Medical Education Transitions

I have been noticeably absent from the online space over the past few months.  However, I think I have a valid reason for this.  I am excited to announce a major professional transition.  I have been given an incredible opportunity, and am excited to begin a new chapter in my career.

Beginning January 4, 2016, I will begin as the Education Editor for the NEJM Group within the Massachusetts Medical Society, which oversees the New England Journal of Medicine and other educational offerings such as Knowledge+.  This position will allow me to learn from and work with an amazing group of folks in medical publishing, and provide exposure to new opportunities for learning in healthcare.  I will work with the adaptive personalized learning product, Knowledge+, and will learn from the other journal deputy editors associated with the Review Articles within the Journal.  NEJM Group already is well established with the Journal itself, Journal Watch, Knowledge+, CareerCenter, and a new product launched in December 2015 called NEJM Catalyst that focuses on healthcare delivery.  Clinically, I will care for patients and continue to teach residents through the Med-Peds Residency at Brigham & Women’s/Children’s Hospital of Boston affiliated with Harvard Medical School, after getting settled.

This means leaving my academic home, the Indiana University School of Medicine, to begin this full-time position with NEJM Group.  I have learned so much from the incredible people there; I will miss my mentors, colleagues and friends who have taught me so much.  I will miss the CME team, who has helped me better understand how physicians and other health care providers learn.  Of course, the residency program with which I have been associated since 2002, and prior to that as a resident trainee, will always be a part of what I do.  As much as I will miss it, I leave knowing that the program is in good hands and thriving, with amazing residents and faculty!

I am excited to begin this new journey; the folks at NEJM Group have been so welcoming to me.  I will pick up my Twitter and blogging presence, and look forward to sharing my experiences with my medical education friends, colleagues, learners and mentors!

The Sunshine Act and Open Payments

Today was a busy day for news about the Sunshine Act and Open Payments. I was asked to present pertinent information about the Sunshine Act to some of the leadership of the medical school where I work, the Indiana University School of Medicine, about this topic.  Essentially, the Physician Payment Sunshine Act (PPSA, shortened to “Sunshine Act”) came out of the Affordable Care Act, and requires that manufacturers of drugs and medical devices (which I'll call “industry”) collect, track and report all payments and financial relationships with physicians and teaching hospitals.  This system was designed to establish a transparent national disclosure system.

As a result, the Center for Medicare and Medicaid Services, or CMS, was tasked with creating a website that provided information about these relationships so that the public can make informed decisions.  That website is known as “Open Payments”.   

As of the time of this writing, for approximately the next three weeks, the “Dispute” period  is still open, whereby individual physicians can register on the website, and review their own data.  If one feels there is a discrepancy, then s/he can file a dispute that industry companies will need to review, and ultimately reconcile.

For my presentation today, I carefully made detailed slides for the leadership to share with the faculty.  I decided today to add in some screen shots of what the report looks like to an individual doctor.  To my dismay, this was the screen I found.

Intrigued with the word "portlet", I sent a request to the CMS Help Desk.  I was pleased with the response time of just a few hours.  This was the response:

[The] portal is down for maintenance at this time.  There is no ETA at this point, but we are working to get this resolved as soon as possible.  We apologize for any inconvenience and Thank you for your understanding.

For further questions please feel free to contact the open payments help desk at 1-855-326-8366.  We are open Monday - Friday from 7:30 am to 6:30 pm CST, excluding Federal holidays.

Thank you,

Open Payments

I wondered what the issue could be.  It turns out that earlier today, this piece was posted by ProPublica.  

How timely! 

I really do hope for two big fixes.  First, that examples like this one here (which generated the ProPublica story) are rare.  The registration to gain access to one’s Open Payments information is complex and cumbersome (the User Guide is unfortunately not much simpler, at 359 pages in length), which one might assume means that CMS is really trying to make sure that someone who logs in is indeed who s/he said s/he is.  Second, that the website can be opened back up very soon. Time is slowly ticking away in the Dispute period.

I am all for transparency, but if a system is going to be put in place to “provide the public with information to make informed decisions”, the information in that system needs to be a) relatively easy to access, and b) correct first and foremost.  It would make sense to me that at the least, industry use the NPI numbers (each physician is assigned a unique number for ONLY that physician and no one else) to insure that physicians with similar names are not mixed up.

-For information about the Sunshine Act and the Open Payments process, see this from the AAMC. 

 -For a step-by-step process about how to register, review, and potentially dispute one’s data, see this from Stanford, along with this FAQ.

 -For a very recent survey of industry and of physicians (85% of whom stated they would like to review their own data BEFORE its submitted to CMS; 7% actually have reviewed their data, however), see this.

By the way, the presentation went fine.  Faculty leaders had great questions.  The take home discussion from many who have already gone through the process: allot two hours for the entire process of registering, waiting for clearance, and potentially for disputing any data that one feels is incorrect.

Fellow doctors, please take the time to review the process and your own data.  After all, we are curious about the details.

Medical School Graduation: The "Calling"

Today was graduation for the Indiana University School of Medicine (IUSM).  It was a privilege being a part of this special day for the graduates; I was honored to be a recipient of a Trustee Teaching Award, and so I was able to sit on the stage for the ceremony and watch all of the graduates receive the hood, as well as congratulations from the Deans.  What an awesome spectacle!  Over 300 IUSM medical students became physicians, and their names now all end with “MD”.  Very cool!

I wonder what others think about graduation ceremonies.  It is a long day for all; the room is packed with people (there were over 3000 at the Sagamore Ballroom at the Convention Center in downtown Indianapolis). Parents, grandparents, spouses, significant others, friends, children and others were able to witness this special day for the graduates.  I saw the pride in so many faces.  Eight of them will be joining me as part of the IUSM Med-Peds Residency Program (sorry, my pics didn’t turn out so great; you all walk too fast!).

One student who would have graduated today passed away earlier this year.  His wife spoke to those in attendance after an honorary posthumous degree was granted.  There was not a dry eye in the room, including my own.

This year our amazing Dean, Dr. D. Craig Brater, is retiring after over 25 years of service to the IUSM. He will certainly be missed, and has been the face of IUSM, leading us with honesty, integrity, and humility for 13 years.

In addition, graduation today included a keynote speaker, Dr. Tom Nasca, the CEO of the Accreditation Council for Graduate Medical Education, which is responsible for graduate medical education in the United States.  It was an honor to meet him before the ceremony.  Dr. Nasca is probably one of the busiest physicians in the United States now, overseeing the accreditation of all of the training programs of residents and fellows.  He is an internationally known medical educator.  We were blessed to have him be part of the ceremony.

In his address today, he showed no slides about duty hours.  He did not mention Milestones or competencies.  Rather, he focused on the “why” of going into medicine, as a “calling”.  He told a story about a dialysis patient who had an incredible impact on him when he was in nephrology training.  He reiterated why many of us choose medicine as a profession: to care for others, and delved into the impact that a patient can have that teaches us as physicians or physicians-in-training.  This was inspiring, and helped me to reflect and understand why I do what I do: to help patients, to train the doctors of the future, and to help educate students, residents and faculty in some small way. 

To all the medical students graduating and becoming physicians over the next few weeks: kudos to you for all of your hard work.  The journey is not yet over, and the learning is really just beginning!  Be proud of your amazing accomplishments, but more importantly, embrace what lies ahead.  The opportunities to do good in the world, and care for others, are now coming to fruition.  Congratulations to the class of 2013!

P.S. If you were wondering, yes I did tweet parts of the graduation.  Check out the hashtag #IUSMGraduation for tweets and pics.