E-DMN - December 3, 2007

December 3, 2007

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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