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December 3, 2007
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IN
THIS ISSUE
Editor's
Column: The Character Of Medical Practice
WSU
Student Volunteers With Hospice, Depression Studies
Social
Security Numbers Erroneously Reported To NPI
WSU Prof Elected
President Of International Organization
AMA
Supports Student Loan Legislation
SCHIP,
Medicare Bills Remain Atop Congressional Agenda
St.
John Doc Takes Helm At Yacht Club
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Editor's
Column: The Character Of Medical Practice
By
JOSEPH WEISS, MD
The medical community faces an increasingly irritated public.
Reasons for their upset include:
Increasing
health costs
A
rickety health insurance structure
Unexplained
variations in medical practice
Concern
for patient safety
The
extent of physician error
The
lag in health information technology
Apprehension
over physician conflict of interest
In response to such stress, we offer our commitment to maintain
competence and to accept responsibility for what we do.
These efforts are necessary in defining the conduct of
medical practice, but are they sufficient? Perhaps we should
do more. The public should know that the practice of medicine
is not primarily a matter of technical expertise but is
one of personal service – more art than science.
Possibly, we need to give more public attention to what ethicists
call discernment and integrity. By discernment, ethicists
mean our capacity to make decisions and recommendations
based on the best interests of that patient. By integrity,
ethicists mean that our decisions are both sound and reliable.
The public should know that our practice of medicine necessitates
we keep an eye on the business of medicine. Physicians
have families and offices. Our offices require employees,
utilities, and upkeep and replacement of the equipment
that defines a modern facility. Without the backing of
a sound financial base, a physician cannot turn full attention
to a patient’s needs. On the other hand, we need to assure
the public that a physician who engages in conflict of
interest and places profit before discernment and integrity,
is a doctor in disgrace.
We have reason for pride in our work. Apparently, the virtues
that guide us do not make themselves known in our dialogue
with patients. We do not need more CME lectures on medical
ethics. What we need is to learn how to make better known
the way we are now.
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WSU
Student Volunteers With Hospice, Depression Studies
Students
at the Wayne State University School of Medicine serve
the community in many ways.
Mike
Kopec, 25, chose to volunteer with Karmanos Hospice slightly
more than one year ago because of his interest in end-of-life
care.
“I
wanted to be exposed to patients who were dying, something
that I had never experienced before,” he said. “I also
felt that I would be able to serve those patients well
by spending time with them when they perhaps needed some
extra companionship or care.”
In
that role, Kopec may sit silently with non-responsive patients,
chat with those who are up to a talk, or bring a holiday
or birthday card to brighten the day. “Sometimes I act
as an advocate within my capacity when the situation calls
for that,” he said.
Since
the summer of 2006, the third-year medical student has
been immersed in a project evaluating depression and its
risk factors among teenagers attending two Detroit-area
teen health clinics.
“I
originally got involved in this project because I have
an interest in community health and wanted to do a project
that contributed to the Detroit area in some way,” said
Kopec. “From this study I hope that we will be able to
come up with some effective interventions to improve mental
health among Detroit teens.”
Kopec
decided to pursue a medical education his senior year in
high school after his family physician assisted him with
recurring headaches. “He helped me, and I thought I’d like
to be there for people and build those types of trusting
relationships. It’s the humanistic side of medicine that
attracted me.”
The
third-year medical student grew up in Flint, but now lives
in Detroit. He chose the Wayne State University School
of Medicine because he wanted to remain near his family
and study in Michigan, but also for the clinical training
opportunities the school provides. “That was a big plus,” he
said. “The patient load here is such that we get a lot
of hands-on training.”
With
18 months of medical school to complete, he has not yet
settled on a specialty, but is considering primary care.
No
matter his chosen field or practice location, Kopec insists
he will live in the community he serves. “I want to be
among the patient population I’m serving. No matter where
I am in the future, I want to be involved in my community.
That appeals to me and that’s why I currently live in Detroit.”
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Social
Security Numbers Erroneously Reported To NPI
Editor’s
note: The following paragraphs from CMS explain, albeit
in an incredibly cumbersome fashion, that Social Security
numbers for physicians and other health care professionals
might be getting into a part of the government’s database
that is subject to Freedom of Information Act queries.
Apparently, there is a field on a common NPI form that
requests Social Security numbers, but the field is not
required. It seems that the field is being filled out by
many physicians who mistakenly believe it is required.
As mentioned, the paragraphs below are confusing, but they
do contain Internet links and phone numbers to help physicians
sort this out.
As
CMS has mentioned in previous outreach messages and on
the CMS NPI website, some health care providers have reported
their Social Security Numbers (SSNs), or the SSNs of other
health care providers, in their NPPES records in fields
that the Freedom of Information Act (FOIA) requires that
CMS make publicly available. For example, there are instances
where SSNs are reported in the “Other Provider Identification
Numbers,” “License Number,” and “Employer Identification
Number (EIN)” fields in providers’ NPPES records. The information
that providers report in these (and certain other) fields
is fully disclosable by CMS to the public and, therefore,
SSNs should never be reported in any of these fields.
Because
SSNs are nine-digit numbers, CMS has been suppressing all
nine-digit numbers found in any FOIA-disclosable field
except for ZIP code and telephone/fax number fields. This
means that these nine-digit numbers—whether or not they
are SSNs -- are not displayed in the NPI Registry and cannot
be found in the monthly NPPES downloadable file. If these
nine-digit numbers are legitimate EINs, “Other Provider
Identification Numbers,” or “License Numbers,” health plans
and others who are using the NPI Registry and the downloadable
file are not able to see them, which means that they cannot
see all of the NPPES data they may need in order to accurately
match providers in NPPES to the providers in their own
files, thus making it more difficult to link NPIs to legacy
identifiers. In some cases, this may adversely affect
payments to providers by health plans.
It
is imperative that providers immediately look at their
NPPES records to ensure that they did not inadvertently
report their, or someone else’s, SSN in a FOIA-disclosable
field; if they did, they need to delete that SSN immediately
and, if appropriate, replace it with the correct information
(e.g., an EIN)Providers
must look in their NPPES records (https://nppes.cms.hhs.gov/)
in order to view all of the information they reported.
If they need assistance in deleting inappropriately reported
SSNs, they may contact the NPI Enumerator at 1-800-465-3203. If
they need assistance in knowing which NPPES fields are
disclosable under FOIA, they should review the document
entitled, “National Plan and Provider Enumeration System
(NPPES) Data Elements Data Dissemination – Information
for Providers,” dated June 20, 2007, and found at on
the CMS NPI web page.
Providers
cannot rely on the information disclosed in the NPI Registry
or in the downloadable file in trying to determine if they
inappropriately reported SSNs in FOIA-disclosable fields
because CMS suppresses these numbers, as explained above;
these numbers will not be seen in the NPI Registry or the
downloadable file.
In
order to protect your personal information from public
disclosure, please correct this information immediately
if this situation pertains to you.
When
to Contact the NPI Enumerator for Assistance
The
topics with which the NPI Enumerator can assist providers
are listed below:
- Status
of an NPI application, update, or deactivation
- How
to apply, update, or deactivate
- Forgotten/lost
NPI
- Lost
NPI notification
- Trouble
accessing NPPES
- Forgotten
password/User ID
- Need
to request a paper application
Health
care providers needing assistance on any of the above topics
may contact the NPI Enumerator at 1-800-465-3203, TTY 1-800-692-2326,
or e-mail the request to the NPI Enumerator at CustomerService@NPIenumerator.com.
The
NPI application form, itself, is also a good source of
information. Please refer to the NPI application
instructions for clarification on information to be submitted
in order to obtain an NPI or update an NPPES record. Refer
to the 'Application Help' tab located on the NPPES
website for additional assistance while online.
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WSU
Prof Elected President Of International Organization
Vijay
Mittal, MD, Chair of the Southeast Michigan Center for
Medical Education (SEMCME) Surgery Committee, member of
the SEMCME Board of Directors, and clinical associate professor
of surgery at Wayne State University School of Medicine
was recently elected President of the International College
of Surgeons (US Section).
The
International College of Surgeons (ICS) is a global organization
dedicated to bringing together surgeons and surgical specialists
of all nations, races, and creeds to promote surgical excellence
for the benefit of all of mankind and to foster fellowship
worldwide.
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AMA
Supports Student Loan Legislation
The
American Medical Association (AMA) voiced its strong support
for new legislation introduced by Sen. Richard Burr (R-NC)
and Sen. Johnny Isakson (R-GA) to permanently reinstate
medical student loan deferment eligibility during residency.
The government’s Council on Graduate Medical Education
now predicts a shortage of 85,000 physicians by the year
2020, as the US population ages. Making it harder for students
to defer medical student loans during a portion of their
residency years could further deter the best and brightest
from pursuing a career in medicine.
In
a recent letter to the senators, the AMA thanked them for
their leadership on this important issue and pledged its
support to help advance the legislation. Helping medical
students, residents and young physicians better finance
their education and manage their high debt burden is a
top legislative priority for the AMA.
“The
average medical student today graduates with $139,000 in
debt,” said AMA Board Member Chris DeRienzo, fourth-year
medical student at Duke University School of Medicine. “Making
it harder for residents to pay back this high debt can
deter young physicians from going into primary care medicine
or practicing in underserved areas where patients desperately
need them.”
The
new legislation, S. 2303, would permanently restore the
medical student loan deferment program, known as the “20/220
pathway,” which allows medical residents to defer payment
on their loans for up to three years during their residency
training based on economic hardship. This bill also expands
the current economic hardship qualifications, which may
allow more medical residents to benefit from this program.
“We
applaud Senator Burr and Senator Isakson for recognizing
the critical importance of the medical student loan deferment
program that so many of our nation’s hardworking medical
residents rely upon during their training,” said DeRienzo. “We
are committed to working with Congress and the Department
of Education on a long-term solution for continued loan
deferment eligibility for medical residents.”
At the
urging of the AMA, the Department of Education temporarily
postponed elimination of the medical student loan deferment
eligibility on Nov. 1. The elimination was part of the
recently-enacted H.R. 2669, the College Cost Reduction
and Access Act. Congressional action is needed to permanently
restore this loan deferment eligibility for medical residents.
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SCHIP,
Medicare Bills Remain Atop Congressional Agenda
Congress returns this week with "many of the year's most contentious
issues waiting to be resolved" by the end of 2007,
most of which have been the "subject of vetoes or
warnings from the White House," USA
Today reports (Kelley, USA
Today, 12/3).
Senate Democrats are "crossing their fingers that the bipartisan
desire to leave town for the holidays will help them unlock some
of the remaining stalemates and allow them to get their work done
in time," according to Roll
Call. However, the "risk of having to punt much
of their agenda into next year remains very real for Democrats," Roll
Call reports (Pierce, Roll
Call, 12/3). According to the AP/Minneapolis Star
Tribune, "leverage is flowing to Bush, who's
armed with both a veto pen and enough Republican allies in the Senate
to sustain filibusters against bills they don't like" (Taylor,
AP/Minneapolis Star Tribune,
12/3).
SCHIP
Legislation
that would reauthorize and expand SCHIP "appears to be on life
support," CongressDaily reports.
House Majority Leader Steny Hoyer (D-Md.) on Friday announced that
Democratic leaders have decided to send Bush an already-passed version
of the legislation. Bush is expected to veto the bill, but Hoyer
said that Democrats want to send the bill "because of concerns
about a pocket veto if we wait" (CongressDaily,
11/30). Under a pocket veto, if Congress were to send the legislation
to Bush less than 10 days before adjourning for the year, the president
could kill the measure by refusing to sign it (Dinan, Washington
Times, 12/3).
Bill supporters hope to schedule a veto override vote as early as
this week, according to Carol Guthrie, a spokesperson for Senate
Finance Committee Chair Max Baucus (D-Mont.) (USA
Today, 12/3). Hoyer said that lawmakers would continue
to work on a compromise. "Our bipartisan discussions on extending
health insurance to 10 million children are ongoing," Hoyer
said in a statement (Wayne, CQ
Today, 11/30).
However, USA Today reports
that a "compromise short of a veto override is unlikely." House
Speaker Nancy Pelosi (D-Calif.) will not agree to covering fewer
than 10 million children under the program, according to spokesperson
Nadeam Elshami (USA Today,
12/3). With the CR that currently is funding SCHIP scheduled to expire
Dec. 14, advocates have asked lawmakers to pass a new CR that would
ensure that states have sufficient funds to maintain current enrollment
levels in the program next year.
Medicare
Discussions about a Medicare package are "pushing full steam
ahead," according to CongressDaily.
The package includes measures backed by Baucus that would reverse
for two years a scheduled 10 percent cut in reimbursements for physicians
and would extend rural and low-income subsidies for beneficiaries.
Although committee members have not reached an agreement on all parts
of the bill, aides said that the disagreements "narrowed considerably
over the break" and "predict[ed] that a package would emerge" from
the Senate Finance Committee with bipartisan support, CongressDaily reports. The committee might mark up the
Medicare package this week.
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St.
John Doc Takes Helm At Yacht Club
David
Martin, partner in the Cardiac Surgery Institute P.C.,
Detroit, and a Grosse Pointe Farms resident, to Commodore
of the Grosse Pointe Yacht Club, Grosse Pointe Shores,
for the 2007-2008 fiscal year.
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