Vol. 109, Issue 1, 2020
Georgia’s federal health care waivers applications
A Physicians Foundation update FSMB’s Workgroup on Physician Sexual Misconduct’s initial report Key considerations for physician employment contracts How an MSW intern enhanced my practice
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TABLE OF CONTENTS VOLUME 109, ISSUE 1
8
7
IN EVERY ISSUE
20
FEATURES
3 President’s Message
7 Physicians Foundation update
4 Editor’s Message
8 MAG weighs in on Georgia’s federal health care waivers
6 Executive Director’s Message 12 Medical Ethics 14 GCMB Update: FSMB’s Workgroup on Physician Sexual Misconduct’s initial report
15 How an MSW intern enhances my practice
16 Legal: Key considerations for physician employment contracts 18 County, Member & Specialty News 20 Perspective
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PRESIDENT’S MESSAGE
We need more doctors in public office Andrew Reisman, M.D. docreisman@gmail.com
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iven our education and training and experience, there is no doubt that physicians should be the ones to lead the health care system. We can’t hope that others are going to do the right thing or defer to us when it comes to our patients or
our profession. And while the Medical Association of Georgia (MAG) deserves its reputation as a strong and effective advocate for physicians, I have come to realize that we must take a more active leadership role in the policy-making process as individuals if we want to address the very real challenges we face – and that means running for public office.
I applaud the four physicians (and fellow MAG members) who currently serve in Georgia’s General Assembly, which includes Sen. Dean Burke, M.D., Sen. Kay Kirkpatrick, M.D., Sen. Ben Watson, M.D., and Rep. Mark Newton, M.D. I also commend Atlanta anesthesiologist Michelle Au, M.D., for her decision to run for the State Senate. And there are no physicians in Georgia’s Congressional delegation, so I admire Lawrenceville ER physician Rich McCormick, M.D., and Rome neurosurgeon John Cowan, M.D., for taking the initiative to run for the 7th and 14th district seats. The bad news is that less than two percent of Georgia’s legislators are physicians – knowing that the State House and Senate are full of lawyers. Imagine what the practice environment and our health care system would look like if those numbers were reversed. Georgia’s 2020 health care budget is more than $5 billion, which translates into 20 percent of every tax dollar. Nearly 70 percent of the state health care budget goes to the Department of Community Health – which administers the Medicaid and PeachCare for Kids programs and the State Health Benefit Plan (i.e., state employees and teachers) – while another 20 percent goes to the Department of Behavioral Health Developmental Disabilities. These aren’t insignificant numbers. Legislators trust physicians, but these are the same lawmakers who are constantly bombarded by messages from other, very well-funded interests. This, coupled with being so outnumbered, means that we are often in a defensive posture when it comes to protecting our profession and our patients.
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Legislation can have profound effects. For example, bad tort laws can increase our overhead and the risk associated with being reported to the National Practitioner Data Base – which can lead to having one’s license restricted or suspended and, ultimately, economic ruin. And health insurance laws can dictate how much we’re paid, whether we’re in a given health insurance network, or whether our patients have access to the drugs and diagnostic tests that we prescribe. These polices can also lead to adverse outcomes, complications, and missed diagnoses that harm our patients and result in complaints to the medical board and malpractice suits, as well as higher costs and undermining our autonomy, practice style, and medical decision making. And legislation can dictate where we practice, the services we offer (i.e., CON laws), and the business climate (i.e., promoting or stifling entrepreneurship). Dr. Au says that, “Health care is the number one issue in this upcoming election, and I strongly believe those of us working at the front lines should have a seat at the table, and that we need health policy written by those who know it best.” Dr. McCormick’s website touts him for his “unique experience in health care and [efforts to reduce] government spending make him the ideal candidate to find solutions for patient care.” And Dr. Cowan asserts that, “Healing a broken health care system will go a long way toward putting us back on the right path. This can’t happen without physicians in Congress.” I wholeheartedly agree with these sentiments, which is why I am appealing to every MAG member to consider running for office. There simply isn’t anyone better or more qualified to establish our health care policies. And if you can’t run for office, I encourage you to support the physicians who are doing so with your dollars and time. Editor’s note: MAG members can go to mag.org/gpla for information on the MAG Foundation’s Georgia Physicians Leadership Academy. MAG members who are interested in running for public office can contact Derek Norton – who is MAG’s Government Relations director and the mayor of Smyrna – at dnorton@mag.org. Physicians can also email politicaleducation@ama-assn.org or call 202.789.7455 for details on AMPAC’s campaign school (AMPAC is the American Medical Association’s political action committee). Go to cowanforcongress.com, richmccormick.us, and auforga.com to support Dr. Cowan, Dr. McCormick, and Dr. Au’s campaigns. www.mag.org 3
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EDITOR’S MESSAGE
2020 challenges The Medical Association of Georgia 1849 The Exchange, Suite 200 Atlanta, Georgia 30339 800.282.0224 www.mag.org MAG’s Mission To enhance patient care and the health of the public by advancing the art and science of medicine and by representing physicians and patients in the policy-making process. Editor Stanley W. Sherman, M.D. Executive Director Donald J. Palmisano Jr. Publisher PubMan, Inc. Richard Goldman, rgoldman@pubman.net 770.855.3608 Editorial Board Sara Acree, M.D. John S. Antalis, M.D. Mark G. Hanly, M.D. John S. Harvey, M.D. William Kanich, M.D. Frank McDonald, M.D. Mark E. Murphy, M.D. Barry D. Silverman, M.D. Michael Zoller, M.D. MAG Executive Committee Andrew B. Reisman, M.D., President Lisa Perry-Gilkes, M.D., President-elect Rutledge Forney, M.D., Immediate Past President Thekkepat G. Sekhar, M.D., First Vice President James L. Smith Jr., M.D., Second Vice President Frederick C. Flandry, M.D., Chair, Board of Directors Steven M. Huffman, M.D., Vice Chair, Board of Directors Edmund R. Donoghue Jr., M.D., Speaker James W. Barber, M.D., Vice Speaker Debi D. Dalton, M.D., Secretary Thomas Emerson, M.D., Treasurer S. William Clark III, M.D., Chair, AMA Delegation W. Scott Bohlke, M.D., Chair, Council on Legislation Advertising PubMan, Inc. Brian Botkin, bbotkin@pubman.net 678.643.7250 Subscriptions Members $40 per year or non-members $60 per year. Foreign $200 per year (U.S. currency only). The Journal of the Medical Association of Georgia (ISSN 0025-7028) is the quarterly journal of the Medical Association of Georgia, 1849 The Exchange, Suite 200, Atlanta, Georgia 30339. Periodicals postage paid at Atlanta, Georgia, and additional mailing offices. The articles published in the Journal of the Medical Association of Georgia represent the opinions of the authors and do not necessarily reflect the official policy of the Medical Association of Georgia. Publication of an advertisement is not to be considered an endorsement or approval by MAG of the product or service involved. Postmaster Send address changes to the Journal of the Medical Association of Georgia,1849 The Exchange, Suite 200, Atlanta, Georgia 30339. Established in 1911, the Journal of the Medical Association of Georgia is owned and published by the Medical Association of Georgia. © 2017.
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Stanley W. Sherman, M.D. n the December issue of Medical Economics magazine, the lead article presents a list of challenges that are facing physicians for the coming year. It also offers advice and help with these challenges. In case you have not yet read this article, I thought it may be helpful to summarize some of its points.
• The first challenge and the issue causing the most physician dissatisfaction is administrative hassles and regulatory burdens. While too much paperwork, government and payer regulations and computer time were noted, most of this section was spent advising physicians on ways to ease the burden of prior authorization. This included documenting the need for procedures in the chart, following guidelines ordering them, and having designated staff members to handle requests. • The next challenge was getting paid. Payers are switching from “fee-for-service” to “quality metrics and outcomes” that need good documentation. Failing to do so means you
will be faced with lower reimbursement. The burden is also on your practice to collect payment from patients with high deductible health plans. The article warns that EHRs that automatically populate to satisfy higher level E/M guidelines must be reviewed for accuracy or they may contradict the validity of your note and its reimbursement level. • The third challenge is increased competition from practices trying to make the patient experience better. The article suggests that your practice consider booking appointments online and filling out forms prior to the visit (preferably electronically). Other suggestions are trying to minimize wait times, trying to respond to questions within 24 hours, and updating your waiting room. • The next challenge is EHR usability and interoperability. Changing systems that were built for billing into helping patient care somehow must occur. • Next is physician wellness, both physical – including good nutrition, exercise and sleep – and mental, including an active social life, healthy relationships and dealing with stress. We hope to carry more articles on physician wellness in the Journal this year. • About half of all physicians will face a malpractice lawsuit at some point in their career. The legal climate in Georgia has worsened, and addressing this problem is a MAG priority. The article advises complete and accurate documentation, careful review of patient medications, following up on tests, apologizing for errors, and careful investigation of persistent symptoms. • Treating patients with chronic conditions and convincing them of the need for medication and lifestyle changes has always been a challenge. Never having enough time to accomplish this and now being financially judged on their health outcomes makes the challenge even more daunting. The article advises partnering with the patient in mutual decision-making to help achieve goals. • More than 83 percent of physician practices have reported some form of cyberattack, including phishing, hacking, and employee theft of patient data. Apparently, this is occurring in every size practice. The article suggests conducting a cybersecurity risk assessment, staff
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training, and using at least 12-character passwords, multifactor authentication, data encryption and backing up all files. • The next challenge that was discussed in the article was negotiating contracts with payers and physician contracts with employers. With the latter, I certainly agree with the author’s advice to consult a health care attorney. I can certainly recommend Dan Huff, Esq., who is a regular Journal contributor.
Hopefully, educating ourselves on these challenges will help us deal with them. Working together through MAG to overcome many of these challenges will be both more effective than facing them alone and provide all of us with the support we will need. Congratulations to our new president, Andrew Reisman, M.D., who addresses the importance of physicians running for public office to help us deal with our challenges. Our lead article is on Georgia’s federal health care waivers application which deals with our challenge of getting paid. In keeping with our hope to help you address another challenge, MagMutual’s article deals with employment contracts. MAG CEO Donald J. Palmisano Jr. writes about not only MAG’s value to physicians, but also now to fourth year medical students and residents in training. Joy Maxey, M.D., our representative to The Physicians Foundation, updates us on the Foundation’s efforts to support physician leadership, and physician well-being, and to continuously survey practice trends.
Our ethics article addresses Mercer medical student Leah Gober’s views on the proposed changes to Title X abortion clinic referrals, while John Antalis, M.D., reminds us of our ethical obligation to report sexual misconduct to the Georgia Medical Composite Board. Michelle Zeanah, M.D., shows us the value a social worker can add to a practice. Mark Murphy, M.D.’s tales of “challenging patients” will remind us that we would probably rather have our own challenging patients than someone else’s. Finally, all of our Journal Editorial Board members and staff, as well as all of our member readers, want to thank Jay Coffsky, M.D., for 14 years of his wonderful “Prescriptions for Life” editorials. Jay was writing his editorials for our DeKalb Medical Society newsletter when I encouraged him to share his wonderful musings with a wider audience in the Journal. We all appreciate what our members describe as his “wisdom, wit, and thought-provoking perspectives.” I know that you all join me in wishing Jay only the best of health and happiness in his retirement. He will be greatly missed.
Weigh in with a letter to the editor The Journal accepts letters to the editor, which should be 150 words or less and are related to an article that appeared in the previous Journal and include the writer’s name and email address. Submit letters to tkornegay@mag.org.
PHYSICIANS NEEDED FOR OUTPATIENT EXAMS Tri-State Occupational Medicine, Inc. (TSOM) is looking for physicians to join their group to perform disability evaluations in their GA offices. Part-time opportunities. No treatment is recommended or performed. No insurance forms. No follow up. No call, no weekends and no emergencies. Preferred specialties - Internal Medicine, Family Medicine, General Medicine, Emergency Medicine or Occupational Medicine. Training and all administrative needs including scheduling, transcription, assisting, and billing are provided. Must have a current GA medical license. TSOM has an excellent reputation for providing Consultative Evaluations for numerous state disability offices.
Contact: Susan Gladys susang@tsom.com /866-929-8766 / 866-712-5202 (fax).
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CEO’S MESSAGE
Striving to create value for every member Donald J. Palmisano Jr. dpalmisano@mag.org
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he value proposition for physicians’ advocacy organizations has changed in dramatic ways in the last 15 years. Back in the day, joining your local, state and specialty associations was just something you did. Physicians were “joiners.” But faced with budget constraints and competing interests, the bar is much higher today – especially when to comes to the younger generations. Advocacy continues to be the Medical Association of Georgia’s “bread and butter” program. However, our members want, and demand, more. That’s why we have taken steps to enhance MAG’s value proposition. This includes launching the ‘MAG Association Healthcare Solutions’ health insurance plan, which is available to MAG member practices that enroll five or more full-time employees – and something that is expected to deliver savings of up to 20 percent compared to standard small group plans. MAG continues to offer a great 401(k) plan for its members and their practice staff that now has about $80 million in assets. And don’t forget that MAG endorses a health information exchange, HealtheParadigm, that enables physicians to generate sophisticated patient data analytics.
MAG has also taken steps to create more value for its resident and student members. When he was MAG’s president in 20152016, John Harvey, M.D., established a non-clinical elective rotation at MAG for residents who are in the Gwinnett Medical Center’s (GMC) ‘Transitional Year Resident’ program. The goal was to let residents work at MAG for one month to get a firsthand look at what the organization does to help and protect physicians and their patients. These residents typically research an issue that they are passionate about or that is aligned with the specialty that they are pursuing. MAG staff mentors them and introduces them to applicable stakeholders, including legislators, regulators, and leading physicians. At the end of the rotation, the resident is featured on MAG’s award-winning ‘Top Docs’ Facebook videocast or writes an article for MAG’s newsletter or makes a presentation to MAG’s Board of Directors. I must admit that I was a little apprehensive about how this program might work or be received by the residents as I recalled a conversation that I had with a resident who was in the ER at CHOA when one of my four one sons had a broken arm. I asked him if he understood the value of organized medicine,
and whether he planned on becoming active in the process. He blurted out that, “With all due respect, I’m just trying not to make a mistake that might kill someone.” That comment resonated with me, and it provided some valuable context in the way I have viewed residents ever since.
With Dr. Harvey’s support and guidance, the program has flourished. If you are familiar with MAG’s ‘Top Docs’ show, you may have heard Wells Yang, M.D., discuss the need to eliminate surprise medical bills. During his one-month rotation, Dr. Yang interacted with MAG staff and discussed the issue with state legislators and affected physicians. Meanwhile, Mohit Agarwal, M.D., addressed health care for the homeless and housing insecure on the ‘Top Docs’ show – as well as writing a comprehensive article on the subject for MAG’s newsletter. Kyle Glasser, M.D., did a ‘Top Docs’ episode on pain management and the push to reduce opioid prescriptions, Umair Syed, M.D., conducted research on the state’s medical cannabis laws for the MAG Institute for Excellence in Medicine, and Hunter Crane, M.D., worked with Steve Walsh, M.D., another former MAG president, on a report on the “perioperative surgical home.” Trust me when I tell you that they all spent a considerable amount of time and effort on their research. Because of the success that we’ve had with GMC, we have developed a comparable program for fourth-year medical students at the Philadelphia College of Osteopathic Medicine’s Georgia Campus in Suwanee – working with its dean, Bill Craver, D.O. MAG Medical Student Section members Yassmin Shariff and Vash Patel subsequently spent a month at the State Capitol in Atlanta, attending committee meetings and meeting with MAG staff and legislators – later discussing their experiences on ‘Top Docs.’ The resident and fourth-year medical student programs have been a success on every level, and I believe that these programs illustrate how MAG continues to evolve to ensure that it is creating for every member, including residents, medical students, and physicians in every specialty and practice setting. Contact Palmisano at dpalmisano@mag.org if you would like more information on MAG’s resident and fourth-year non-clinical rotation programs. Every ‘Top Docs’ show is available at mag.org/topdocs.
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THE PHYSICIANS FOUNDATION
Empowering Georgia’s physicians to lead national change By Joy A. Maxey, M.D., FAAP, MAG representative, The Physicians Foundation Board of Directors
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Joy Maxey, M.D., FAAP
jmaxaccc@mindspring.com
he Physicians Foundation seeks to empower physicians to lead in the delivery of high-quality, cost-efficient health care. As the U.S. health care system continues to evolve, The Physicians Foundation is steadfast in its determination to strengthen the physician-patient relationship, support physicians in sustaining their medical practices, and help practicing physicians navigate the changing health care system. The Physicians Foundation pursues this mission by funding research, grants and other resources that advance physician leadership, physician wellbeing, and physician practice trends.
physician workloads, interfere with patient needs, and contribute to physician burnout. The Physicians Foundation is addressing physician burnout and making physician wellbeing a priority. There must be a national dialogue to consider how any new mandates, care paradigms, consolidation, and reimbursement models could impact physicians before they are implemented.
Physician leadership
Physician practice trends
Since 2003, The Physicians Foundation has given nearly $1.8 million in grants to key stakeholders in Georgia, including six grants to two non-profits that are affiliated with the Medical Association of Georgia (MAG). One of those is the MAG Foundation’s Georgia Physicians Leadership Academy (GPLA), which enhances and refines physicians’ leadership skills. GPLA features interactive classes that address three key areas: advocacy, communication, and conflict resolution. GPLA helps to shape physicians into better leaders, and it provides physicians with tools to deliver better care for their patients and tend to their own wellbeing. To date, nearly 150 physicians have graduated from GPLA – leading to fundamental change across Georgia. Over the next two years, GPLA will expand its focus on physician wellness by adding a unit on “physician resiliency.” GPLA sees this as a logical step toward preventing physician burnout. GPLA will also be adding a unit to teach physicians about the multiple aspects of health care economics. Meanwhile, The Physicians Foundation’s ‘Interoperability Fund’ has been used to improve health information exchanges (HIEs) in Georgia and five other states. This has helped MAG and other state medical societies develop programs to enable physicians to use HIEs to effectively share clinical information with each other and hospitals. Physician wellbeing To ensure that physicians in Georgia and across the U.S. are in the driver’s seat of health care reform, The Physicians Foundation leverages its collective voice to influence national discourse on issues such as social determinants of health (SDOH) and regulatory burdens. Physicians are being unnecessarily burdened by practice demands and regulatory and reimbursement mandates that increase
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As part of its commitment to physician wellbeing, The Physicians Foundation recently launched the ‘Vital Signs’ campaign – which is designed to help raise awareness about the physician suicide epidemic and to provide physicians with tools to attend to their own wellbeing. Through its two biennial surveys, The Physicians Foundation continuously takes the pulse on how physicians and their patients feel about the health care system. Our 2019 ‘Survey of America’s Patients’ evaluated Americans’ attitudes on the physician-patient relationship, the cost of health care, and key drivers of health care outcomes – such as SDOH and the opioid misuse epidemic. In order to continue empowering physicians, understanding their perspectives and challenges is crucial. This means that you can help effect change in the health care system by participating in The Physicians Foundation’s 2020 Biennial Physician Survey, which is the only survey that is by and for physicians. Please monitor MAG’s communications for more information on this survey. Physicians are the foundation of health care and the evolution that surrounds it. As the health care system in America continues to change, The Physicians Foundation is committed to identifying how the system can adapt to the real needs of physicians and patients in Georgia and across the U.S. It is time for physicians to have a seat at the table – both in Georgia and the national level – to ensure that our voices are heard and the needs of our patients are met. The Physicians Foundation was established in 2003 following the settlement of a class-action lawsuit that was led by physicians, MAG and 18 other state medical societies, and three county medical societies against private third-party payers. Each signatory is represented on The Physicians Foundation’s Board of Directors. Go to physiciansfoundation.org for additional information. Dr. Maxey served as MAG’s president in 2000-2001. She is a member of the American Medical Association, the American Academy of Pediatrics, and the DeKalb Medical Society. Dr. Maxey is the president and owner of Atlanta Children’s Clinical Center P.C. www.mag.org 7
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MAG weighs in on Georgia’s federal health care waivers
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eorgia lawmakers passed the ‘Patients First Act’ (S.B. 106) in 2019, so Gov. Brian Kemp subsequently submitted two health insurance “waivers” to the federal government to “extend and stabilize health insurance coverage for thousands of Georgians.”
‘Georgia Pathways’ (1115 Waiver) • Would enable certain Georgians to obtain Medicaid coverage, including those who…
– Are Georgia residents
Gov. Kemp asserts that the ‘Georgia Pathways’ program would “create a new opportunity (i.e., a “pathway”) for the nearly 408,000 hardworking Georgians who make less than 100 percent of the federal poverty level (FPL) to afford health insurance,” enabling the state to increase the number of Georgians who are eligible for Medicaid beyond the traditional Medicaid population.
– Are 19 to 64 years old
Meanwhile, the governor believes that the ‘Georgia Access’ program would create a “state reinsurance program that [would provide] more insurance coverage options, [foster] competition among insurance providers, and [lower] insurance costs for Georgia families” – replacing the options that are available on healthcare.gov and allowing the state to give subsidies to eligible carriers to insure people who are between 100 percent and 400 percent of the FPL who purchase private insurance.
– Aren’t incarcerated
The following is a summary of the two waivers’ key provisions, and it is based on information that Gov. Kemp’s office distributed.
– Have income of less than 100 percent of FPL – Aren’t already eligible for Medicaid – Are U.S. citizens or a documented/qualified alien
• Members would be required to fulfill an “activities” threshold of 80 hours per month (i.e., employment or community service or education) • Designed to prepare participants to transition to commercial health insurance plan once their income exceeds 100 percent of FPL • Would offer premium assistance for those who become eligible for Medicaid and who have access to employer sponsored insurance (ESI)
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Premiums • Members would pay a monthly premium that’s tiered based on income • Premiums wouldn’t exceed two percent of the member’s household income • Members would receive monthly invoice that includes details on the consequences associated with non-payment • The state would determine whether the member’s premium contribution should be adjusted if their income changes during the enrollment period
“MAG President Andrew Reisman, M.D., submitted a letter to Gov. Brian Kemp to outline MAG’s views on the ‘Georgia Pathways’ and ‘Georgia Access’ waivers applications.”
Penalties for failing to pay premium • First month: A grace period. The member retains their eligibility, claims are paid, and care management organization (CMO) capitation payments are made • Second month: The member is “suspended,” but CMO capitation payments are still made on pending claims. If the member makes the missed payment during this month, the suspension is lifted (retroactive to date of suspension) and claims are paid back to that date • Third month: The member remains “suspended.” If they make their outstanding payments during this month, the suspension is retroactively lifted to the date of the suspension and the claims are paid back to that date. If the member fails to make their outstanding payments by the end of this month, they would be disenrolled
Co-payments • Co-payments and premiums would not exceed five percent of a member’s household income, something that would be evaluated quarterly
• Phase II would establish a ‘Georgia Access’ health insurance plan that would be open to every individual health plan that is licensed and in good standing with the state, including those that are available through the ‘Federally Facilitated Exchange’ (i.e., healthcare.gov) and the rest of the marketplace • In Phase II, the state would begin subsidizing qualified health plans (QHPs) and eligible non-QHPs that matches the federal subsidy structure for individuals who are between 100 percent and 400 percent of FPL • The state hopes to waive the federal exchange requirement (healthcare.gov) for five years • The private sector would provide “front-end consumer shopping experience and operations,” while the state would validate the applicant’s eligibility for state-based subsidies in the individual health insurance market or Medicaid • The state’s goal is to spur innovation in the individual market while maintaining access to QHPs and ensuring consumer protections for individuals with pre-existing conditions
• Co-payments would not be assessed at the point of care and would not be collected by physicians
Reinsurance program
• Co-payments would be retrospectively assessed/adjudicated after the delivery of care/services
• Would use a claims-based model that includes an “attachment point” (i.e., when excess insurance or reinsurance limits kick in), cap, and tiered coinsurance rate
‘Member Rewards Account’ • Funded with Medicaid dollars • Designed to help members manage their own health and incentivize healthy behaviors • Funds could be used for co-payments and services that aren’t covered by Medicaid • State would provide additional incentives for members to engage in behavior and activities that support good health outcomes • If a member’s account balance exceeds $200, they could use the funds for other medical expenses that aren’t covered by Medicaid (e.g., over the counter drugs, dental services, glasses, contacts) • If a member’s income exceeds 100 percent of FPL and they obtain commercial health insurance, they could use their account balance for future health expenses
‘Georgia Access’ (1332 Waiver)
• The three tiers would include low cost, mid cost and high cost regions • The state estimates that it will reimburse members at an average coinsurance rate of 27 percent for claims that are between the $20,000 attachment point and a cap of $500,000 in the first year
State subsidies • The state would continue to certify metal-level (i.e., bronze, silver, gold, platinum) Affordable Care Act (ACA) QHPs and catastrophic plans • The state would certify eligible non-QHPs to expand access to affordable health care coverage options • Eligible non-QHPs would be allowed to offer a more limited set of essential health benefits, but they would be required to be in the single-risk pool, maintain protections for those with pre-existing conditions, and not medically underwrite.
• Would cover Georgians who earn between 100 percent and 400 percent of FPL
Funding cap
• Phase I would feature a ‘Reinsurance Program’ to “stabilize the market by reducing premiums and attracting/retaining carriers”
• The state would grant subsidies on a “first in, first out” basis if enrollment exceeds its projections
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• Additional enrollees would be placed on a wait list
MAG, members weigh in on waivers
On December 3, Medical Association of Georgia (MAG) President Andrew Reisman, M.D., submitted a letter to Gov. Brian Kemp to outline MAG’s views on the ‘Georgia Pathways’ Section 1115 and ‘Georgia Access’ Section 1332 waivers applications. Dr. Reisman’s correspondence highlighted MAG member feedback, and it stated that MAG supports the Georgia Access/Section 1332 waiver’s overall goal, in general, because it is aligned with MAG Policy 290.971 – which says that, “MAG supports innovations and modifications of the Georgia Medicaid program balancing the needs of Georgia’s uninsured patients with the need to achieve a sustainable solution to the budget shortfalls and expected future financial challenges.” The letter to Gov. Kemp also noted that… • MAG supports a $0 copay for primary care visits because it will encourage patients to establish a medical home with a primary care physician, thereby reducing the state’s overall health care costs • MAG believes that patients who transition from the Georgia Pathways plan to a commercial health insurance plan should still have access to the funds they accumulated in their Georgia Pathways ‘Member Rewards Account’ • The plan’s employer-sponsored insurance premium assistance feature is important because the administrative burden associated with private insurance is generally lower than the one associated with CMOs – and private insurers typically offer better reimbursement • MAG members want to know if the proposal includes any “hold harmless” provisions (i.e., physicians would not be subjected to additional risk or liability), especially during the early stages of the program’s implementation • MAG members are concerned about the work requirement for adults who have chronic conditions and/or who don’t meet Medicaid’s “disabled” standards. MAG would consequently like to work with the state and other applicable stakeholder groups to develop exemptions for specific diagnoses, especially the ones that are related to mental health conditions • The state should look for ways to reduce the administrative burden that is associated with CMO prior authorization processes, which result in a multitude of patient care and claims problems • Reimbursement levels need to be high enough to establish and sustain an adequate network of physicians across all specialties – keeping in mind that a lot of physicians don’t accept Medicaid because they would effectively lose money on every patient they see (i.e., the cost of providing the care is higher than the payment) • The state needs to work with health insurers to find ways to compensate physicians for “no-shows” and missed appointments, which translate into costs practices can’t recover. It should also work with insurers to develop innovative solutions to help patients secure reliable forms of transportation to get to and from appointments
• The plan’s database should be updated on a regular basis to ensure that practices can determine if a patient/member’s coverage is up to date (e.g., they haven’t been suspended for failing to pay their premium) • MAG members want to know how the state/insurers will handle patients/members who use the emergency department for nonemergency purposes (i.e., ensure that physicians aren’t penalized). This would be a significant challenge since much of the plan’s target population hasn’t received medical care on a regular basis • MAG encourages the state to incentivize eligible patients to participate in the plan’s ‘Early and Periodic Screening, Diagnostic, and Treatment’ (EPSDT) program by increasing the amount of money that is available for health care expenses in their ‘Member Rewards Account’ • MAG encourages the state to increase physician reimbursement for Medicaid’s primary care codes (including obstetricians and gynecologists) to equal the 2018 Medicare rates, which will improve access to care • MAG believes that the plan’s premiums should be reduced to ensure that patients can obtain and maintain the benefits • MAG is concerned about the state’s request to eliminate the threemonth retroactive Medicaid benefit. This might deliver the target savings goal of 2.2 percent per member/per month, but MAG believes that this will further strain the state’s struggling rural health care system – including physicians and hospitals
As for the ‘Georgia Pathways’ (Section 1115 Waiver), Dr. Reisman’s letter said that, “The [wavier] is consistent with MAG Policy 290.968, which states that, “MAG supports Georgia seeking a waiver from the U.S. Department of Health & Human Services Secretary to allow Georgia to use the Medicaid expansion funds to buy private insurance in the state health insurance exchange for eligible Georgia citizens at or below 100 percent of the federal poverty level.” The letter also stressed that… • MAG supports efforts to increase the number of Georgians who have health insurance and reduce the costs associated with purchasing that health insurance • MAG supports the goal of moving as many patients from Medicaid to commercial health insurance as possible • MAG believes that the current trajectory of rising health insurance premiums is unsustainable • MAG supports the need to continue to protect patients who have pre-existing conditions • MAG members have asked whether this proposal includes any “hold harmless” provisions (i.e., physicians would not be subjected to additional risk or liability) • MAG believes that this plan should have a “robust” set of “essential” benefits. MAG is also concerned that a lot of patients/ members may not understand what is included in a non-qualified health plan (i.e., they will purchase the cheapest plan without understanding the implications) – which is something the state/
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insurers should be prepared to address. The ‘Georgia Access’ model could allow health insurers and other private sector entities to market both non-eligible non-qualified health plans (QHPs) and eligible non-QHPs. MAG consequently encourages the state to work with MAG and state medical specialty groups and other applicable stakeholder groups to ensure that consumers/patients are protected under this plan
50,000 of them would be eligible to get coverage under one of these two plans.
• MAG is concerned about the plan’s lack of guidance or policies to ensure that it has adequate networks, which could undermine the Georgia Access and Reinsurance Program (i.e., patients could receive health insurance that physicians and hospitals do not accept)
Go to medicaid.georgia.gov/patientsfirst for additional information on the ‘Georgia Pathways’ Section 1115 or ‘Georgia Access’ Section 1332 health insurance waivers applications. MAG members can also contact Ryan Larosa at rlarosa@mag.org with questions about the waivers.
• MAG is concerned about insurance carriers misrepresenting the size of their networks during the open enrollment period. MAG would consequently like the state to establish penalties to eliminate this common practice (e.g., reduce the coinsurance subsidy for health insurers’ inaccurate listings)
In addition to Dr. Reisman’s letter, a MAG team – including CEO Donald J. Palmisano Jr., Legal Counsel Bethany Sherrer, and Corporate Relations Director Ryan Larosa – met with the governor’s staff in early December to discuss MAG’s views on the waivers applications.
This article was updated for accuracy in the middle of March, when the Journal was submitted to the printer. MAG members are encouraged to monitor mag.org and MAG’s other communications for the latest developments on the waiver applications.
CDC & Georgia DPH websites provide latest information on Coronavirus The Centers for Disease Control and Prevention and the Georgia Department of Public Health have created websites that provide the latest information on the 2019 Novel Coronavirus (COVID-19), including cdc.gov/ coronavirus and dph.georgia.gov/novelcoronavirus.
“MAG is going to remain fully engaged and keep a very close eye on this process,” says Palmisano. Also monitor mag.org for the latest information on Editor’s notes: The governor’s office estimates that there are about the Coronavirus. 408,000 adults in the state who lack health insurance, and some
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MEDICAL ETHICS
The need to preserve the crucial link between free speech and patient care By Leah Gober, MS-3, Mercer University School of Medicine
T
he beginning of our medical education commences with the recitation of a version of the Hippocratic Oath. In doing so, we, a cohort of future physicians, vow to “raise medical ethics above the self-interests of class and status.” It’s a rite of passage, a solemn promise that’s supposed to be our guide throughout a lifetime of medical practice. Title X, a Nixon-era federal funding program, is, in a way, supposed to be a form of the government embodiment of this oath. Providing for family planning and preventive health services, it serves more than four million of America’s most vulnerable with free birth control, cancer screenings, STI testing, treatment, and nonjudgmental care. In Georgia alone, more than 59,000 patients were treated, in one form or another, through Title X services in 2018. At its most basic, the program allows for the treatment of individuals without regard to class or status. But in February of this year, the Trump Administration finalized plans for a “Gag Rule” on Title X programs that would allow it to control the information that is exchanged in the patientdoctor relationship – namely referrals to centers that provide abortions. The decision thrusts politics into a sacrosanct relationship that is already a delicately balanced endeavor for hard-earned trust. The Title X changes threaten the physicianpatient relationship, with especially devastating effects on rural and underserved populations in the Southeastern United States. Once a privilege for the wealthy, medicine in the 21st century is increasingly a right for citizens and non-citizens alike, including all races and classes. A practice once idolized for its hoarding of medical knowledge and cures is now being taught – especially at my home institution – as involving the sharing of medical knowledge between patient and physician. There is an emphasis on involving the person seeking help in all aspects of care, from allopathic therapy options to more holistic modalities. The focus is now on developing a therapeutic partnership with the person seeking help. Truly informed consent or refusal is vital to this partnership. But the proposed changes to Title X aim to prevent physicians
Leah Gober
working in Title X funded clinics from offering access to safe and legal abortions or from referring patients to abortion providers. These clinics are already restricted from using federal funding for performing abortions themselves, but they have, until now, maintained the ability to inform patients of their options. As a result of the changes to Title X, caregivers – many of whom give their time for limited compensation – are being threatened with punishment from a government entity that is scores of bureaucracies removed from the provision of medical care and information. The effects will be especially devastating for rural and underserved areas. In Savannah, where I live, Curtis Cooper Primary Health Care and JC Lewis Primary Health Care Center both receive federal funding from Title X. Curtis Cooper alone served over 19,000 Savannah locals last year, providing resources from primary care to behavioral health. Restricting the physicians who donate their time to our institution from properly educating their patients in order to maintain federal funding status is unacceptable. Beyond the patients who will be directly affected, the Gag Rule will likely have the greatest effect on Planned Parenthood. The organization, an avid proponent of women and minority health care, released a statement insisting that the Title X changes are “not about health care but about restricting reproductive health and rights.” Shortly after the release of this statement, Planned Parenthood withdrew from all Title X funding and began a fundraising spree to make up for the deficit that will emerge. This move, although adept, was one that I believe will only result in a loss of advocating for patients who rely on their stability for health care. If we live up to the highest values of our profession, we will spend our careers fighting for our patients’ health; for their rights and ability to access the best care available; for insurance companies to reimburse them appropriately; and for drug companies to provide affordable options. In training to treat, we must advocate for our right to free speech. It is the only way that we can protect our relationships with our patients. MAG members are encouraged to submit their ethics articles and comments and questions to David Baxter, M.D., FACP, at baxter_ jd@mercer.edu.
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GCMB UPDATE
Initial report on FSMB’s ‘Workgroup on Physician Sexual Misconduct’ By John S. Antalis, M.D., past chair, Georgia Composite Medical Board
T
he Federation of State Medical Boards (FMSB) – which represents more than 70 medical boards – created a ‘Work Group on Physician Sexual Misconduct’ in 2017. It was led by Patricia King, M.D., and it includes one of my fellow Georgia Composite Medical Board (GCMB) members, Alex Gross, M.D. The work group was charged with five deliverables, including… 1. Collecting and reviewing current sexual misconduct disciplinary data, including the number of incidents, severity of behavior, and sanctions 2. Identifying and evaluating barriers for reporting sexual misconduct 3. Assessing the effectiveness of state medical board policies to encourage the public to report physician sexual misconduct 4. Updating FSMB’s current sexual misconduct policy – which was established in 2006 – as needed 5. Assessing today’s sexual boundary/harassment training for physicians and developing new recommendations as needed The work group’s draft report stated that sexual harassment is an issue in medicine, and particularly in academic settings – although it emphasized that the vast majority of physicians observe appropriate boundaries. The draft report addressed the consequences associated with sexual misconduct, a physician’s responsibility to report sexual misconduct, state medical boards’ investigatory, regulatory, legal, and disciplinary roles, the need for state medical boards to be transparent, and the physician “reentry” and remediation processes. The work group stressed that physician sexual misconduct often begins with a “grooming” process, which is when a victim is lured into a sexual relationship in a subtle and secretive way. It may include giving the patient – or their parents – a gift or special treatment to gain their trust. This grooming process can evolve to include seduction, innuendo, or demeaning the patient. The work group also discovered that patients often unfortunately do not report sexual misconduct because they do not trust authorities, fear retaliation, or are ashamed or embarrassed. The work group consequently recommended that FSMB simplify the reporting process on its website. It believes that patients should be able to report sexual abuse claims on an anonymous basis, and once FSMB receives a complaint it should investigate the claim as soon as possible. The work group has also recommended
John S. Antalis, M.D.
that medical practices make educational material available in their offices and that the affected physician/practice should communicate with the complainant in an open and transparent way. Physicians, hospitals, and medical clinics in Georgia have a duty to report cases of sexual misconduct to GCMB and other applicable authorities, including law enforcement. Failing to do so could subject vulnerable patients to more abuse. It is also crucial for patients in Georgia to report a physician’s sexual misconduct to GCMB and the other applicable authorities. An increase in the number of physicians who are employed also has made reporting more challenging – as some corporations incorrectly view sexual misconduct as an “internal matter.” Employed physicians are also often less inclined to report their fellow physicians for sexual misconduct because it’s harder to do so anonymously and because they fear retaliation. Therefore, the work group has suggested that state boards be given the authority to fine health care facilities that fail to report sexual misconduct. It is also suggesting that hospitals and health systems create a separate peer review process that is focused on sexual misconduct (i.e., the performance and quality peer review processes would not change). The peer review data would be shared with applicable state medical boards for possible action. The work group further believes that these facilities, including those in academic settings, should be required to report any physician who is dismissed or resigns because of sexual misconduct. And, these facilities should educate their physicians on professionalism and patient interaction. It is every physician’s duty to report sexual misconduct. Assuming they are doing so in good faith, they should remain anonymous and be protected from retaliation – keeping in mind that physicians who make frivolous claims or file reports for personal gain will face discipline. I have only addressed one part of the work group’s report in this article. Other sections address a patient’s rights, the investigative process, and hearings for misconduct, remediation, and monitoring, which I will address in future editions of the Journal – after FSMB’s House of Delegates votes on the work group’s report. Dr. Antalis is a member of the Whitfield-Murray County Medical Society, and he was MAG’s president in 2004-2005.
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PRACTICE MANAGEMENT
How an MSW intern enhanced my practice By Michelle Zeanah, M.D., and Kyleah Boyd Michelle Zeanah, M.D. Kyleah Boyd is completing a master’s degree in social work (MSW) at Valdosta State University. As part of that process, Boyd completed an internship at Michelle Zeanah, M.D.’s practice in Statesboro. Dr. Zeanah is a pediatrician who focuses exclusively on behavioral pediatrics. Dr. Zeanah recently hired Boyd on a full-time basis. The following Q&A addresses Boyd’s internship and contributions to the practice. How has an MSW intern helped your practice? Dr. Zeanah: I have more time. I have always felt pressured to stay on schedule and serve my patients in a timely manner. I also know that a lot of parents need a safe place to share their feelings. Having an MSW intern has allowed me to do both. Kyleah helps caregivers get emotional support, find community resources, and become educated about their child’s diagnosis and cognitive behavioral therapy options. How do MSW interns differ from medical students? Dr. Zeanah: Medical students learn how to diagnose and treat acute and chronic conditions. They are ill-equipped to help resolve psycho-social barriers to patient compliance. MSW interns can address no shows, medication or dietary noncompliance, transportation issues, housing issues, domestic violence, and caregiver burnout. They provide patient education and reinforce the physician’s care plan. During their “concentration” year, MSW interns can also provide cognitive behavioral therapy, supportive counseling, and other services – like brief interventions for substance abuse or smoking cessation. What surprised you most about the social work needs of the patients at Dr. Zeanah’s practice? Boyd: The level of emotional support that caregivers require. Caregivers often request an emotional support appointment or become emotional during an appointment because they become overwhelmed by the day-to-day responsibilities of caring for a child with special needs. I let these parents share their feelings, emotions and worries in a non-judgmental and stress-free environment. It is vital for caregivers to take care of themselves mentally, physically and emotionally. Are patients concerned when they learn they’ve been referred to a social worker? Boyd: Yes, so the first thing I do when I talk to a caregiver is to explain my roles and responsibilities. This puts them at ease and allows them to communicate their needs. I also always ask them
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how I can help them, which lets them know I’m on their side. Would you encourage other physicians to use an MSW intern? Boyd: Yes. Every MSW program requires a practicum/ internship. A social worker can improve patient compliance by knocking down barriers that prevent clients from coming to their appointments. A social worker can also help to improve the patient/doctor relationship because they serve as a liaison between the two. The social worker can also reinforce the physician’s treatment plan. Why did you choose a physician’s office for your practicum? Boyd: My professor told me that there was a pediatrician who focuses on behavioral pediatrics (Dr. Zeanah) who was looking for a social work intern. Originally, I didn’t want to focus on children specifically. I wanted to work with families. But my field instructor encouraged me to explore the opportunity with Dr. Zeanah’s practice because I would have a chance to influence the entire family system. I also thought that learning about autism would be interesting. The members of my support system also encouraged me to “challenge” myself. What did you take away from this experience? Boyd: Don’t be afraid to step out of your comfort zone. The educational background of a health care team is diverse. Each person brings something different to the table, which helps keep the practice innovative. Dr. Zeanah has one of the only practices in this part of the state that can serve as a central hub for this kind of care. How can physicians get their own MSW intern? Boyd: Physicians can contact any school that has a social work program. The director of field education should be able to connect the physician with a student. If there isn’t a school in a physician’s area that offers a degree in social work, schools like Valdosta State University offer hybrid programs that have students all over the state. Each program has standards that mimic the National Association of Social Workers standards. If you have a need and document the intern’s responsibilities, the field director should be able to place a student. Dr. Zeanah was GAMPAC’s chair in 2016-17, she has served on the MAG Foundation’s GPLA Steering Committee, and she is a MAG HOD delegate, a member of MAG’s Council on Legislation, and a member of the Ogeechee River Medical Society. www.mag.org 15
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LEGAL
Key considerations for physician employment contracts By Todd Van Dyke, attorney, Jackson Lewis P.C., Atlanta, MagMutual partner
H
ealth care employers, human resource directors and other professionals who routinely deal with contracting issues should understand that physician employment contracts are unlike other employment contracts – as they pose unique and heightened risks that deserve special consideration.
Pay and benefits Employment contracts commonly cover one’s base salary, a signing bonus, and/or relocation expenses. While this is typical for most employment contracts, physician contracts often contain 1) a productivity component, which makes their pay directly impacted by their productivity level, and 2) a quality component. Productivity may be measured by the number of patients seen, the speed of the care delivered, or the overall amount of time each physician spends on each patient. A quality component is typically measured by patient satisfaction scores. It is important for the contract to be very specific about compensation components. Disputes over pay are some of the most common involving employment contracts, and any ambiguity is construed against the drafter – usually the practice or other health care provider.
Job duties All job duties should be clearly described in the contract. One unique issue to address is call responsibility. A contract should describe how call responsibilities are allocated among physicians and whether there is a cap on call time. It should also describe hours of work and whether a physician will be required to work weekends and, if so, the frequency and duration.
Terms and termination clauses Simply having a contract is no guarantee of employment. Contracts frequently state that a physician is employed at-will, meaning they can be terminated or resign for any reason at any time. These contracts usually have no term. However, some contracts guarantee employment for a certain period – subject to “cause” termination. Any such clause needs to specifically define “cause.” Of course, cause could include factors like a physician losing their license, having their board certification revoked, or committing a crime. But the contract should also explain whether cause includes unsatisfactory performance and whether it includes more serious offenses such as gross negligence or gross misconduct. Lastly, such a contract usually includes a term – typically one or two years – that may automatically renew
unless advance notice of non-renewal is provided by either party.
Restrictive covenants Restrictive covenants include non-competes, patient non-solicits, employee non-solicits, and non-disclosure covenants that can be used to protect legitimate business interests, including training and patient relationships. The enforceability of these covenants is entirely dependent on state law. In Georgia, non-competes are enforceable. They must be limited to a reasonable period of time (usually two years or less), the same or substantially the same job duties performed by the physician, and a specific territory (with some exceptions under Georgia law). Some Georgia courts have been reluctant to enforce non-compete clauses because of the public’s interest in health care, while others have not. In either case, the physician can be sued for monetary damages.
Fraud and abuse prevention There are three important federal laws that apply to physicians, and physician employment contracts should contain provisions to ensure their basic understanding. The Physician Self-Referral Law (Stark law) prohibits physicians from referring patients to receive certain designated health services payable by Medicare or Medicaid from entities with which the physician, or an immediate family member, has a financial relationship – unless an exception applies. The Anti-Kickback Statute prohibits the knowing and willful payment of “remuneration” (anything of value) to induce or reward patient referrals or the generation of business involving any item or service payable by federal health care programs. And the False Claims Act makes it illegal for a physician to submit claims for payment to Medicare or Medicaid that the physician knows or should know to be false or fraudulent.
Tail insurance Physician contracts should also clearly address medical malpractice insurance and who will pay for any “tail coverage” [also known as an extended reporting period] once the physician’s employment ends. A claims-made policy covers a physician for incidents that occur and are reported during the policy period. For example, if a policy expired at the end of 2019 and a claim is brought in 2020 for an incident that occurred in 2019, the claim would not be covered unless the physician has tail coverage. An occurrence policy covers a physician for any claims that arise during the time that the physician was covered by the policy, even after the policy ends. Generally, tail coverage is not required with occurrence policies.
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CMS & SPECIALTY NEWS
COUNTY MEDICAL SOCIETY NEWS Bibb County Medical Society
by Dale Mathews, Executive Director The Bibb County Medical Society (BCMS) held its annual ‘President’s Party’ at the Idle Hour Country Club in Macon in December. The society’s officers for the year include President Zachary Lopater, M.D., President-elect Cameka N. Scarborough, M.D., Immediate Past President Christopher E. Minette, M.D., Vice President John J. Rogers, M.D., Secretary/ Editor Charles C. Snow, M.D., Treasurer L. Arthur Schwartz Jr., M.D., and at-large directors I. J. Shaker, M.D., Rana K. Munna, M.D., Harold P. Katner, M.D., Ashwini Gore, M.D., and R. Jonathan Dean, M.D. The MAG directors for the year include Robert C. Jones, M.D., and Malcolm S. Moore Jr., M.D., while the MAG alternate directors include Allen G. Garrison, M.D., and William P. Brooks, M.D. Maria H. Bartlett, M.D., is the historian, while J. Eric Roddenberry, M.D., is the parliamentarian. Minor C. Vernon, M.D., was honored with the society’s Physician of the Year Award. He has served as BCMS’
president, as a member of MAG’s Judicial Council, and as a MAG HOD delegate. Go to www.bibbphysicians. org or contact Dale Mathews at bibbphysicians@gmail. com to join BCMS or for more information. DeKalb Medical Society
by Melissa Connor, Executive Director The DeKalb Medical Society’s (DMS) officers for the year include President Andrea Juliao, M.D., Vice President Al Scott, M.D., and Secretary/ Treasurer Colin Segovis, M.D. DMS will host a free ‘Medical Cannabis in Georgia’ dinner meeting at the Druid Hills Golf Club in Atlanta from 6:30 p.m. to 9 p.m. on Thursday, April 16. The event is being sponsored by Curaleaf (curaleaf.com). Contact Melissa Connor at mconnor@ pami.org to make a reservation, which is required. Georgia Medical Society
by Ca Rita Connor, Executive Director The Georgia Medical Society’s (GMS) held its annual meeting in Savannah in January. It installed its’ officers for the year, including President Patrick L. Blohm, M.D., Vice President Roland Summers, M.D., President-elect William Darden, M.D., Secretary
The 2020 Bibb County Medical Society’s ‘President’s Party.’
Edmund R. Donoghue Jr., M.D., Treasurer Fred L. Daniel, M.D., and members at-large Michael Zoller, M.D., and Thomas E. Shook, M.D. The society’s MAG delegates for 2020 are E. Daniel DeLoach, M.D., Michael J. Wilkowski, M.D., and Luke J. Curtsinger, M.D., while the MAG alternate delegates are Tonya McCullough, M.D., Michael E. Greene, M.D., and Karen E. Turner, M.D. The meeting featured a ‘Physician Leadership and the Urgency of the Moment in Medicine’ talk by American Medical Association President Patrice A. Harris, M.D. Contact Ca Rita Connor at gamedsoc@ bellsouth.net with questions related to GMS. Hall County Medical Society
by Melissa Connor, Assistant Executive Director The Hall County Medical Society (HCMS) held a free ‘Medical Cannabis in Georgia’ dinner meeting that was sponsored by Curaleaf (curaleaf.com) in December. The event addressed the state’s medical cannabis laws – including which medical conditions are covered by the law – and physicians’ roles and responsibilities. Contact Melissa Connor at mconnor@pami. org to join HCMS or for more information.
From the left are Drs. David Hogue, Donnie Dunagan and George Pursley being installed as RCMS officers for 2020 – while Drs. Bashir Chaudhary and Joseph P. Bailey Jr. look on.
muscogeemedical.org or contact Stacie McGahee at smcgahee@medicalbureau. net or 706.322.1254 to join MCMS or for more information. Richmond County Medical Society
by Dan Walton, Executive Secretary The Richmond County Medical Society (RCMS) held its 2019 holiday party in December. It also held a meeting in January that featured a talk on the opioid misuse crisis by Shawn Williams, D.O., who is the medical director for the Bluff Plantation in Augusta. The RCMS officers for the year include President George Pursley, M.D., PresidentElect Donnie Dunagan, M.D., Vice President David Hogue, M.D., and Secretary/ Treasurer Pascha Schafer, M.D. Go to www.rcmsga.org or contact Stacie McGahee at smcgahee@medicalbureau. net or 706.733.1561 to join RCMS or for more information.
Muscogee County Medical Society
SPECIALTY SOCIETY NEWS
by Dan Walton, Executive Director The Muscogee County Medical Society (MCMS) hosted a family night at a Columbus River Dragons hockey game in March. Go to www.
by Maryann B. McGrail, CAE, CMP, Executive Director The Atlanta Association for Dermatology and Dermatologic
Atlanta Association for Dermatology and Dermatologic Surgery
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Surgery (AADDS) will hold dinner CME activities on May 5, July 14, September 12, and October 27. Contact Maryann McGrail at maryann@ theassociationcompany. com for details. Go to www. atlantaderm.org for additional information on AADDS. American College of Physicians Georgia Chapter
by Mary Daniels, Executive Director Jacqueline Fincher, M.D., MACP, will begin her term as the president of the American College of Physicians (ACP) on April 25. ACP represents 159,000 internists. Three members of the Georgia ACP Chapter will receive national ACP honors in April, including Anne Schuchat, M.D. FACP (Mastership), Melinda Wharton M.D., FACP (Mastership), and Tracey Henry, M.D., MPH, MS (McDonald Early Career Physician Award). GA-ACP held a joint state advocacy day with the Patient Centered Physician Coalition at the State Capitol in Atlanta in March. ACP’s ‘Leadership Day’ will take place in Washington, D.C. on May 12-13. And, GA-ACP’s annual meeting will take place at the Atlanta Evergreen Marriott Conference Resort in Stone Mountain on October 23-25. Go to www.gaacp.org or contact Mary Daniels at mdaniels@ gaacp.org to join GA-ACP or for more information. Georgia Academy of Family Physicians
by Tenesha Wallace, Director of Communications and Public Health The Georgia Academy of Family Physicians (GAFP) is encouraging applicable
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physicians to register for its ‘2020 Summer CME Meeting,’ which will take place at the Sandestin Golf and Beach Resort in Destin, Florida on June 4-6. This joint GAFP/Georgia Primary Care Association meeting will address a wide array of topics and best practices in primary care. Go to www.gafp.org for additional information and to register. Call 800.392.3841, extension 106, with questions. Georgia Chapter of the American Academy of Pediatrics
by Kasha Askew Director of Membership & Education The Georgia Chapter of the American Academy of Pediatrics’ award recipients for 2019 include Harry L. Keyserling, M.D., of Atlanta, for the Denmark Lifetime Achievement Award, Lynette Wilson Philips, M.D., of Clarkston, for the Outstanding Achievement Award, Katherine F. Duncan, M.D., of Macon, and Sylvia M. Washington, M.D., of Rome, for the Young Physician Award, Beverly Knight Olson for the Friend of Children Award, and Rep. Sharon Cooper for the Legislator of the Year Award. Kudos to Sally Goza, M.D., FAAP (Fayetteville) who was installed as the president of the American Academy of Pediatrics during its national conference in October. The Chapter held a ‘Day at the Capitol’ in concert with the Patient-Centered Physicians Coalition on March 5. The Chapter is encouraging applicable physicians to register for its ‘Pediatrics by the Sea’ summer CME meeting, which will take place at The Ritz-Carlton,
Amelia Island in Florida on June 17-20. The meeting co-chairs include Valera Hudson, M.D. (Augusta) and Lisa Leggio, M.D. (Augusta). In addition to plenary sessions and workshops, this event will feature preconference seminars on pediatric infectious disease and immunizations, trauma, and practice management. Other upcoming events include the Jim Soapes Charity Golf Classic, which is a benefit for the Pediatric Foundation of Georgia that will take place at Cherokee Run Golf Course in Conyers on April 22, and the Pediatric Practice Managers & Nurses Association Spring Meeting, which will take place at the Macon Marriott City Center on May 15. Visit www.gaaap.org or call 404.881.5091 for more information, including details on the Chapter’s webinars. Georgia Chapter of the American College of Cardiology
by Hank Holderfield, Executive Director The Georgia Chapter of the American College of Cardiology (GA-ACC) held its annual scientific meeting in November – an event that featured more than 40 speakers from across North America. More than 150 cardiologists and allied staff attended the meeting, and 94 percent of them rated it as “extremely valuable.” This year’s scientific meeting will take place at The Ritz-Carlton Reynolds, Lake Oconee in Greensboro on November 20-22. The Georgia and Tennessee chapters of ACC are co-sponsoring the second annual ‘Women in Cardiology Meeting’ at Callaway Gardens in Pine Mountain on May 1-3. Go
to accga.org to register for the meeting and to make a room reservation. Contact Melissa Connor at mconnor@pami. org to join GA-ACC or for more information. Georgia Gastroenterologic and Endoscopic Society
The annual Georgia Gastroenterologic and Endoscopic Society (GGES) meeting for 2020 is scheduled for September 12 at the W Midtown Atlanta. For more information or to join GGES, visit www.ggesonline.org. Georgia Society of Dermatology and Dermatologic Surgery
by Maryann B. McGrail, CAE, CMP, Executive Director The Georgia Society of Dermatology and Dermatologic Surgery (GSDDS) will host its ‘Congress of Clinical Dermatology’ at the Hilton Sandestin Hotel in San Destin, Florida on May 22-25. Contact Maryann McGrail at maryann@ theassociationcompany. com for details. Go to www.gaderm.org for more information on GSDDS. Submit your county medical society, member or specialty society news to Tom Kornegay at tkornegay@mag.org. Also contact Kornegay with any corrections, which will run in the next edition of the Journal. The Journal reserves the right to edit submissions for length and clarity. Bolding recognizes the physicians who are active MAG members at the time the Journal was prepared. Go to www.mag.org/membership to renew your MAG membership. www.mag.org 19
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PERSPECTIVE
Medical terminology
T
he old woman grinned at me. Her hair, a gray halo, framed a weathered face which bore the stigmata of many decades of smoking cigarettes as well as the relentless assault of the South Georgia sun. “The worst sickness I ever had was the Smilin’ Mighty Jesus!” she exclaimed. “I was in third grade, I think. I don’t rightly remember. It’s been a while.” I glanced at her over my clipboard, puzzled. “Smiling Mighty Jesus?” I asked, cocking my head to one side. “What were your symptoms?” She rolled her eyes upward, as if reading an invisible memorandum inscribed on the inside of her eyelids. “I had a fever and a stiff neck, and my head was a-pounding like a drum. The doctors said I could’ve died.” I cogitated over this for a moment before the light went on. “Spinal meningitis?” I said at last. She nodded, her gap-toothed grin even broader than before. “Yep, that’s it. Smilin’ Mighty Jesus!” I’ve practiced medicine for over three decades. During that time, I’ve seen a lot of unusual things, from strange and nonsensical folk remedies (wrapping potato peels around lacerated fingers, poultices made of cow dung, spiderwebs used as wound packing) to the plethora of gross medical misconceptions perpetuated in popular culture (“If you open up somebody with cancer, the cancer will hit the air and spread all over their body”). I’ve had numerous patients with “Cadillacs” in their eyes, and others who underwent hysterectomies because of “fireballs in the eucharist.” The cornucopia of offbeat medical tales I’ve accrued over the years could fill a journal. I was doing a colonoscopy on a lightly sedated patient once and remarked to the nurse that he had “tics” (diverticula) in his colon. “Ticks?” the patient exclaimed. He shook his head, disgusted. “I’ve got bugs everywhere!” “What do you mean?” I asked. “Well, I’ve got roaches in my liver, and now I’ve got ticks in my colon!” he said. One of the most egregious fonts of medical disinformation is my nonagenarian mother-in-law. I’ve known her since I was a teenager. It took quite a while after I had finished residency and fellowship for her to comprehend that I was actually a physician and not merely the pimple-faced adolescent who had once darkened her door. A Southern belle to the core, she is always polite – but she
Mark Murphy, M.D. can also dispense rapier-like commentary if she does not believe something someone says. One of the things she likes to say is “Bless their heart.” She uses it like this… “Patsy says her husband isn’t cheating on her, but everyone knows he is. She just doesn’t want to admit it.” (Pause) “Bless her heart.” Unfortunately, most of my mother-in-law’s medical knowledge is derived from anecdotes she’s heard from friends. For years, I spent lots of time refuting the torrent of balderdash that she believed to be absolutely true. It was exhausting. But then I found out about Jeannine. Jeannine was my mother-in-law’s best friend. They talked daily. One day, my mother-in-law was rambling on about a particularly absurd idea regarding a colon cleansing regimen expunging poorly defined “toxins” as well as a loose aggregation of various intestinal parasites from the body. It was all a load of crap, if you’ll pardon the pun. “Where did you hear that?” I asked. “Why, Jeannine told me all about it,” my mother-in-law said. Before too long, Jeannine became my patient. She soon became an unwitting ally in my campaign to re-educate my mother-inlaw about her health care. I was finally able to correct a lot of her medical inaccuracies at the source. Problem solved! Alas, nothing good lasts forever. Jeannine eventually passed away, and my mother-in-law found other sources of disinformation to tap into. Those sources were unclear, however. She never accessed the Internet, and the only things she ever watched on television were on the Hallmark Channel and PBS. I began to suspect outright fabrication. My mother-in-law came down with a cold recently. She wanted to take antibiotics for it. “Antibiotics aren’t helpful for a virus,” I said. “They can actually make you sicker.” “Oh, that’s not true. Everybody knows antibiotics are good for you,” she replied. “You could get Clostridium difficile from them. It can cause diarrhea,” I said. She glanced up at me, smiled sweetly, and said simply, “Mark, you’re always so helpful to me. You’re the best son-in-law a woman could ever have.” And then she paused for just a moment before adding, “Bless your heart.” Dr. Murphy is a Savannah gastroenterologist, a longtime MAG member, and a former president of the Georgia Medical Society.
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