBINAR:  November 30, 2016 | 12:15pm - 1:15pm

This webinar offers 1 free AMA PRA Category 1 Credit™ for CMA members. This webinar is also available to nonmembers for $99.*

This webinar will provide an overview of the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program, authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Our speaker will provide key details and dates you’ll need to know and information about how to prepare for the start of the program on January 1, 2017. We will also review key elements of the Merit Based Incentive Payment System (MIPS) pathway and provide a comparison to the other pathway in the program, Advanced Alternative Payment Models (APM). Finally, we will review the flexibilities clinicians have to pick how and when they begin this program during the 2017 transitional year, and review available resources currently available for clinicians seeking technical support.

Featured Presenter: Ashby Wolfe, M.D., MPP, MPH, is a board-certified family physician who currently serves as Chief Medical Officer for California, Arizona, Nevada, Hawaii and the Pacific Territories for CMS. Her focus is on implementation of the many facets of the Affordable Care Act and its role in providing access to high-quality care and improved health at a lower cost.

Participants should register at least one hour before the webinar. If you do not register an hour before the webinar start time, we cannot guarantee your attendance.

To register, click here

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Contact: CMA Member Help Center (800) 786-4262 or memberservice@cmanet.org.


*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council on Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The California Medical Association/Institute for Medical Quality (CMA/IMQ) designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP370, for 1 contact hours.

On-demand webinars are not available for CEU or CME credits.



Highlights from the OCMA Board of Directors meeting on November 10, 2016

By:  Darla S. Holland, M.D., President, OCMA

The OCMA Board of Directors met on Thursday, November 10.   The following highlights the major discussions and actions that took place at that meeting: 

The Resident Representative, Dr. Duy Nguyen, indicated that the Resident Physicians in Orange County are interested in Physician Wellness Programs geared toward physicians in training.  A resolution addressing burnout in Medical Students was discussed at the CMA Board of Trustees meeting in October.    The Board is very supportive of sponsoring and supporting such activities for the Medical Students and Residents in programs in Orange County.   
There was vigorous discussion about the CMA's role in the passage of Senate Bill 72.   Many hospital based physicians are affected by this legislation, slated to take effect on January 1, 2017.   A recommendation was made to have the Legislative Leadership Committee recommend language to be submitted through the Resolution process to the House of Delegates year round process.     
The Building Committee made a presentation recommending that OCMA purchase a building as leasing continues to deplete our reserves.   The principles guiding the building search involve the following priorities: 1) To have a location convenient for most members to access; 2) To invest in a manner that generates revenue for both operating expenses and special projects that and will grow to at least keep pace with inflation so that the value of the principle does not diminish over time; 3) To allow OCMA staff to function most of their time on activities that support the core mission of the organization.    These principles will be incorporated into the building search.   
The Physicians of Excellence Reception will be on January 25, 2017.


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