Mission: Our role as an organization in creating the world we envision The mission of the New Hampshire Medical Society is to bring together physicians to advocate for the well-being of our patients, for our profession and for the betterment of the public health

Vision: The world we hope to create through our work together The New Hampshire Medical Society envisions a State in which personal and public health are high priorities, all people have access to quality health-care, and physicians experience deep satisfaction in the practice of medicine

NH Medical Society

7 North State Street

Concord, NH 03301

(603) 224-1909

(603) 226-2432 fax

nhmed@nhms.org www.nhms.org

John Robinson, MD ......... President Palmer P. Jones .........................EVPCatrina Watson ....................... Editor

President’s Remarks .......................... 1Farewell ............................................... 6CME, Meetings.................................... 7Inauguration Photos .......................... 8Risk Management............................... 9Palmer Jones Award ........................ 10CAPS ................................................. 11

Do you or a colleague need help?The New Hampshire Professionals’ Health Program (NH PHP) is here to help! The NH PHP is a confidential resource that assists with identification, intervention, refer-ral, and case management of NH physicians, physician assistants, dentists, and dental hygienists who may be at risk for or affected by substance use disorders, behavioral/mental health conditions, or other issues im-pacting their health and well-being. NH PHP provides recovery documentation, education, support, and advocacy – from evaluation through treatment and recovery. For a confidential consultation, please call Dr. Sally Garhart @ (603) 491-5036

Opinions expressed by authors may not always reflect official NH Medical Society positions. The Society reserves the right to edit contributed articles based on length and/or appropriateness of subject matter. Please send correspondence to “Newsletter Editor” at the above address

Physicians Bi-Monthly

NEW HAMPSHIRE MEDICAL SOCIETY NEWSLETTERNH Medical Society; For The Betterment of Public Health Since 1791

January/February 2010

New Hampshire Medical Society Welcomes its 178th PresidentChanging Physician Employment Demographics: Challenges and OpportunitiesTaken from the inaugural speech of John Robinson, MD

Along with the rest of the country, physi-cians are witnessing an overdue tectonic shift in the way health care is organized and paid for in this country. These federal reforms will compound and magnify other changes already underway and, combined, will likely transform the very nature of the profession of medicine. I hope here to highlight some of these changes, to explore some of their implications and sound a call to action for more physicians to shift from a reactive to proactive involvement as this revolution unfolds.

A Personal Illustration of the Changing ProfessionI am compelled to focus on these changes because your election of me to be the 178th president of the New Hampshire Medical Society is itself illustrative of some of the

shifts in practices and attitudes in the medi-cal profession. Not all member physicians outside of the Executive Council and Committee are fully aware that 15 years ago, I left my solo neu-rology practice in Portsmouth to start a sec-ond career in administrative medicine as an associate medical director for Healthsource. I had a variety of reasons for this change including the model of my own father, in attendance here tonight, who undertook a late life career change by leaving his general practice in rural Pennsylvania to start a psy-chiatry residency at Maine Medical Center; if he could do it, so could I. But not everyone saw my career change as a positive thing. At that time in 1995, I was the Vice President of the Medical Society expecting to move along the executive officer chain as was the normal progres-

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sion. But 15 years ago electing a health insurance medical director to the office of President was not a tolerable idea even to the Executive Committee, let alone the membership and so I was not nominated to become President-Elect. To the great credit of the Society however, a new At-Large position was con-structed and I was able to continue to participate in the leadership of the organization. After a two year “exile” from the Medical Society while working at a Medicaid plan in Massachusetts during their health care reform, I was repatriated to New Hampshire by Schaller Anderson, an Aetna company with a NH Medicaid contract and again offered my services to the Society. This time I was not only welcomed back but placed immediately in the executive officer line-up. As I said, things are changing.

The ChangesBut let us examine some of these changes in the profession further. In particular let us explore the changes in employment demographics for physicians that are sweeping inexorably over the state and the country and let us consider the ripple effects of those changes and then let us construct some possible responses.First let me share a startling factoid provided by Steve Ahnen, EVP of the NH Hospital Association: fully 70% of primary care physicians in NH are em-ployed by hospitals or clinics. This figure is really an educated guess because in fact specific statistics about employment status are only now being tabu-lated by the Board of Medicine in the process of physician license renewals and reliable statistics will not be available for another cycle or two.Surveys conducted by the Center for Studying Health System Change provide a snapshot of fig-ures at a national level. One of the principle drivers of employment change is the decreasing ability of small practice self-employed physicians to afford fixed cost overhead for items such as EMR systems, malpractice premiums, education loans and recruit-ment. Also data collection requirements necessary to realize bonus incentives may be significant. Increas-ingly, even specialist physicians are participating in this shift.Many such changes started in reaction to managed care activities in the 90’s such as a trend toward multi-specialty groups. Lately the trend has been away from multi-specialty

groups and toward large single specialty practices, in part in an effort to leverage more favorable contract terms and in part because the backlash against the overreaches of managed care in the 1990’s led to less restrictive network arrangements.But the size of even single specialty practices is shifting significantly away from solo and small group practices toward mid-size practices employing six to 50 physicians. More importantly for this presenta-tion, physicians increasingly are giving up practice ownership in favor of employment by large orga-nizations. Again, this is true not only for primary care but for medical and surgical specialties as well. Although there are greater opportunities for proce-duralists to gain economies of scale from ownership of diagnostic and treatment devices and ambulatory facilities even they are not immune to the larger economies afforded by hospitals and integrated delivery systems.

Practice Characteristics Accompanying the ChangesThe shift away from private ownership of small prac-tices has been accompanied by a shift in compensa-tion arrangements away from those based purely on the financial performance of the practice. Many practices favor productivity adjustments to individual physician income. While quality-of-care, peer-pro-filing and patient satisfaction measures still account only for 10-15% of compensation, more in primary care practices and more often in smaller practices, this factor continues to increase and is likely to be accelerated by federal reform efforts. The trend away from very small practices toward larger non-owned practices is actually higher among physicians 51 years and older although small prac-tice ownership is still highest among older physi-cians. The lower trend among young physicians is explained partly by the lower number in small and owned practices to begin with; they were more likely to join large practices right out of training than was the case with older physicians. From this factor alone, a generation from now there will likely be only a handful of small owned practices in existence. Importantly for federal reform plans, the acceptance of new Medicaid patients varies by practice charac-teristics. Those in larger practices or in specialties dealing with episodic conditions and those in rural areas, are more likely to accept new Medicaid

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patients. But primary care physicians in mid-size practices, especially those with institutional owner-ship are less likely to accept new Medicaid patients. This is also the case with acceptance of any charity care cases.

Implications and Effects of the ChangesQuality and Administrative ActivitiesFinding adequate physician human capital to attend to governance and quality improvement activities has been a perennial problem. Now regulatory and accreditation requirements along with quality-based reimbursement incentive programs are increasing the demand for physician administrative work at the same time that productivity demands and increasing complexity of patient care administrative needs are reducing the time available for physicians to meet these needs.Employment trends may compound these problems. Administrative duties are unavoidable for physicians in small practice settings and a certain pride of own-ership may increase the sense of satisfaction from tending to these tasks. In larger practices however it may be easier to let someone else step forward for such duties. Further, younger physicians comprised of an increasing percentage of part-time workers and females, who place a higher value on lifestyle priori-ties, compounds the challenges. On the other hand, employed status may engender more engagement for administrative duties including quality improvement work, especially if they are part of the salary structure. However financial compensa-tion by itself does not necessarily lead to effective-ness. So one question is whether the move toward larger practices and employed status is reducing the sense of mission felt by physician providers as they engage in their daily work. And if that sense of mission is diluted then what are the implications for physicians taking a leadership role for activities out-side of their work setting? They would be even less inclined to participate in ad hoc task forces which might be convened to fully realize the promises of federal health reform efforts than they are to engage in the bureaucratic activities of their own organiza-tion.One other solution to the problem of insufficient physician human capital for administrative activities has been to hire physicians specifically dedicated to these requirements. These are the Chief Medical

Officer (CMO) and Vice President of Medical Af-fairs (VPMA) positions that almost all mid-size and large hospitals have developed over the last several years. Typically CMO positions are focused more on hospital medical staff policy issues including documentation, credentialing and disruptive behavior policies whereas VPMA positions are more often fo-cused on hospital and clinic affiliated providers and their governance, technical and quality improvement infrastructure.Having such dedicated administrative physicians does much to ensure continuity and effectiveness of effort compared to the volunteer part-time members of a medical staff, a critical element for success when dealing with accreditation and contracting activi-ties. But one challenge for this new arrangement is the effect on cohesiveness of medical professional cultures and attitudes. Is the CMO seen by the rest of the staff as a shill for hospital administration? Is the VPMA tending to the needs of the employed physicians differently than for the independent practitioners on the staff? Similar to the issues of the emerging hospitalist movement, another emerg-ing employment trend, there is a question of whether increased efficiency in one arena is coming at the cost of increased fragmentation of care delivery and professional relationships.

Medical EthicsMedical professionals moved from a simple ethical standard of beneficence in the patriarchal days of medicine to one inclusive of concerns for the prin-ciple of patient autonomy. The profession now faces the prospects of more systematically addressing the principle of justice whereby we are directly charged with decisions involving the allocation of scarce resources. As physician employment demographics change there is a possibility that this previous separation of physicians from any in-depth knowledge of the cost of care may accelerate. Insofar as a physician owes an obligation to his employer, she must consciously husband the employer’s resources. Will doctors at-tend too much to use of their employer’s resources but not enough to any cost implications for patients? Since they may not be as fully engaged in the fiduciary operation of the organization compared to physicians who own their own practices, employed doctors may defer to managers and administrators.

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Patients may then get less information than they need about the costs of care decisions which, in turn, could increase non-adherence rates as they find themselves unable to afford the doctor’s recommendations.

Acceptance of New Patients and Government Payment ProgramsThe likely effects of acceptance rates for new pa-tients, particularly those with government sources of payment, are difficult to predict. On the one hand increasing institutional ownership appears to indi-cate decreasing acceptance of government payment programs, especially Medicaid with its poor reim-bursement rates. Insofar as federal reform efforts rely on enrollment of previously uninsured patients into Medicaid expansion programs, access for these newly covered patients could prove problematic, es-pecially in non-rural areas. On the other hand cover-age of previously uninsured patients reduces the need to provide charity care. This positive effect on access to health care will be magnified if new coverage op-tions include reimbursement rates at Medicare levels or better. But, as the Massachusetts experience has taught us, there is a pent up demand for primary care services which could significantly tax system capac-ity once coverage is available.

Emergence of Accountable Care Organizations (ACO)

The concept of an ACO is still quite new in the medi-cal world. There are no fully functioning ACOs any-where in the country although some of the larger and more mature delivery systems such as Inter-Moun-tain Health Care in Utah and The Geisinger Clinic in Pennsylvania contain most of the elements necessary to take this concept from theory to practice. Design principles are still being worked out but likely would include a robust governance structure, advanced abil-ity to share clinical information electronically, data gathering and analysis capacity and financial distri-bution capabilities. In many ways the concept of an ACO is an expansion of the concept of the Patient Centered Medical Home (PCMH). In the PCMH there is a premium paid for undertaking coordina-tion of care activities centered on patient needs and values in a primary care setting. In a fee for service environment such efforts are not reimbursable. The ACO expands these concepts so that an entire system of care is incented in the direction of devoting the

resources to communication and collaboration such as researching the particulars of a patient situation to determine whether a given intervention is duplicative contrary to another provider’s plan of care for that patient.In terms of the effects of changing employment demographics on the viability of the ACO concept, again the effects are not clear at this time. Employed status would perhaps allow the employer, probably a hospital, to direct its staff to participate in the ACO model and to make sure that physicians are engaged in its design and operation. Additionally an em-ployed situation makes it more likely that a unified EMR or other communications system is available and used effectively. Conversely small, largely rural areas such as NH are likely to have difficulty gath-ering all the necessary providers including special-ists under one organization and the divide between employed and independent practitioners in such com-munities may be very difficult to bridge so that true integration may not be achieved.

Responses and a Call to ActionThe challenge to the profession of medicine and to the Medical Society is how to embrace these chang-es. How do we cultivate further the positive effects of these changes on society and on health care? How do we preserve the special, indeed sacred, nature of the doctor-patient relationship where the balance remains in favor of the moral principles of physi-cian beneficence and patient autonomy while not discounting the principle of distributive justice when allocating scarce resources? How do we keep the practice of medicine an enjoyable and uplifting call-ing?Let me suggest a few answers to these questions.First, medical care is always about the patient; but we need to continue to cultivate and broaden that concept. We need to find ways to move beyond the complaint- or disease- or episode-driven interaction with a patient to a more holistic evaluation of their total needs, a so-called biospychosocial model of care. And we should strive to learn more about the drivers of patient satisfaction and not just be content with good medical outcomes.Second, helping our patients with cost considerations requires that we expend more effort to compile a working knowledge of the costs of care that we are ordering. Some data sets have been constructed in

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NH to bring greater transparency to cost informa-tion for providers and consumers, for example the all payer data set of the NH Department of Insurance and the data found at NH Health Cost along with information at the NH Hospital Association web site. But much more needs to be done. In terms of comparative data, one concrete proposal being discussed in NH envisions an all-payer and all-provider database similar to the Regional Health Information Exchange in operation in Maine. Dis-cussions to date have involved the construction of a “trusted independent entity” yet to be further defined but possibly a State or Regional Health Improve-ment Collaborative that would be funded voluntarily by insurance plans and perhaps hospitals and other sources. This independent entity would have respon-sibility for analysis and reporting with results made available to health care delivery systems to help them operate an ACO. Physicians should engage in the further discussion about this concept, ensuring that the data is indeed meaningful, transparent and properly adjusted to reflect different health and insur-ance risks.Third, we need to do all we can to cultivate more physician leaders and change champions. Over the last decade the NH Medical Society Executive Coun-cil and Committees have had increasing representa-tion from administrative physicians including man-aged care medical directors. But we have had little representation by hospital Chief Medical Officers or VPs of Medical Affairs and we have had virtually no representation from hospitalists. The Foundation for Healthy Communities operates a CMO committee to share best practices and discuss challenges and opportunities for their specialty. To my knowledge there is no similar venue for VPs of Medical Affairs. I propose that we should do more to facilitate inter-actions among and between these emerging special-ties and to bring their perspectives to the operations of the Medical Society. In addition we would be well-advised to encourage open and frank dialogue between these specialties and physicians who are and who prefer to remain independent practitioners. As with the Third Party Payer Liaison Committee of the Medical Society, venues and forums such as I envi-sion would reduce misunderstandings and misap-prehensions about motives and agendas. They would help to ensure that we engage in constructive rather than destructive exchanges and are seen by others as leaders rather than obstructionists in the evolution of health care.

SummaryThe medical profession in NH is far up the face of a wave of change that, with the promises and challeng-es of federal health reform, is about to crest and alter the nature of professional practice for the foreseeable future. Decreasing practice ownership and increas-ing employment status trends are well-established and will accelerate. Physician compensation will be increasingly tied to productivity, quality and satisfac-tion metrics. More slowly due to cultural, political and technical issues, health care delivery systems are being reorganized away from solo practitioners engaged in individual encounters in a fee-for-service environment toward true clinical integration and teamwork mentality supported by information infra-structures and focused on patient-centered values and interests.Many of these changes will create strife and upheav-al for some physicians. But most changes are desir-able and will better serve the interests of individual patients and society at-large in terms of moderation of costs and major improvement in the consistency and quality of health care. The medical profession in general and the Medical Society specifically should embrace these changes but in such a way as to ensure the preservation of the core values of the doctor-patient relationship. We should continue to facili-tate interaction and dialogue with physicians in all specialties including administrative specialties and with physicians in all types of employment settings, avoiding any sort of guild mentality. We should rejuvenate the professional value of collegial sharing of expertise and mentoring each other. And we strive again to seek and maintain leadership among all stakeholders as health care reform evolves. Thank you.John Robinson, MD

Thank you to our dinner sponsors:

AETNA, Anthem Blue Cross and Blue Shield, New England Employee Benefits Company, Portsmouth Regional Hospital and Sulloway & Hollis

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It has been a pleasure to serve as President of the NHMS in 2009.

Not surprisingly, it has been very busy but it has also been fun to travel around to a number (nine) of the state’s hospitals to discuss some of the issues the NHMS is working on. The visits have given me

a much broader insight into the issues we face around the state in trying to practice high quality medicine.

I have also had the opportunity to partake in several political forums, three different trips to Washington, DC as well as AMA meetings in Orlando and Chicago. These events, particularly in this year of intense work on health care reform, have given me the chance to voice some of the is-sues of concern to physicians and also learn much about how our political system works. Please be in touch with your state and federal representatives when there are issues of importance to the practice of medicine. If you don’t speak up, these issues will be ignored by those making policy! The AMA makes it super easy with an “800” number

that will connect you to your representatives office in less than one minute.

I had hoped to focus some of this year on topics of communication. We had a successful annual scientific meeting in Durham with excellent pre-sentations on various aspects of communication in medicine. We have also upgraded our commu-nications in our Bi-Monthly newsletter as well as adding a “president’s note” and expanded bulletin board in the weekly E-News.”

The NHMS has added two energetic and excellent physicians to our presidential line:

Bill Kassler and Cindy Cooper.

We will bring on a new executive vice-president this summer as Palmer Jones retires. I am opti-mistic that the NHMS will continue in its mission of improving the public health and making the practice of medicine deeply satisfying for all of us who take care of patients.

A special thanks to the staff at the NHMS who continue to move the organization forward in our ability to improve the health of New Hampshire citizens and help to make it satisfying to practice medicine in New Hampshire.

Thank you for this opportunity to represent you.

Charles Blitzer, MD

A reflection on serving as President of the NHMS in 2009:

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CME MEETINGS & EVENTS

A Discourse on Suicide Through Film

The Suicide Prevention Council invites you to join us for a viewing of Ordinary People.

The movie will be followed by a discussion facilitated by Humanist Maren Tirabassi for those who wish to participate

Ordinary People will be shown at Derry Public Library on February 27th from 1-4pm and Portsmouth Community

Campus February 28th from 1-4pm. Email catrina.watson@nhms.org for registration information

SAVE THE DATE: May 12, 2010 Grappone Center

Concord, NH

Getting a Handle On Autism: Screening, Diagnosis, Treatment and

Support in the Pediatric Medical Home

NH Pediatric Society (NHPS)

SAD Lonely Accept Why?

Silence Pain Cry Sin? Hurt ANGER regret Love

Hope LOST

Guilt Save Faith

HEAL Withdrawn Grow Help Sorry TearsForgive

CME IN THE WHITE MOUNTAINS April 16-18 Mountainview Grand Resort

Female Urinary Incontinence Erectile Dysfunction

Female Sexual DysfunctionNutrition

Cardiovascular DiseasePractice

Enhancement

Many activities available at the hotel including swimming, horseback riding, hiking, spa treatments, fitness center,

game room and more

Catrina.watson@nhms.org for information or visit www.nhafp.org for brochure

*This program has been awarded 15.5 CME credits by American Academy of Family Physicians

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PRESIDENT’S INNAUGURATION

Carol Sobelson, Seddon Savage, MD, Carl Cooley, MD, Front: Karl Lanocha, MD, Julie Lanocha, Pamela Clairmont, Tom Clairmont, MD,

Gary Sobelson, MD

Bill Shaheen, Sally Abdulla, MD, Alwan Haider, Dr. Selesnick, Linda Selsnick, Jen Frizzell; Front: Cinde Warmington, Karyn Forbes, Bill Christie and Don

Crandlemire (all of Shaheen & Gordon)

Jeanine Poole, Mike Lehman, Doug Chamberlain, Front: Jan McClure, (Mrs. Mike Lehman), Peter Meyer, Nicole Schultz-Price, Martin Honigberg, Melissa Hanlon

Peter Forssell, MD, Gary Woods, MD, Charles Blitzer, MD , Mae Bradshaw, Burt Dibble, MD, Front: Mary Forssell, Renia Woods, Janet Monahan, William Kassler,

MD, Doris Lotz, MD

Rear Left to Right: Brianna Kling, Travis Murray, Edward Robinson, MD, Front: John Robinson, MD, Ellen Perry Harris, Jacquelyn Robinson

Albee Budnitz, MD, Barbara Brown, Renata Dutton, Catrina Watson, Front: Vivian Rowe, Devra Cohen, MD, Mark Sadowsky, MD, Joy Potter, Mary Pyne

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Faxing Patient Information Maintaining the confidentiality of patient informa-tion is the responsibility of all healthcare entities. Communication of patient information occurs through many different mediums including tradi-tional paper and electronic faxing. When faxing is used, a policy should be in place to assure that the confidentiality of the information is protected.Policy The following elements should be consid-ered for inclusion in a policy. I. Location

• Assure the fax machine or computer (if faxing electronically) is located in a secure area, not accessible to unauthorized per-sons.

II. Faxing Documents • Cover sheet should display:

• Date and time of transmission • Sender facility name, address and

sender’s name if relevant • Patient’s name • Receiving facility’s name, telephone

number, fax number • Authorized receiver’s name • Number of pages transmitted • Statement addressing redisclosure of

information • Instructions to verify receipt of

documents • Verify availability of receiver before

beginning transmittal. • Request authorized receiver to acknowl-

edge the receipt of the documents. • Document the receiver’s acknowledg-

ment in the patient’s medical record.III. Receiving Fax

• Paper method • Identify one individual to monitor the

fax machine.

• Remove the documents from the tray immediately upon completion of the transaction.

• Count the number of pages to assure the correct number was received.

• Read cover letter and follow the instruc-tions for acknowledgement of the trans-mission.

• Deliver or send the documents electroni-cally to the intended receiver.

IV. Misdirected Fax • If a fax transmission fails to reach re-

cipient, check internal logging system of the fax machine (for paper faxes) to obtain recipients fax number or retrieve through the software program, the fax number to which an electronic fax was sent. Fax a request to the recipient, using the incorrect fax number, explaining the misdirection and asking that all received documents be immediately returned via mail. Note that electronic faxes may be able to be rerouted to the sender.

• Notify the sending physician of the error and the corrective action taken.

• Keep a log of misdirected faxes, identify causes/trends and implement procedural changes to prevent a reoccurrence.

V. Faxes should not be used: • As the sole notification method of abnor-

mal test results • To communicate urgent requests

VI. Faxing Prescriptions • Laws and regulations for faxing prescrip-

tions must be followed and may vary by state. For Schedule II Controlled Substances and III-V Substances please refer to the Drug Enforcement Administration (DEA) website or access the latest version of the Drug Enforcement Administration Practitioner’s Manual also found on-line.

Medical Mutual Insurance Company of Maine: Risk Management Practice Tip

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SummaryImplementation of the above recommendations will assist in minimizing the risk of unauthorized ac-cess and the breach of patient confidentiality. While utilizing either method to fax patient information is acceptable, electronic faxing may offer greater security. Faxing directly from a software program allows faxes to be directed from the privacy of the user’s computer. Incoming faxes can be password protected and can be directed only to specified individuals, thereby, assuring tighter security. The electronic option prevents access by unauthorized individuals and the potential misplacement or loss of a paper document.

Medical Mutual’s “Practice Tips” are offered as reference information only and are not intended to es-tablish practice standards or serve as legal advice. MMIC recommends you obtain a legal opinion from a qualified attorney for any specific application to your practice.♣

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The AMA presented Palmer Jones, EVP of NHMS, with the 2009 Medical Executive Lifetime Achieve-ment Award to honor his contributions to the goals and ideals of the medical profession. The award was presented at the AMA’s semi-annual policy making meeting in Houston.Palmer Jones has served the physicians of NH as the Executive Vice President of the state medical society with integrity, distinction and dedication for 24 years. He is as patient and supportive of those physicians and students who are just learning the process of leg-islation and leadership as he is with the most seasoned veteran. He has also earned the respect of the leader-ship in our statehouse, our state hospital association and our Congressional delegation.Palmer considers his service to physicians as a “call-ing” rather than a job. He understands the stress of practicing medicine and the priorities physicians place on the care for their patients. His kindness and his empathy are unmatched.Palmer taught those of us who have worked with him many valuable lessons. Each of us who have had the privilege of his guidance carries those lessons with us and uses them daily. We are never “angry.” Rather we are “confused” and need “clarification.” We know that our adversary today may well be our ally tomorrow.

Palmer is respectful of physicians, treating all as equals. As the only male on the NH Medical Society staff, he is truly a “man among women!”I know that I am not the only physician that Palmer has gently guided into a leadership role; that is his strength and the reason we all care so deeply for him. It is therefore with the greatest respect and admi-ration that I place the name of Palmer P. Jones into nomination for this well-deserved recognition. ~ Georgia Tuttle, MD

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The New Hampshire Medical Society

Corporate Affiliates

NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org

Affinity Marketing Group Anthem BCBSAthenahealth

Cigna HealthcareCrown Healthcare Apparel

ServiceGraduate Education

Foundation I C System

iSekurityKilbride & Harris

Maxim Healthcare ServicesMedical Mutual Ins Co of Maine

NEEBCONortheast Delta Dental

Northeast Health Care Quality Foundation

ProMutual GroupRath Young and Pignatelli PCRisk Transfer Alliance, LLC

Sage SolionSulloway and Hollis

Wyeth Pharmaceuticals

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revenue management specialist?

Let us help you improve your bottom line and let you do what you do best...practice medicine. We have taken care of the financial side of medical practices throughout NH since 1990 and have a 100% satisfaction rate among our clients. Call to learn more, and schedule a meeting to see how we can help you. Also…ask about our Patient Registration Kiosk and the possibility of being a beta site for this exciting, new self-check-in technology.

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More than 17,000 healthcare professionals in the Northeast depend on

medical malpractice insurance from ProMutual Group for protection

and peace of mind.

• We have the long-term vision and financial resources to provide the

coverage you need today and in the future.

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To learn more about ProMutual Group, call us at (800) 225-6168 or visit us

online at www.promutualgroup.com.

PROTECT, PREVENT, DEFEND.

ProMutual Group Agents:Terry AbbottTD Insurance AgencyNorth Conway, NH – 800-540-6337

Marc BerubeEaton & Berube InsuranceMilford, NH – 603-673-0500

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Joseph CroteauMarsh USAPortland, ME – 207-774-5911

Joe KilbrideKilbride & Harris Insurance ServicePortland, ME – 207-774-7919

Shawn McLaughlinRisk Transfer Insurance AllianceSouthborough, MA – 508-303-9470

Jeff OlsenFred C. Church InsurancePortsmouth, NH – 888-433-1865

Michelle PerronHUB International New EnglandPortsmouth, NH – 603-436-7069

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Emmanuel PsilakisWilliam Gallagher AssociatesBoston, MA – 617-261-6700

Stephen WainwrightGowen & Wainwright Insurance ServicesGilford, NH – 603 - 528-5255

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Don’t forget the Chamber’s

8th Annual Chamber Ski Day on Friday, February 26th: 

Skiing, snowboarding, X-country, snowshoeing and the Chamber Challenge fun race, all for only $40 per person for Chamber members and their

families! Please register online at www.concordnhchamber.com. Sponsored by

All-Ways Accessible, Inc.

GreaterConcordChamberofCommerce40CommercialStreetConcord,NH03301

Tel603.224.2508/Fax603.224.8128www.concordnhchamber.com

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New Hampshire Medical Society7 North State StreetConcord, New Hampshire 03301-4018

ADDRESS SERVICE REQUESTED

Prsrt Std.U.S. Postage

PAIDConcord, NH

Permit No. 1584

NH Medical Society…1. Defends medical liability reform

2. Advocates for your interest with health insurance companies to reduce hassles, eliminate payment problems.

3. Collects and records your CME credits.

4. Offers members health, dental, life and disability insurance.

5. Successfully lobbied in 2009 to defeat five of six “trial attorney” bills relating to medical liability, with the remaining one referred for further study.

6. Prevents under-trained health professionals from practicing.

7. Maintains a presence with the business community through membership in the NH Business & Industry Association, including participation with the Fiscal Policy, Human Resources and Health Subcommittee.

8. Represents physicians at the quarterly meetings of the New England Medicare Carrier Advisory Committee.

9. Publishes and distributes bi-monthly newsletters and weekly E-updates.

10. Offers money and time saving resources for your practice.

10 Reasons NHMS Members Get a Good Night’s Sleep