MedChi is studying the implications of non-compete clauses in healthcare. Non-compete clauses are a staple of thousands of healthcare agreements in Maryland. While some non-compete language can be fair and reasonable, some non-compete clauses put the physician at a severe disadvantage. Physicians can use non-compete language to protect their practice when hiring mid-level employees like nurse practitioners or physician’s assistants.  Other physicians are required to agree to a non-compete as a condition of  employment by a hospital system. Most often, non-competes will limit the area the physician can work to a certain geographic region after a physician leaves an employer.

As MedChi studies the public policy implications, we thought it would be helpful to give an overview of Maryland law and ask for members’ input. 

In Maryland, non-compete language found in employment contracts are enforceable if non-compete conditions are:

1. Supported by adequate consideration;  
2. Ancillary to an employment contract; 
3. Limited to the area and duration which are reasonably necessary for the protection of the employer; and
4. Not an undue hardship on the employee or contravene public policy. 

Becker v. Bailey, 299 A.2d 835, 838 (Md. 1973)

Maryland law will enforce non-compete restrictions for two reasons: 1) if the former employee could misuse trade secrets or client lists that would result in unfair competition or 2) if the former employee provided unique services. 

Maryland courts employ the "blue-pencil" approach and will strike unreasonable provisions of the non-compete while enforcing the remainder of the restriction. Other state courts may strike the entire agreement if it is even partially unenforceable. 

Please consider the following when you are negotiating non-compete language. Please consult an attorney before signing anything. MedChi can refer you to a lawyer who understands healthcare and non-compete clauses. Remember that each state’s laws are different, and what applies to your colleague in Texas may not apply to you, here in Maryland. Every State has a different set of codes, rules and case law in effect.  

MedChi has had an increasing number of questions and comments from its members concerning non-compete clauses and what is considered fair public policy. We would love to hear your questions, comments, or concerns. Please do not hesitate to let us know your thoughts on this or any other issue. 

Gene M. Ransom, III

CEO MedChi, The Maryland State Medical Society

In 2017, the Centers for Medicare and Medicaid Services (CMS) will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including:

• Individual eligible professionals (EPs)
• Comprehensive Primary Care (CPC) practice sites
• PQRS group practices
• Accountable Care Organization (ACO) participant TINs

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review between September 26, 2016 and November 30, 2016 requesting CMS investigate your payment adjustment determination. All informal review requestors will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review. 

Follow these steps to submit an informal review request:

1. Go to the Quality Reporting Communication Support Page (CSP)
2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
3. Select “Informal Review Request”
4. Select “PQRS Informal Review”
5. A new page will open
6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see the PQRS informal review fact sheet for more information. 

Note: Any EP or group that is awaiting a response or resolution of a QualityNet Help Desk ticket to access their PQRS Feedback Report or QRUR may still submit an informal review after November 30, 2016, by providing verification of a QualityNet Help Desk ticket numbers generated before the end of the informal review period (November 30, 2016) that involve EIDM access. Individuals or groups (as identified by their taxpayer Identification Number (TIN) may also use EIDM-related help desk tickets generated during the informal review period to enable late filing of a Value Modifier or PQRS informal review request. These late requests may be submitted through December 7, 2016.

Additionally, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account. For details on how to obtain your report, please see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports”. For information on understanding your report, please see the “2015 PQRS Feedback Report User Guide”. Both guides are on the PQRS Analysis and Payment webpage. 

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.

MedChi is now beginning to staff the First Aid Room in Annapolis for the upcoming 2017 legislative session.  The First Aid Room, located in the basement of the State House, is equipped with oxygen, hospital bed, wheelchair, crutches, thermometers, stethoscope, and blood pressure cuff.  A nurse is also on the premises every day and rarely do you encounter anything more than colds or the flu, so that the Physician of the Day can spend some time in the chambers observing the Senate and House conducting the work of our state government.  There are also a variety of over-the-counter medications provided including aspirin, cough and cold preparations, and antacids.  Volunteers are asked to bring their own prescription pads in the event treatment requires prescribed medication.

Please take a day to help with this project.   It is actually fun and very interesting.    We hope you will volunteer during the 2017 session.  Emeritus Physicians, who have an active license, are encouraged to participate.  They were an enormous help last year.

Volunteers may wish to speak with the senator or delegates from their own district while serving in this capacity, in which case Stephanie Wisniewski would be helpful in making the connection.  Stephanie will provide briefing materials that will aid volunteers in speaking knowledgeably to their legislators on MedChi agenda items.

Time slots consist of Monday evenings from 5pm to 9pm, Tuesdays, Wednesdays, and Thursdays from 9am to 3pm, and Fridays from 9am to 1pm throughout the session (most legislators leave after lunch on Friday).  There will also be a schedule of hearings and meetings that deal with health-related issues posted right in the First Aid Room.  Volunteers are encouraged to sit in on these meetings as well.

If you are interested in participating, please feel free to contact Stephanie Wisniewski at (410) 539-0872 ex. 6001 or swisniewski@medchi.org or send in the fax back form that can be found at THIS LINK.  The Legislative Session runs from Wednesday, January 11 through Monday April 10, 2017.

A collection of the most up-to-date, cleared information on the ongoing Zika virus outbreak.

http://www.cdc.gov/zika/pdfs/zika-key-messages.pdf

We live in a time of climate change, natural disasters, and fear of terrorism and pandemics. As physicians, we have an obligation to provide care for patients not just under “normal” circumstances but also during these potential crises. The Disaster Preparedness Committee is dedicated to helping physicians prepare themselves, their families, and their medical practices for these eventualities.  Each week a different link on the Disaster Preparedness Website http://www.medchi.org/disaster-preparedness/ will be highlighted.  Take a moment to explore the wealth of information contained in the links.

Watch for a new tip next week.

The Weekly DHMH Public Health Preparedness and Situational Awareness Report is posted HERE.

This report lists the following for all of Maryland and broken down by Maryland regions:

• Syndromic Surveillance Reports
• Syndrome Related to Category A Agents
• Maryland Reportable Disease Surveillance
• Syndromic Influenza Surveillance
• Other disease reports

USB Payment Processing is a leading provider of electronic payment processing services for the Maryland medical community.  USB’s location in Towson, Maryland allows them to offer more personalized service with local representatives, an award winning 24 hour toll-free customer service, as well as same day on site technical support.  Serving hundreds of medical practices since 1996, USB has developed specific products and services in demand by medical professionals.  We offer MedChi members savings and solutions as a MedChi Advantage Vendor.  USB offers low-cost credit and debit card processing, ACH processing, recurring billing, patient retention programs and customized solutions for your practice.  These solutions are designed to help you improve cash flow, minimize your collections risk and better serve your patients.  USB guarantees to find savings for practices that complete a free cost analysis.  Take advantage of our Smart ProcessingTM Program available to all MedChi members.  Call an account representative today for more information at 410-828-4286.  Find out how much you can save by switching to USB. 

For more information, visit http://www.usbne.com/

An article by NPR reports that the U.S. could rein in rising drug prices by being more selective about giving patents to pharmaceutical companies for marginal developments, a study concludes.

That's because brand-name drugs with patents that grant exclusivity account for about 72 percent of drug spending, even though they are only about 10 percent of all prescriptions dispensed, according to the study, published Tuesday in JAMA, the journal of the American Medical Association.

The Maryland Rx Card is a free option to lower out-of-pocket prescription costs. If you have a high deductible, or take a medication not covered by insurance, or have no prescription coverage, the Maryland Rx Card can save you up to 75%. Log on to www.MarylandRxCard.com to print a free card. You can walk in to any Safeway Pharmacy and request to use the Maryland Rx Card. You can also contact John Cenerazzo at John@MarylandRxCard.com for more information.” 

Celebrate the 10th annual "Socs from Docs" campaign by purchasing socks for children and youth and bringing them to the BCMS annual holiday reception on Tuesday, December 13, at 6:00 p.m.  Over fifteen community-based organizations providing programs and services to children have been the beneficiaries of our docs' generosity.
Enjoy holiday cheer and a chance to relax with colleagues as the holiday season gets underway.  RSVPs required - 410-625-0022, or info@bcmsdocs.org.

Internal Revenue Service Circular 230 Disclosure: In compliance with IRS requirements, you are on notice that any U.S. tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any transaction or matter addressed herein.