Commentary

“It is all in your head.” Patients hate to hear that. I am not sure why physicians still say it.

Lots of “real disease” is in your head: multiple sclerosis, strokes, pain, and depression. That does not mean that there is not organic pathology.

The report from the evidence-heavy Institute of Medicine (IOM) validates what so many patients have known all along: Chronic fatigue syndrome is a valid diagnosis.

No, we do not have laboratory or radiologic markers of the disease. Of course, there are not biomarkers of many other diseases, including posttraumatic stress disorder, pain, and depression.

What is tremendously important about this report is that it scientifically validates the experiences of so many patients – patients who previously have been dismissed by their physicians, thereby adding to their misery.

To reiterate the conclusions of the report:

“Myalgic encephalomyelitis/chronic fatigue syndrome – commonly referred to as ME/CFS – is a legitimate, serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals.” In the report, the IOM developed new diagnostic criteria for the disorder that include five main symptoms. In addition, it recommended that the disorder be renamed “systemic exertion intolerance disease” and be assigned a new code in the International Classification of Diseases, Tenth Edition.

The report goes on to say that between 836,000 and 2.5 million Americans suffer from ME/CFS, and an estimated 84%-91% of people with ME/CFS are not diagnosed. The disease’s symptoms can be treated, even though a cure does not exist. Its cause remains unknown, although in some cases symptoms have been triggered by an infection.

Less than one-third of medical schools include ME/CFS-specific information in the curriculum. Most patients (67%-77%) said that it took more than a year to receive a diagnosis – about 29% of these patients said it took more than 5 years. The direct and indirect economic costs of ME/CFS to society have been estimated at $17 billion to $24 billion annually, $9.1 billion of which has been attributed to lost household and job productivity.

Clearly, it is a disorder that physicians should take seriously. Especially psychiatrists, who know many diseases are “all in the head.”

Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington. She retired from the U.S. Army in 2010 after serving for 24 years and holding many leadership positions, including chief of psychiatry.

“It is all in your head.” Patients hate to hear that. I am not sure why physicians still say it.

Lots of “real disease” is in your head: multiple sclerosis, strokes, pain, and depression. That does not mean that there is not organic pathology.

The report from the evidence-heavy Institute of Medicine (IOM) validates what so many patients have known all along: Chronic fatigue syndrome is a valid diagnosis.

No, we do not have laboratory or radiologic markers of the disease. Of course, there are not biomarkers of many other diseases, including posttraumatic stress disorder, pain, and depression.

What is tremendously important about this report is that it scientifically validates the experiences of so many patients – patients who previously have been dismissed by their physicians, thereby adding to their misery.

To reiterate the conclusions of the report:

“Myalgic encephalomyelitis/chronic fatigue syndrome – commonly referred to as ME/CFS – is a legitimate, serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals.” In the report, the IOM developed new diagnostic criteria for the disorder that include five main symptoms. In addition, it recommended that the disorder be renamed “systemic exertion intolerance disease” and be assigned a new code in the International Classification of Diseases, Tenth Edition.

The report goes on to say that between 836,000 and 2.5 million Americans suffer from ME/CFS, and an estimated 84%-91% of people with ME/CFS are not diagnosed. The disease’s symptoms can be treated, even though a cure does not exist. Its cause remains unknown, although in some cases symptoms have been triggered by an infection.

Less than one-third of medical schools include ME/CFS-specific information in the curriculum. Most patients (67%-77%) said that it took more than a year to receive a diagnosis – about 29% of these patients said it took more than 5 years. The direct and indirect economic costs of ME/CFS to society have been estimated at $17 billion to $24 billion annually, $9.1 billion of which has been attributed to lost household and job productivity.

Clearly, it is a disorder that physicians should take seriously. Especially psychiatrists, who know many diseases are “all in the head.”

Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington. She retired from the U.S. Army in 2010 after serving for 24 years and holding many leadership positions, including chief of psychiatry.

“It is all in your head.” Patients hate to hear that. I am not sure why physicians still say it.

Lots of “real disease” is in your head: multiple sclerosis, strokes, pain, and depression. That does not mean that there is not organic pathology.

The report from the evidence-heavy Institute of Medicine (IOM) validates what so many patients have known all along: Chronic fatigue syndrome is a valid diagnosis.

No, we do not have laboratory or radiologic markers of the disease. Of course, there are not biomarkers of many other diseases, including posttraumatic stress disorder, pain, and depression.

What is tremendously important about this report is that it scientifically validates the experiences of so many patients – patients who previously have been dismissed by their physicians, thereby adding to their misery.

To reiterate the conclusions of the report:

“Myalgic encephalomyelitis/chronic fatigue syndrome – commonly referred to as ME/CFS – is a legitimate, serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals.” In the report, the IOM developed new diagnostic criteria for the disorder that include five main symptoms. In addition, it recommended that the disorder be renamed “systemic exertion intolerance disease” and be assigned a new code in the International Classification of Diseases, Tenth Edition.

The report goes on to say that between 836,000 and 2.5 million Americans suffer from ME/CFS, and an estimated 84%-91% of people with ME/CFS are not diagnosed. The disease’s symptoms can be treated, even though a cure does not exist. Its cause remains unknown, although in some cases symptoms have been triggered by an infection.

Less than one-third of medical schools include ME/CFS-specific information in the curriculum. Most patients (67%-77%) said that it took more than a year to receive a diagnosis – about 29% of these patients said it took more than 5 years. The direct and indirect economic costs of ME/CFS to society have been estimated at $17 billion to $24 billion annually, $9.1 billion of which has been attributed to lost household and job productivity.

Clearly, it is a disorder that physicians should take seriously. Especially psychiatrists, who know many diseases are “all in the head.”

Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington. She retired from the U.S. Army in 2010 after serving for 24 years and holding many leadership positions, including chief of psychiatry.

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²

With 2014 behind us, we are finally able to assess the implications of Meaningful Use Stage 2 for Eligible Professionals. It is now clear – as anticipated – that the updated criteria have presented a significant challenge to many. In fact, it is predicted that only a fraction of those who attained Stage 1 of Meaningful Use will attest for Stage 2 for the 2014 year. As a result, physicians who have received financial incentives under the program will now face penalties, and may see a real impact on their bottom lines.

If it’s any consolation, there is hope (and even some evidence) that the Centers for Medicare & Medicaid Services will make a few amendments to the Meaningful Use program over the next few months. This will allow for additional flexibility for providers, and with any luck, will mean more people qualify in 2015. In this column, we’ll highlight the proposed changes and share a few observations from the first year of Stage 2.

Here’s what’s new

On Jan. 29, 2015, CMS released a proposed rule that would adjust the reporting period for 2015 – currently set for the entire year – to 90 days. While this is the same length as 2014, it would give providers an extra 9 months to upgrade software, systems, and work-flows to attest for Stage 2. For those who were able to take advantage of the CEHRT [certified EHR technology] Flexibility and continue Stage 1 in 2014, this may be just the reprieve needed to stay on track. For those who made an unsuccessful attempt at Stage 2 last year, this just makes the second try a bit easier.

In case you are wondering, if you “miss” a year of Meaningful Use, you simply continue as if you made it. In other words, under the current rule, if you are due to start a full year of Stage 2 reporting in 2015, you are still obligated to do so even if you were unsuccessful with 90 days of Stage 2 in 2014. The proposed rule would change that, and keep everyone’s reporting period at 90 days regardless of stage or year. (Remember: A 1% per year penalty is assessed for every year an eligible professional fails to meet the requirements, up to a maximum of 5%. These penalties continue indefinitely.)

CMS is considering other changes as well. Specifically, their press release states they are looking to “modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” As of now, it is unclear what that might include, but a review of the challenges from 2014 may point to some strong possibilities. We’ll start with a principle we’ve dealt with previously:

Interoperability is hard

The most noteworthy changes from Stage 1 to Stage 2 are all requirements to pass information into and out of the EHR. These include: making records available through a secure patient portal, the ability to communicate with patients through electronic means, and the transmission of “summary of care” documents between providers. These requirements also happen to be the most challenging for physicians, because they rely on other systems and individuals to make the connections possible.

Up to this point, EHR vendors have not prioritized adopting established standards for data transmission, and Stage 2 really brought this shortcoming to light. So much so, that CMS considered it a valid reason to invoke the CEHRT Flexibility. By “limited exception” providers could continue with Stage 1 this past year if “their referral partners [did] not upgrade to 2014 Edition Certified EHR Technology” (i.e., doctors are given a pass on the need to send “summary of care” data if there’s no one around to receive it). But secure and reliable electronic communication with other physicians is just one area of struggle. Another that is arguably more difficult is communicating electronically with patients. Compared with the challenges of interoperability, we’ve observed that:

Patient care is even harder

It’s one thing to incentivize (or penalize) physicians for adopting Health Information Technology, but it is an entirely different thing to hold them responsible for whether or not their patients choose to embrace it. Unfortunately, the 2014 Meaningful Use measures seem to do just that. With quotas for providing “secure electronic access” through a patient portal, the MU program forces physicians to engage patients on a new virtual “playing field.” This may seem like a good thing on the surface, but it has been riddled with headaches for providers and patients alike.

With the dawn of EHR portals, physicians suddenly perceive a new level of exposure. Patients can now peer into their charts and uncover unfiltered diagnosis terminology or slightly abnormal lab values that may raise unwarranted concern. As a result, physicians have become much more conscientious about documentation, but most feel this is just one more layer of complexity to slow them down. Additionally, as patients discover the convenience and immediacy of secure e-mail, more care is now being delivered outside the context of an office visit. This requires a huge time commitment from physicians and, in most cases, provides no income – and this time demand is not limited to just the doctors! Office staff have the new and unwelcome task of providing technical support to patients for website problems, lost passwords, etc. All of these underscore this final observation:

This isn’t getting any easier

We realize this last point is self-evident, but its impact is hard to quantify. With every new stage of meaningful use, new requirements aimed at making care more efficient for patients only seem to make delivery of care much less efficient for physicians. As physicians become mired in regulations and visit volumes drop, care will ultimately become less efficient for everyone. In response to these and many other issues, we are hopeful to see some significant adjustments made to the timeline and requirements of meaningful use. In the meantime, we certainly acknowledge the challenges and as always invite your feedback and comments.

Dr. Notte is an FP and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

With 2014 behind us, we are finally able to assess the implications of Meaningful Use Stage 2 for Eligible Professionals. It is now clear – as anticipated – that the updated criteria have presented a significant challenge to many. In fact, it is predicted that only a fraction of those who attained Stage 1 of Meaningful Use will attest for Stage 2 for the 2014 year. As a result, physicians who have received financial incentives under the program will now face penalties, and may see a real impact on their bottom lines.

If it’s any consolation, there is hope (and even some evidence) that the Centers for Medicare & Medicaid Services will make a few amendments to the Meaningful Use program over the next few months. This will allow for additional flexibility for providers, and with any luck, will mean more people qualify in 2015. In this column, we’ll highlight the proposed changes and share a few observations from the first year of Stage 2.

Here’s what’s new

On Jan. 29, 2015, CMS released a proposed rule that would adjust the reporting period for 2015 – currently set for the entire year – to 90 days. While this is the same length as 2014, it would give providers an extra 9 months to upgrade software, systems, and work-flows to attest for Stage 2. For those who were able to take advantage of the CEHRT [certified EHR technology] Flexibility and continue Stage 1 in 2014, this may be just the reprieve needed to stay on track. For those who made an unsuccessful attempt at Stage 2 last year, this just makes the second try a bit easier.

In case you are wondering, if you “miss” a year of Meaningful Use, you simply continue as if you made it. In other words, under the current rule, if you are due to start a full year of Stage 2 reporting in 2015, you are still obligated to do so even if you were unsuccessful with 90 days of Stage 2 in 2014. The proposed rule would change that, and keep everyone’s reporting period at 90 days regardless of stage or year. (Remember: A 1% per year penalty is assessed for every year an eligible professional fails to meet the requirements, up to a maximum of 5%. These penalties continue indefinitely.)

CMS is considering other changes as well. Specifically, their press release states they are looking to “modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” As of now, it is unclear what that might include, but a review of the challenges from 2014 may point to some strong possibilities. We’ll start with a principle we’ve dealt with previously:

Interoperability is hard

The most noteworthy changes from Stage 1 to Stage 2 are all requirements to pass information into and out of the EHR. These include: making records available through a secure patient portal, the ability to communicate with patients through electronic means, and the transmission of “summary of care” documents between providers. These requirements also happen to be the most challenging for physicians, because they rely on other systems and individuals to make the connections possible.

Up to this point, EHR vendors have not prioritized adopting established standards for data transmission, and Stage 2 really brought this shortcoming to light. So much so, that CMS considered it a valid reason to invoke the CEHRT Flexibility. By “limited exception” providers could continue with Stage 1 this past year if “their referral partners [did] not upgrade to 2014 Edition Certified EHR Technology” (i.e., doctors are given a pass on the need to send “summary of care” data if there’s no one around to receive it). But secure and reliable electronic communication with other physicians is just one area of struggle. Another that is arguably more difficult is communicating electronically with patients. Compared with the challenges of interoperability, we’ve observed that:

Patient care is even harder

It’s one thing to incentivize (or penalize) physicians for adopting Health Information Technology, but it is an entirely different thing to hold them responsible for whether or not their patients choose to embrace it. Unfortunately, the 2014 Meaningful Use measures seem to do just that. With quotas for providing “secure electronic access” through a patient portal, the MU program forces physicians to engage patients on a new virtual “playing field.” This may seem like a good thing on the surface, but it has been riddled with headaches for providers and patients alike.

With the dawn of EHR portals, physicians suddenly perceive a new level of exposure. Patients can now peer into their charts and uncover unfiltered diagnosis terminology or slightly abnormal lab values that may raise unwarranted concern. As a result, physicians have become much more conscientious about documentation, but most feel this is just one more layer of complexity to slow them down. Additionally, as patients discover the convenience and immediacy of secure e-mail, more care is now being delivered outside the context of an office visit. This requires a huge time commitment from physicians and, in most cases, provides no income – and this time demand is not limited to just the doctors! Office staff have the new and unwelcome task of providing technical support to patients for website problems, lost passwords, etc. All of these underscore this final observation:

This isn’t getting any easier

We realize this last point is self-evident, but its impact is hard to quantify. With every new stage of meaningful use, new requirements aimed at making care more efficient for patients only seem to make delivery of care much less efficient for physicians. As physicians become mired in regulations and visit volumes drop, care will ultimately become less efficient for everyone. In response to these and many other issues, we are hopeful to see some significant adjustments made to the timeline and requirements of meaningful use. In the meantime, we certainly acknowledge the challenges and as always invite your feedback and comments.

Dr. Notte is an FP and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

With 2014 behind us, we are finally able to assess the implications of Meaningful Use Stage 2 for Eligible Professionals. It is now clear – as anticipated – that the updated criteria have presented a significant challenge to many. In fact, it is predicted that only a fraction of those who attained Stage 1 of Meaningful Use will attest for Stage 2 for the 2014 year. As a result, physicians who have received financial incentives under the program will now face penalties, and may see a real impact on their bottom lines.

If it’s any consolation, there is hope (and even some evidence) that the Centers for Medicare & Medicaid Services will make a few amendments to the Meaningful Use program over the next few months. This will allow for additional flexibility for providers, and with any luck, will mean more people qualify in 2015. In this column, we’ll highlight the proposed changes and share a few observations from the first year of Stage 2.

Here’s what’s new

On Jan. 29, 2015, CMS released a proposed rule that would adjust the reporting period for 2015 – currently set for the entire year – to 90 days. While this is the same length as 2014, it would give providers an extra 9 months to upgrade software, systems, and work-flows to attest for Stage 2. For those who were able to take advantage of the CEHRT [certified EHR technology] Flexibility and continue Stage 1 in 2014, this may be just the reprieve needed to stay on track. For those who made an unsuccessful attempt at Stage 2 last year, this just makes the second try a bit easier.

In case you are wondering, if you “miss” a year of Meaningful Use, you simply continue as if you made it. In other words, under the current rule, if you are due to start a full year of Stage 2 reporting in 2015, you are still obligated to do so even if you were unsuccessful with 90 days of Stage 2 in 2014. The proposed rule would change that, and keep everyone’s reporting period at 90 days regardless of stage or year. (Remember: A 1% per year penalty is assessed for every year an eligible professional fails to meet the requirements, up to a maximum of 5%. These penalties continue indefinitely.)

CMS is considering other changes as well. Specifically, their press release states they are looking to “modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.” As of now, it is unclear what that might include, but a review of the challenges from 2014 may point to some strong possibilities. We’ll start with a principle we’ve dealt with previously:

Interoperability is hard

The most noteworthy changes from Stage 1 to Stage 2 are all requirements to pass information into and out of the EHR. These include: making records available through a secure patient portal, the ability to communicate with patients through electronic means, and the transmission of “summary of care” documents between providers. These requirements also happen to be the most challenging for physicians, because they rely on other systems and individuals to make the connections possible.

Up to this point, EHR vendors have not prioritized adopting established standards for data transmission, and Stage 2 really brought this shortcoming to light. So much so, that CMS considered it a valid reason to invoke the CEHRT Flexibility. By “limited exception” providers could continue with Stage 1 this past year if “their referral partners [did] not upgrade to 2014 Edition Certified EHR Technology” (i.e., doctors are given a pass on the need to send “summary of care” data if there’s no one around to receive it). But secure and reliable electronic communication with other physicians is just one area of struggle. Another that is arguably more difficult is communicating electronically with patients. Compared with the challenges of interoperability, we’ve observed that:

Patient care is even harder

It’s one thing to incentivize (or penalize) physicians for adopting Health Information Technology, but it is an entirely different thing to hold them responsible for whether or not their patients choose to embrace it. Unfortunately, the 2014 Meaningful Use measures seem to do just that. With quotas for providing “secure electronic access” through a patient portal, the MU program forces physicians to engage patients on a new virtual “playing field.” This may seem like a good thing on the surface, but it has been riddled with headaches for providers and patients alike.

With the dawn of EHR portals, physicians suddenly perceive a new level of exposure. Patients can now peer into their charts and uncover unfiltered diagnosis terminology or slightly abnormal lab values that may raise unwarranted concern. As a result, physicians have become much more conscientious about documentation, but most feel this is just one more layer of complexity to slow them down. Additionally, as patients discover the convenience and immediacy of secure e-mail, more care is now being delivered outside the context of an office visit. This requires a huge time commitment from physicians and, in most cases, provides no income – and this time demand is not limited to just the doctors! Office staff have the new and unwelcome task of providing technical support to patients for website problems, lost passwords, etc. All of these underscore this final observation:

This isn’t getting any easier

We realize this last point is self-evident, but its impact is hard to quantify. With every new stage of meaningful use, new requirements aimed at making care more efficient for patients only seem to make delivery of care much less efficient for physicians. As physicians become mired in regulations and visit volumes drop, care will ultimately become less efficient for everyone. In response to these and many other issues, we are hopeful to see some significant adjustments made to the timeline and requirements of meaningful use. In the meantime, we certainly acknowledge the challenges and as always invite your feedback and comments.

Dr. Notte is an FP and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

Do we physicians need LinkedIn? It depends. LinkedIn is the No. 1 social platform for professionals. However, many physicians feel that if they aren’t looking for a job, then LinkedIn isn’t useful. However, spending an hour to complete your LinkedIn profile may bring you more value than you imagined. That’s because LinkedIn is ranked highly by search engines, which means that when people, including patients or colleagues, search for information about you online, your LinkedIn profile will most likely show up. LinkedIn is important because it helps people find out about your educational background, professional experiences, and personal brand.

Because it’s easy, both to complete your profile and to use, LinkedIn is a good starting point for physicians who are trying to create a digital footprint. Moreover, unlike online physician review sites, you are in control of the content on your LinkedIn profile, so it’s a way for you to build your brand and showcase your expertise.

There are no ratings, but you can be endorsed by other LinkedIn members. Are you board certified? An expert in skin cancer? Do you do clinical research? Your colleagues can (and will) endorse you for those skills. Do the same for them. Importantly, when patients search for you, they will see that your colleagues have endorsed you for your excellence in those areas.

Ready to start using LinkedIn? It’s easy: Go to LinkedIn.com, select “register,” then fill out your profile. Be sure to include your educational background, medical expertise, areas of interest, professional experience, and links to your practice site online. Be thorough, because members with more complete profiles rank higher in search results.

Here are 15 tips for maximizing LinkedIn:

1. Upload a professional photo of yourself. According to LinkedIn data, users with photos are seven times more likely to be contacted about opportunities.

2. Use keywords to optimize your profile, including the name and geographic location of your practice.

3. List at least five skills that represent you accurately as a physician. For dermatologists, they might include, “Mohs” or “psoriasis expert.” (Resist the temptation to embellish.)

4. Build your network organically by starting with connections to people you already know. Unlike with Twitter or other social platforms, expert LinkedIn users do not accept connection requests to people they don’t know. If you really want to connect with someone, then ask a mutual connection for an introduction.

5. Aim for a minimum of 50 connections, which will improve your ranking on search results.

6. Include a link to your practice website, as well as contact information including your office address and phone number. LinkedIn is highly ranked by search engines, so it can drive traffic to your practice’s site, potentially leading to new clients.

7. Unlike with Twitter and Facebook, which encourage users to post personal experiences, LinkedIn content should be professional. Post pictures of your kid’s birthday party on Facebook. Post an article you’ve written about eczema on LinkedIn. Share links to quality content that will be valuable to your network.

8. Participate by sharing an academic or news article, recommending someone, or commenting on a group discussion. Shorts bursts of activity are fine on this social platform.

9. Be generous but selective with your recommendations, as they are a reflection of you. If you wouldn’t recommend that person in real life, then don’t recommend him or her on LinkedIn.

10. When asking someone for a recommendation, be specific. Specify which skills you’d like them to mention.

11. Consider joining LinkedIn Groups that match your professional expertise and interests. Participating in groups is a great way to show your expertise and manage relationships. Some examples of groups to which physicians belong include “Healthcare Physician Practice Management,” “The Medical Doctor (MD) Network,” and “Networking for Business Professionals and Doctors.”

12. To broaden your professional horizons, consider joining LinkedIn Groups that aren’t in your specialty. For example, you might be a practicing dermatologist who is hoping to start a telemedicine program. In that case, you should consider joining telemedicine or mHealth groups.

13. Include a link to your LinkedIn profile in your e-mail signature, on business cards, and on your practice website.

14. If you used LinkedIn to share original content such as blog posts or academic articles, or to stay abreast of news in your field, then consider using Pulse, an app that makes it easier to consume information on mobile devices.

15. Use the LinkedIn Events Page to promote upcoming events.

So next time you’re on LinkedIn, ask me to endorse you. So long as it’s not for president, I got you.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

Do we physicians need LinkedIn? It depends. LinkedIn is the No. 1 social platform for professionals. However, many physicians feel that if they aren’t looking for a job, then LinkedIn isn’t useful. However, spending an hour to complete your LinkedIn profile may bring you more value than you imagined. That’s because LinkedIn is ranked highly by search engines, which means that when people, including patients or colleagues, search for information about you online, your LinkedIn profile will most likely show up. LinkedIn is important because it helps people find out about your educational background, professional experiences, and personal brand.

Because it’s easy, both to complete your profile and to use, LinkedIn is a good starting point for physicians who are trying to create a digital footprint. Moreover, unlike online physician review sites, you are in control of the content on your LinkedIn profile, so it’s a way for you to build your brand and showcase your expertise.

There are no ratings, but you can be endorsed by other LinkedIn members. Are you board certified? An expert in skin cancer? Do you do clinical research? Your colleagues can (and will) endorse you for those skills. Do the same for them. Importantly, when patients search for you, they will see that your colleagues have endorsed you for your excellence in those areas.

Ready to start using LinkedIn? It’s easy: Go to LinkedIn.com, select “register,” then fill out your profile. Be sure to include your educational background, medical expertise, areas of interest, professional experience, and links to your practice site online. Be thorough, because members with more complete profiles rank higher in search results.

Here are 15 tips for maximizing LinkedIn:

1. Upload a professional photo of yourself. According to LinkedIn data, users with photos are seven times more likely to be contacted about opportunities.

2. Use keywords to optimize your profile, including the name and geographic location of your practice.

3. List at least five skills that represent you accurately as a physician. For dermatologists, they might include, “Mohs” or “psoriasis expert.” (Resist the temptation to embellish.)

4. Build your network organically by starting with connections to people you already know. Unlike with Twitter or other social platforms, expert LinkedIn users do not accept connection requests to people they don’t know. If you really want to connect with someone, then ask a mutual connection for an introduction.

5. Aim for a minimum of 50 connections, which will improve your ranking on search results.

6. Include a link to your practice website, as well as contact information including your office address and phone number. LinkedIn is highly ranked by search engines, so it can drive traffic to your practice’s site, potentially leading to new clients.

7. Unlike with Twitter and Facebook, which encourage users to post personal experiences, LinkedIn content should be professional. Post pictures of your kid’s birthday party on Facebook. Post an article you’ve written about eczema on LinkedIn. Share links to quality content that will be valuable to your network.

8. Participate by sharing an academic or news article, recommending someone, or commenting on a group discussion. Shorts bursts of activity are fine on this social platform.

9. Be generous but selective with your recommendations, as they are a reflection of you. If you wouldn’t recommend that person in real life, then don’t recommend him or her on LinkedIn.

10. When asking someone for a recommendation, be specific. Specify which skills you’d like them to mention.

11. Consider joining LinkedIn Groups that match your professional expertise and interests. Participating in groups is a great way to show your expertise and manage relationships. Some examples of groups to which physicians belong include “Healthcare Physician Practice Management,” “The Medical Doctor (MD) Network,” and “Networking for Business Professionals and Doctors.”

12. To broaden your professional horizons, consider joining LinkedIn Groups that aren’t in your specialty. For example, you might be a practicing dermatologist who is hoping to start a telemedicine program. In that case, you should consider joining telemedicine or mHealth groups.

13. Include a link to your LinkedIn profile in your e-mail signature, on business cards, and on your practice website.

14. If you used LinkedIn to share original content such as blog posts or academic articles, or to stay abreast of news in your field, then consider using Pulse, an app that makes it easier to consume information on mobile devices.

15. Use the LinkedIn Events Page to promote upcoming events.

So next time you’re on LinkedIn, ask me to endorse you. So long as it’s not for president, I got you.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

Do we physicians need LinkedIn? It depends. LinkedIn is the No. 1 social platform for professionals. However, many physicians feel that if they aren’t looking for a job, then LinkedIn isn’t useful. However, spending an hour to complete your LinkedIn profile may bring you more value than you imagined. That’s because LinkedIn is ranked highly by search engines, which means that when people, including patients or colleagues, search for information about you online, your LinkedIn profile will most likely show up. LinkedIn is important because it helps people find out about your educational background, professional experiences, and personal brand.

Because it’s easy, both to complete your profile and to use, LinkedIn is a good starting point for physicians who are trying to create a digital footprint. Moreover, unlike online physician review sites, you are in control of the content on your LinkedIn profile, so it’s a way for you to build your brand and showcase your expertise.

There are no ratings, but you can be endorsed by other LinkedIn members. Are you board certified? An expert in skin cancer? Do you do clinical research? Your colleagues can (and will) endorse you for those skills. Do the same for them. Importantly, when patients search for you, they will see that your colleagues have endorsed you for your excellence in those areas.

Ready to start using LinkedIn? It’s easy: Go to LinkedIn.com, select “register,” then fill out your profile. Be sure to include your educational background, medical expertise, areas of interest, professional experience, and links to your practice site online. Be thorough, because members with more complete profiles rank higher in search results.

Here are 15 tips for maximizing LinkedIn:

1. Upload a professional photo of yourself. According to LinkedIn data, users with photos are seven times more likely to be contacted about opportunities.

2. Use keywords to optimize your profile, including the name and geographic location of your practice.

3. List at least five skills that represent you accurately as a physician. For dermatologists, they might include, “Mohs” or “psoriasis expert.” (Resist the temptation to embellish.)

4. Build your network organically by starting with connections to people you already know. Unlike with Twitter or other social platforms, expert LinkedIn users do not accept connection requests to people they don’t know. If you really want to connect with someone, then ask a mutual connection for an introduction.

5. Aim for a minimum of 50 connections, which will improve your ranking on search results.

6. Include a link to your practice website, as well as contact information including your office address and phone number. LinkedIn is highly ranked by search engines, so it can drive traffic to your practice’s site, potentially leading to new clients.

7. Unlike with Twitter and Facebook, which encourage users to post personal experiences, LinkedIn content should be professional. Post pictures of your kid’s birthday party on Facebook. Post an article you’ve written about eczema on LinkedIn. Share links to quality content that will be valuable to your network.

8. Participate by sharing an academic or news article, recommending someone, or commenting on a group discussion. Shorts bursts of activity are fine on this social platform.

9. Be generous but selective with your recommendations, as they are a reflection of you. If you wouldn’t recommend that person in real life, then don’t recommend him or her on LinkedIn.

10. When asking someone for a recommendation, be specific. Specify which skills you’d like them to mention.

11. Consider joining LinkedIn Groups that match your professional expertise and interests. Participating in groups is a great way to show your expertise and manage relationships. Some examples of groups to which physicians belong include “Healthcare Physician Practice Management,” “The Medical Doctor (MD) Network,” and “Networking for Business Professionals and Doctors.”

12. To broaden your professional horizons, consider joining LinkedIn Groups that aren’t in your specialty. For example, you might be a practicing dermatologist who is hoping to start a telemedicine program. In that case, you should consider joining telemedicine or mHealth groups.

13. Include a link to your LinkedIn profile in your e-mail signature, on business cards, and on your practice website.

14. If you used LinkedIn to share original content such as blog posts or academic articles, or to stay abreast of news in your field, then consider using Pulse, an app that makes it easier to consume information on mobile devices.

15. Use the LinkedIn Events Page to promote upcoming events.

So next time you’re on LinkedIn, ask me to endorse you. So long as it’s not for president, I got you.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

Hello Dr. Danielsen,

Your statement about the profit-driven health system captured my attention.

The US health care system is probably the most expensive in the world, and yet it was rated the worst in terms of its overall ranking for quality of care, access, and efficiency. (I got this information while I was in graduate school studying health care policy.) This resonates with your statement about the entrepreneurial and corporatized US health care system.

I surmise that the high cost of health care may be partly due to the over-utilization of services, and technology and drug charges that may not be necessarily effective. As a researcher, I support the role of Comparative Effectiveness Research as a cost-efficiency strategy by identifying and eliminating the "me too" drugs and services that are found to be less or not efficacious.

As a supporter of the PA profession, I think PAs are part of the solution to help mitigate the deficiency in access to health care. In addition, using PAs in place of physicians for certain services can defray the rising cost of health care. There's been data to show that PAs can perform 80% of the duties performed by physicians. PAs should find the right platform to be heard and integrated into all state or federal health care programs.

Maribelle Guloy, MSHS, CCRP
Executive Director
Clinical Research
Montebello, California 

Hello Dr. Danielsen,

Your statement about the profit-driven health system captured my attention.

The US health care system is probably the most expensive in the world, and yet it was rated the worst in terms of its overall ranking for quality of care, access, and efficiency. (I got this information while I was in graduate school studying health care policy.) This resonates with your statement about the entrepreneurial and corporatized US health care system.

I surmise that the high cost of health care may be partly due to the over-utilization of services, and technology and drug charges that may not be necessarily effective. As a researcher, I support the role of Comparative Effectiveness Research as a cost-efficiency strategy by identifying and eliminating the "me too" drugs and services that are found to be less or not efficacious.

As a supporter of the PA profession, I think PAs are part of the solution to help mitigate the deficiency in access to health care. In addition, using PAs in place of physicians for certain services can defray the rising cost of health care. There's been data to show that PAs can perform 80% of the duties performed by physicians. PAs should find the right platform to be heard and integrated into all state or federal health care programs.

Maribelle Guloy, MSHS, CCRP
Executive Director
Clinical Research
Montebello, California 

Hello Dr. Danielsen,

Your statement about the profit-driven health system captured my attention.

The US health care system is probably the most expensive in the world, and yet it was rated the worst in terms of its overall ranking for quality of care, access, and efficiency. (I got this information while I was in graduate school studying health care policy.) This resonates with your statement about the entrepreneurial and corporatized US health care system.

I surmise that the high cost of health care may be partly due to the over-utilization of services, and technology and drug charges that may not be necessarily effective. As a researcher, I support the role of Comparative Effectiveness Research as a cost-efficiency strategy by identifying and eliminating the "me too" drugs and services that are found to be less or not efficacious.

As a supporter of the PA profession, I think PAs are part of the solution to help mitigate the deficiency in access to health care. In addition, using PAs in place of physicians for certain services can defray the rising cost of health care. There's been data to show that PAs can perform 80% of the duties performed by physicians. PAs should find the right platform to be heard and integrated into all state or federal health care programs.

Maribelle Guloy, MSHS, CCRP
Executive Director
Clinical Research
Montebello, California 

Religious exemptions to vaccinations are a contradiction in terms and should be eliminated, Dr. Paul A. Offit opines in his op-ed in The New York Times, “What Would Jesus Do About Measles?”

Measles is back in the United States because of a lack of herd immunity that has three sources: Nineteen states have philosophical exemptions to vaccination, 47 states have religious exemptions, and parents are not afraid of measles, according to Dr. Offit.

But Dr. Offit, a pediatrician who is chief of the division of infectious diseases and the director of the vaccine education center at Children’s Hospital of Philadelphia, said he is afraid of measles because he has seen what an outbreak can do. In the Philadelphia outbreak between October 1990 and June 1991, more than 1,400 people were infected with measles, and 9 children died. The outbreak centered around two fundamentalist Christian churches, the members of which did not vaccinate their children and did not take them to the hospital when they were infected. One-third of those who were infected during the outbreak belonged to one of the two churches and six of the nine children who died were members of the congregations, according to a Centers for Disease Control and Prevention report.

To read the entire article go to: The New York Times Feb. 10, 2015

Religious exemptions to vaccinations are a contradiction in terms and should be eliminated, Dr. Paul A. Offit opines in his op-ed in The New York Times, “What Would Jesus Do About Measles?”

Measles is back in the United States because of a lack of herd immunity that has three sources: Nineteen states have philosophical exemptions to vaccination, 47 states have religious exemptions, and parents are not afraid of measles, according to Dr. Offit.

But Dr. Offit, a pediatrician who is chief of the division of infectious diseases and the director of the vaccine education center at Children’s Hospital of Philadelphia, said he is afraid of measles because he has seen what an outbreak can do. In the Philadelphia outbreak between October 1990 and June 1991, more than 1,400 people were infected with measles, and 9 children died. The outbreak centered around two fundamentalist Christian churches, the members of which did not vaccinate their children and did not take them to the hospital when they were infected. One-third of those who were infected during the outbreak belonged to one of the two churches and six of the nine children who died were members of the congregations, according to a Centers for Disease Control and Prevention report.

To read the entire article go to: The New York Times Feb. 10, 2015

Religious exemptions to vaccinations are a contradiction in terms and should be eliminated, Dr. Paul A. Offit opines in his op-ed in The New York Times, “What Would Jesus Do About Measles?”

Measles is back in the United States because of a lack of herd immunity that has three sources: Nineteen states have philosophical exemptions to vaccination, 47 states have religious exemptions, and parents are not afraid of measles, according to Dr. Offit.

But Dr. Offit, a pediatrician who is chief of the division of infectious diseases and the director of the vaccine education center at Children’s Hospital of Philadelphia, said he is afraid of measles because he has seen what an outbreak can do. In the Philadelphia outbreak between October 1990 and June 1991, more than 1,400 people were infected with measles, and 9 children died. The outbreak centered around two fundamentalist Christian churches, the members of which did not vaccinate their children and did not take them to the hospital when they were infected. One-third of those who were infected during the outbreak belonged to one of the two churches and six of the nine children who died were members of the congregations, according to a Centers for Disease Control and Prevention report.

To read the entire article go to: The New York Times Feb. 10, 2015

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Measles vaccination must be mandatory, Dr. Robert Pearl asserted in an article in Forbes.

There is no effective treatment once children or adults contract measles; patients may experience high fevers and are at risk to develop bronchitis, secondary pneumonia, encephalitis, or hearing damage. They may die, said Dr. Pearl , a plastic and reconstructive surgeon who is CEO of The Permanente Medical Group.

Measles is extremely contagious; its airborne particles can remain infectious for up to 2 hours. Yet 19 states allow personal exemptions for vaccination.

Dr. Pearl stated, “As a society, we don’t condone behavior that puts others at risk for injury or death. There are no exemptions for laws that prohibit drunk driving, for example.

Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves. Those who remain unvaccinated pose a great risk to many, including: all children under 1 year old who are too young to be vaccinated, older adults who don’t know their immunity has lapsed, and others with impaired immune systems.”

To read the entire article, go to Forbes Feb. 5, 2015

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.

Physicians who espouse views based on anecdotes, myths, or ideology, especially in the middle of an epidemic, should have their medical licenses revoked, said Arthur L. Caplan, director of the division of medical ethics at New York University Langone Medical Center’s department of population health.

In a commentary about measles vaccination in The Washington Post, Mr. Caplan outlined in detail why three physicians who have made public their views against vaccination can and should lose their medical licenses, in his opinion.

A doctor is held to a higher standard than the average person, and “must consider the public health and the patient good in all that he says in his role as expert. To do otherwise ... is unprofessional. It might even constitute misconduct if it contributed to an epidemic. Counseling against vaccination is exactly that kind of misconduct,” he said.

To read the entire article, go to: The Washington Post, Feb. 7, 2015.

*Correction, 2/19/2015: An earlier version of this article carried a headline that misstated Dr. Kaplan’s profession.