February 22, 2019
Vol. 26, No. 4
Second Opinion: Are You a Robot or a Doctor?
MSDC is pleased to introduce Second Opinion , a new semiregular blog highlighting viewpoints on the state of medicine in our nation's capital and beyond. This is intended as an open physician forum and submissions are welcome by contacting duryea@msdc.org.

The first edition is written by MSDC Executive Vice President Robert Hay Jr, CAE.
Are You a Robot or a Doctor?
By Robert Hay Jr.
Recently I read a short story in Wired Magazine ’s fiction issue about an imagined future of medicine. In an oncology ward, a professional actor playing a physician went to administer pain medication to a terminally ill patient, only to be shocked when the patient asked emotional questions about her care. The actor, with a robot behind him monitoring his performance, was torn between being a real person and following a script written by an insurance company.

Describing the story makes it sound ridiculous, but also sounds eerily familiar. When I talk to physicians in any setting, I often hear a longing in their voice for the way medicine used to be practiced. Today, with an overload of codes to input, insurance companies dictating the “correct” treatments, and the demand to see more patients in less time makes the practice of medicine more a chore. Physicians at times feel like actors instead of practitioners, required to say the right thing or be sued. Read more.

The topic of physician burnout and wellness is also highlighted later in this newsletter.
Welcome New Members!
MSDC welcomes the following physician who recently joined the Medical Society:

Diana Lapp, MD ( Family Practice )
District Healthcare Policy
The DC Council's public oversight hearings are still underway but the bulk of hearings impacting physicians have passed. By and large, the hearings yielded robust discussion about the city's diverse healthcare needs, especially the plight of the most vulnerable patients and those impacted by the city's burgeoning opioid crisis. MSDC submitted a letter to Committee on Health Chair Vincent Gray on the District's budget to ensure adequate funding for the District's diverse physician and patient population.

As hearings wrap up, MSDC's physician advocacy committee is vigorously reviewing a series of recently introduced bills which address access to care, patient education and scope of practice in the District. Among the bills under consideration, MSDC expects to come out in support of legislation which would prohibit insurance companies from factoring the use of pre-exposure prophylaxis in decisions related to the issuance of disability, life, or long-term care insurance policies. If you are interested in this legislation or wish to learn more about MSDC advocacy, contact Robert Hay Jr . Public hearings have not yet been scheduled for many of the bills under consideration, but MSDC welcomes physicians who would like to share their expertise with the DC Council.
National Healthcare Policy
CMS Predicts Healthcare Spending Will Rise to $5.9 Trillion by 2027
The Washington Post reports that as baby boomers age, they “will consume an ever-larger share of the nation’s health-care spending over the coming decade, regardless of the success of Democrats running for president with ambitious plans to broaden Medicare,” according to an analysis conducted by CMS’ Office of the Actuary and published in Health Affairs

Healthcare Policymakers, Industry Clash Over Proposed Legislation to End Surprise Medical Bills
Modern Healthcare reports that the “healthcare policy and industry worlds are poised for a clash" over a forthcoming bill to end all surprise medical bills. The tension surrounding a proposed bill in Congress “lies in its potential scope as a catch-all for widespread frustration over healthcare costs.” On Wednesday, “a coalition of hospitals led by the American Hospital Association outlined for congressional leaders the overarching principles they want policymakers to keep in mind” and “included a warning that they don’t want Congress to foray into their negotiating relationships with insurers.” 

MSDC previously joined more than 100 state medical and specialty societies in a letter to the Ways and Means Committee calling for greater insurer accountability, transparency and limits on patient responsibility.
MSDC eNewsline
Pia R. Duryea
202-355-9414 (direct)
202-466-1800 (main)
For previous editions, visit eNews Archives

MSDC Media
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2018-2019 Board of Directors
Susanne Bathgate, MD
Chair of the Board, At-large

Raymond Tu, MD, MS
President, AMA Alternate Delegate

J. Desiree Pineda, MD
President-elect, AMA Alternate Delegate

Barry L. Lewis, MD, MBA
Immediate Past President

Joseph E. Gutierrez, MD
Treasurer, AMA Delegation Chair

Peter E. Lavine, MD
AMA Delegate

Laurie Duncan, MBBS, MS

E.W. Emanuel, MD

Alice Fuisz, MD
At-large, Secretary

Daniel I. Perlin, MD

Marc Rankin, MD

Carla C. Sandy, MD

Robert Hay Jr., CAE
Executive Vice President
Physician Wellness and Burnout
How Does Your Lifestyle and Happiness Compare to Other Doctors?
The National Physician Burnout, Depression & Suicide Report takes an in-depth look at the prevalence and severity of a growing issue in medicine. Physicians reveal the depths of their burnout and how they cope at work, as well as the frequency of suicidal thoughts and whether or not they seek help for these emotions. See how physicians in your specialty and other specialties compare.
Empathy: A Critical Ally in Battling Physician Burnout  
With almost half of doctors nationally experiencing burnout, one medical group turned to empathy training for doctors and other staff members. Find out what they learned about empathy’s capacity to reduce burnout in  the AMA Wire .
Practice Management
New in Novatisphere: Billed in Error
Novitas, the Medicare Administrative Contractor for Jurisdictions H and L, is pleased to announce that now Part B customers have a self-service function to correct paid claims that have been Billed in Error. Users can report paid claims, or individual paid lines of a claim as billed in error, with no additional paperwork required. The feature is fast, and easy to use, while saving your office additional time and paperwork. Once your Billed in Error request has been processed, you may use the Immediate Recoupment feature within Novitasphere to have your overpayments repaid.

To find Novitasphere enrollment instructions, or view a copy of the User Manual, visit the Novitasphere Portal Center  at   JL Novitasphere Center. For questions, please contact the Novitasphere Help Desk at 1-855-880-8424.
Attention Practice Managers!
Would you like to connect with others?MSDC is forming a Practice Management Group for managers to socialize with their colleagues, share practice tips and resources. If interested, please contact Pia Duryea ( duryea@msdc.org )
CMS Launches New Podcast,
CMS: Beyond the Policy
The Centers for Medicare & Medicaid Services (CMS) launched a new podcast series, CMS: Beyond the Policy , and the inaugural episode focuses on Evaluation and Management Coding . Last November, CMS finalized changes in the Calendar Year 2019 Physician Fee Schedule (PFS) to help create a more accessible, affordable and innovative healthcare system that delivers quality for patients to help them make the best decisions about their healthcare. The CY2019 PFS included significant changes to how doctors and other clinicians document office and outpatient visits billed to Medicare.
MSDC Community
Upcoming Board Meeting
MSDC's next board meeting will be Monday, February 25 at 6:30 PM at MSDC headquarters (1250 23rd Street, NW). MSDC members in good standing who are interested in attending may contact Robert Hay Jr for an invitation.

MSDC's Annual Meeting Date Set for October 25, 2019! * Save the Date*
MSDC will be holding its 2019 annual meeting on Friday, October 25, 2019, from 6:00 to 9:30 PM. The meeting will take place at the AAMC Learning Center, located at 655 K Street NW. Mark your calendars for this once-yearly event, which features ample opportunity to catch up with physician colleagues from across the metropolitan Washington area.
Thank You To Our Corporate Supporters
MSDC 1817 Society
Public Health
Federal Government May Be Forced to Intervene on State Vaccination Exemption Laws
FDA Commissioner Scott Gottlieb, MD, said in an interview with CNN that states granting wide exemptions for vaccines are “creating the opportunity for outbreaks on a scale that is going to have national implications” and may eventually “force the hand of the federal health agencies.”  Recent measles outbreaks across the country, which led to an urgent message from US Surgeon General Jerome Adams, MD , have raised red flags about laws that allow individuals to seek vaccination exemptions on religious or philosophical reasons.
Getting a Head Start on Flu Season:
Planning and Pre-booking Vaccines
Provided by MSDC Corporate Partner Atlantic Health Partners
While the Centers for Disease Control and Prevention (CDC) begins tracking each year's influenza, "flu," season in October , preparation begins long before autumn arrives. In February of each year, the World Health Organization (WHO) gathers an advisory group to analyze influenza surveillance data and issue recommendations for the Northern Hemisphere’s upcoming seasonal flu vaccine. Healthcare organizations and vaccine manufacturers use these recommendations to plan and design seasonal flu vaccines, which protect against the most threatening influenza virus strains as predicted by researchers, reports the CDC. This important set of decisions is an early signal to the start of the annual influenza vaccination cycle. Read more .

Study Raises Concerns over A1C Testing in Diabetes Patients
According to a study by the Agency for Healthcare Quality and Research, titled Treatment and Monitoring of Adults with Diagnosed Diabetes by Race, at least one in five adults with diabetes in all racial and ethnic groups did not know whether they had received an A1C test during the year. This raises concerns about patient care and health literacy given the common blood test's role in diagnosing and monitoring type 1 and type 2 diabetes . The study found that understanding differences in diabetic patients' receipt of treatment and services by race/ ethnicity may be helpful in directing resources for managing diabetes among diverse groups.
Corporate Partners
End the Epidemic: Opioid-related Resources and News
HHS Official: Better Pain Treatment a Key to Ending Opioid Crisis  
HHS official says two keys to ending the opioid epidemic are finding better ways to treat pain and moving from a crisis framework to a sustainable system.  Read more from the AMA
Reminder: Comply With New Part D Opioid Prescribing Rules
CMS implemented new opioid policies for Medicare drug plans effective January 1. According to the AMA , there are three key elements of the new policies for 2019:
1) Opioid-naïve patients will be limited to an initial seven-day supply.
2) When pharmacies receive a prescription that leads to the patient's cumulative daily morphine milligram equivalent (MME) dose reaching 90 MME or more, the pharmacist will receive an alert and may consult with the prescribing physician to confirm that the dose is medically necessary. This is not an MME limit.
3) Medicare Part D plans may also implement drug management programs this year for patients determined to be at risk of opioid overutilization.

These policies are discussed in depth in Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019, a MLN Matters article. Additional resources can be found at Reducing Opioid Misuse, a webpage on the CMS strategy.
CDC Opioids Training Modules
Help stop the growing  number of drug overdose deaths  in the United States. Take the final three modules in a training series from the CDC:  Applying CDC’s Guideline for Prescribing Opioids . Each module includes clinical scenarios, knowledge feedback prompts, and a resource library to help enhance learning:
View additional modules on the   Interactive Training Series  webpage. The modules offer free continuing education.
DC Prescription Drug Monitoring Program
Enroll and participate in the District of Columbia Prescription Drug Monitoring Program at https://dchealth.dc.gov/service/prescription-drug-monitoring-program .
AMA "End the Epidemic" Website
See the AMA's End the Epidemic website , with resources and recommendations from the AMA Opioid Task Force
Healthcare Technology
Americans Using Latest Inventions to Prevent, Diagnose Illnesses to Avoid Medical Costs
As politicians debate how to improve the nation’s expensive — and some would say broken — health care system, Americans are eagerly turning to the latest tech devices in hopes of preventing and detecting medical problems early and avoiding costly trips to the doctor or emergency room. Read more in the New York Times .
Comment on Guidelines for Mobile Health Apps
In 2016 the American Medical Association (AMA) and a number of other health-related organizations partnered to establish Xcertia, with the goal of developing guidelines for safe and effective digital health apps that will facilitate virtual care, including remote patient monitoring for chronic diseases. This is an emerging set of technologies, which is largely unregulated. Many solutions are not evidence-based and have not demonstrated that they are safe and effective tools for use as part of a patient’s treatment plan.
Xcertia has now released a complete set of guidelines covering the privacy, security, operability, usability and clinical content of mHealth solutions: https://xcertia.org/news-announcements/ . The guidelines are now available for public comment until May 15, 2019 at: https://www.xcertia.org/the-guidelines/ . Xcertia will rely on these public comments to create a final version of the guidelines. For questions, comments or if you wish to join this effort, please contact Michael L Hodgkins, MD, VP & CMIO, AMA at michael.hodgkins@ama-assn.org .
Feds’ EHR Problem-tracking Program Must Do These 3 Things  
The AMA has been tenacious in its advocacy toward improving electronic health record usability, an area in which physicians have told the organization that its support is greatly needed.  Read more from the AMA.
Saturday, February 23, 2019
8:00 AM - Noon
Lisner Hall (2023 G Street NW, Room 201, Washington, DC)
G2Z Law Group, PLLC and GW Law are pleased to invite you to the 4th Annual Healthcare Law & Compliance Boot CampTM of the greater Washington metropolitan area. Healthcare providers face a myriad of legal and regulatory issues on a daily basis. Awareness of and compliance with healthcare laws and regulations not only enhance patient quality of care but also promote healthy and efficient healthcare practices. At the 4th Annual Healthcare Law & Compliance Boot CampTM learners will analyze and debate challenging issues routinely is seen by healthcare professionals. The event is complementary for providers and GWU students. RSVP to Rghafoorian@g2zlaw.com by February 19, 2019. Read the flyer for more information on the program, speakers, and CME accreditation. 
Loss Prevention Seminars
April 9, 2019 (DC)
April 25, 2019 (MD)
May 9, 2019 (DC)
July 25, 2019 (MD)
September 19, 2019 (DC)
Registration opens at 5:30 PM, Seminar runs 6:00 - 8:00 PM
DC: American College of Cardiology (2400 N Street, NW, Washington, DC)
MD: Bethesda Marriott (5151 Pooks Hill Road, Bethesda, MD)
This year, ProAssurance, MSDC's 1817 Society Member and partner for medical professional liability insurance, will offer a sports-themed loss prevention seminars titled, Out-of-Bounds: Previous Claims Under Further Review Participation in this seminar will better enable participants to:
·    Explain the relationship between physician-patient boundaries and professional liability risks
·     Identify a previous encounter where expectations were not met
·     Recognize the need to apply an internal or external boundary in a patient scenario

Whether you are competing for a championship sports title or practicing medicine, there are consequences for crossing the line. In this course, physicians and other healthcare professionals will hear the professional liability considerations associated with personally and professionally stepping out of bounds. The information and examples will help you stay in the game. Register online at proassurance.com/OutofBounds
Abdominal Wall Reconstruction 2019
June 6-8, 2019
Grand Hyatt Washington (1001 H Street NW, Washington, DC)
MedStar Georgetown University Hospital is pleased to announce Abdominal Wall Reconstruction (AWR) Conference taking place on June 6 to 8, 2019. This comprehensive conference will offer evidence-based discussion on all aspects of AWR through lectures and case presentations to address the growing rate of hernia repairs and updates in technology and procedures. We will also cover the high overall complication rate as well as the association of ventral hernia repair as the cause of the second highest postoperative readmission rate. The agenda is constructed to provide an in-depth understanding of the complexity of AWR. 

To register please visit AWRConference.com
Medical Real Estate Listings
Brought to you by MSDC Corporate Partner GZ Medical Realty. Contact Pete Papantoniou for your real estate needs.  
Office Sublet Available
600 square foot sublet available on 19th Street NW between Farragut North and Dupont Circle Metro. Brand new build out with separate suite number, entrance, waiting area. One office and one exam room with large window. One smaller office without windows. Sublet space is connected to an established private internal medicine practice. Price negotiable . Contact Dr. Alice Fuisz if interested. alicefuiszacp@gmail.com .

University Medical Building
2141 K Street NW
Washington, DC 20037
University Medical Building is conveniently located in the heart of DC with easy access to Metro stations. Please contact Peter Papantoniou at 301-961-1941 or see the online listing for more information
Part Time/Full Time Office Space Available
3 Washington Circle
Washington, DC 20037
Part time/full time office space available immediately at 3 Washington Circle. This includes a large consultation room, fully equipped examination room, lab drawing facility onsite, EKG machine, space for receptionist, space for medical records, shared use of copier, telephone system, wireless internet and waiting room. Ideal for general internist, medical subspecialist or surgeon. If interested, please call Mark Sklar, MD. 202-887-4769 or email mmsklar@gmail.com .
Boutique Townhouse Medical Office for Rent Across From GWU Hospital/ Medical School
900 New Hampshire Ave., NW
Washington, DC 20037
Boutique townhouse medical office for rent across from G.W.U. Hospital & School of Medicine. Very close to Foggy Bottom Metro. Three rooms, one on entry level with powered table/chair & overhead surgical light. Consultation room, reception/waiting room, & possibility of 2 additional rooms. Two-car driveway. Call/text Sheldon K. Gottlieb, MD, 301-509-3319, or email skgottliebmd@comcast.net .
Woodburn Medical Park
3229 Woodburn Road
Merrifield, VA 22003

Woodburn Medical Park is located within walking distance of INOVA hospital directly off Capital Beltway. Common area has recently been upgraded. Contact Peter Papantoniou at 301-961-1941 or see the online listing for more information .
Full Time/ Part Time Office Space Available
Well-designed and attractively decorated office of three general internists has additional consulting room/exam room suite available. Looking for another general internist to share space and overhead in fully staffed and equipped internal medicine office. Shared call coverage is possible. Contact Alan Stone, MD, 202-466-8118 or aws.md@verizon.net
Medical Resources and Announcements
Get Over $66,000 Towards Loan Repayment
DC’s Health Professional Loan Repayment Program (HPLRP) provides loan repayment (up to $66,809.92) to eligible providers practicing in underserved areas of the District for at least two years. Eligible participants include licensed and certified physicians, dentists, dental hygienists, advanced practice nurses, registered nurses, clinical psychologists, clinical social workers, and licensed professional counselors practicing at HPLRP-certified Service Obligation Sites (SOS). A certified SOS must be either a nonprofit or a public entity that provides primary care, mental health and/or dental services to District residents regardless of their ability to pay and is located in a federally-designated Health Professional Shortage or Medically Underserved Area within the District that corresponds to the services the entity provides.  Applicants must be already employed or have a signed employment contract with a certified SOS at the time of application. Read more about the HPLRP or get a list of approved site on DC Health's website .
Healthcare Job Opening/Service Opportunities
DC Health Seeks Senior Deputy Director, Health Emergency Preparedness and Response Administration (HEPRA)
 DC Health invites qualified applicants to visit DCHR careers site to complete your application.
Directions :
1. Select the  link to access the careers site
2. Sign In to access your account, or if you are not an existing user, select the New User link to create one. 
3. Review the job description and select the Apply button to begin your application.

General Job Information : Bring your professional career to Washington, D.C., the most dynamic and diverse city in the country. With its proximity to major museums, world class parks, entertainment and restaurants, increasing job opportunities and the seat of the federal government, the District of Columbia continues to be ranked in the top 10 of thriving city indicators where you can live, work and play. Contribute to and work for a nationally accredited Health Department. The District of Columbia Department of Health (DOH) earned national accreditation by the Public Health Accreditation Board (PHAB) and is an early adopter in attaining the designation. Come see where your skills are appreciated and rewarded by applying for the following public health opportunity. 

Job Summary : This position is located in the District of Columbia’s DC Health, Health Emergency Preparedness and Response Administration. The Senior Deputy Director directs activities of the DC Health relating to protecting the District population from acts of bio-terrorism and other public emergencies through effective planning and timely operational response. The Senior Deputy Director for HEPRA oversees DC Health’s efforts to prepare for and protect against, respond to, and recover from all acts of bio-terrorism and other public health emergencies, including but not limited to; Prevention/Deterrence/Protection, Emergency Assessment/Diagnosis, Emergency Management Response, Incident/Hazard Mitigation, Public Protection, Investigations, Recovery and Remediation.
 The DC Medical Reserve Corp (MRC) is actively recruiting for medical and public health professionals. The MRC is a network of local medical volunteers who are willing to donate their time during emergencies and other times of community need like parades or inaugurations. All volunteers receive comprehensive instruction in areas of emergency response. Learn more here .
Medical Society of the District of Columbia
1250 23rd Street NW, Ste 270
Washington, DC 20037