NEW HAMPSHIRE MEDICAL SOCIETY NEWSLETTER
NH Medical Society; For The Betterment of Public Health Since 1791
NH Medical Society
Dartmouth Announces the Students Chosen in information technology and then move to
7 North State Street to Receive the Dudley J. Weider, M.D./NH China. Even though consulting was interest-
Concord, NH 03301 Medical Society Scholarship Fund ing and exciting work, I found it lacking. I
(603) 224-1909 wanted a job that made me feel like I was
Weider Scholarships are scholarships of endowment given making a real difference in individuals’
(603) 226-2432 fax by the New Hampshire Medical Society to Dartmouh Medical lives, so I explored alternate
email@example.com School in memory of Dudley Weider, MD, an ENT physician
careers. I worked at Dana -Faber Cancer
www.nhms.org at Dartmouth, former President and longtime friend of NHMS,
and an outdoor adventurer. Each year two students at Dart- institute in Boston as a Clinical Research
mouth Medical School who are New Hampshire residents Coordinator in the Gastrointestinal Cancer
with demonstrated interest in ourdoor recreation and health Center. This truly cemented my desire to
policy are chosen to receive Weider Scholarships. This year's become a physician. During my time at
Seddon Savage, MD, MS…..President
Scholars are Kara Detweller and Courtney Warner. Their DFCI, I took a Chemistry class at night to
Palmer P. Jones…………….EVP stories are shared below."
explore my science aptitude. The following
Catrina Graves. .....................Editor year, I enrolled in the Bryn Mawr College
Kara Detwiller, Dartmouth Medical School Postbaccalaureate Program to complete my
Scholarship Winners……………...1 2008, Hopkinton, NH pre-medical requirements. During the sum-
President’s Perspective…………..2 mer I worked as a Research Technician at
Collections……………………………….3 “As a New Hampshire native, I am very happy Massachusetts General Hospital in the lab
Choosing a Merchant Acct.…………...4 to be at Dartmouth Medical School. My family of Sam Yoon, a Surgical Oncologist. It was
CAP Services…………………………….5 is particularly important to me and one of the
Tamper Resistant Prescription Pads..6
an amazing experience to participate in ba-
CME…………….……………………….…7 main reasons I chose to return to NH for my sic science research and I hope to get back
Humanities ………………………………8 medical degree. My mother and younger to the lab during my residency or fellow-
brother live less than an hour away: I am lucky ship. If you haven’t guessed already, my
to be so close to them. In addition, I have two primary area of interest is Oncology. I am,
Opinions expressed by authors may not younger sisters who both live in NY City. Un- however, open to other disciplines. During
always reflect official NH Medical Society fortunately, I lose my father seven years ago. my first year, I shadowed a Gastroenterolo-
positions. The Society reserves the right to gist and truly enjoyed it.
edit contributed articles based on length I attended high school at St. Paul’s School in
and/or appropriateness of subject matter. Concord, NH, and completed my B.A. cum
Please send correspondence to laude at Wellesley College in Wellesley, MA. My first two years at DMS have been won-
As an undergraduate, I majored in Chinese derful. This past year, I co-chaired the Com-
Do you or a colleague need help? munity Service Committee, headed the
Studies and Economics. I studied in Beijing
The New Hampshire Professionals’ Health and Nanjing, China for a year, which was one DMS side of the Hanover Diversion Com-
Program (NH PHP) is here to help! mittee, and continued to participate in the
of the highlights of my college experience. In
The NH PHP is a confidential resource that the future, I hope to find a way to combine my Patient Partnership Program. I passed Step 1
assists with identification, intervention, refer- of the USMLEs and started my clerkship
ral, and case management of NH physi-
interest of China with y medical degree, but
cians, physician assistants, dentists, and right now my Mandarin is pretty rusty! During this summer. I have completed the internal
dental hygienists who may be at risk for or my three and a half years at Wellesley, I was a medicine clerkship and am currently on the
affected by substance use disorders, behav- member of the Zeta Alpha Literacy Society family medicine clerkship. In addition, I am
ioral/mental health conditions, or other is- taking a class at the tuck School of Business
sues impacting their health and well-being.
(House Vice President) and the varsity squash
NH PHP provides recovery documentation, team. I volunteered through TEACH (a men- called Medical Care and the Corporation.
education, support, and advocacy – from toring program to young children in Boston’s Outside of school, I love to cook and am
evaluation through treatment and recovery. Chinatown) and the Listening Line (a student– working on building up my Chinese cuisine
For a confidential consultation, please call run helpline). repertoire. I still play squash and enjoy
Dr. Sally Garhart @ (603) 491-5036 reading and visiting the pottery and jewelry
After graduation I accepted a position at Com- studios here on campus.”
puter Sciences Corporation (CSC) in their Con-
sulting and Systems Integration group. I origi- Continued on pg. 6
nally intended to build a foundation
“Newsletter Editor” at the above address
As the primary election season rolls out across New recognition as New Englander of the year. The roster of
Hampshire, concern about the healthcare system is second speakers includes many other exceptional and noted individu-
only to concern about Iraq, in the minds of the public. New als. (see program elsewhere in newsletter).
Hampshire physicians have an unparalleled opportunity to
The healthcare reform survey and focus on these is-
provide leadership for change. As New Hampshire resi-
sues at the Annual Scientific meeting are natural companions
dents, we are uniquely privileged to engage, if we choose,
to the strategic planning effort in which NHMS is engaged
in personal conversations with any or all of the Presidential
this year. Several in leadership have spent many hours re-
candidates,- in our neighbors living rooms, at small town
flecting on a clear and simple vision for health and healthcare
meetings or in larger forums. We can ask difficult ques-
in our State, on what our role or mission as an organization
tions, pose solutions, and sew seeds of change; it is a gift to
should be in working toward that vision, and what values are
be so intimately engaged in the democratic process. Town
fundamental to all of our work. We offer these here (see ta-
meetings are a precious tradition in our State, but the op-
ble “NHMS Evolving Vision, Mission and Values”) in draft
portunity to infuse our ideas into the national Presidential
form for comment of all NHMS members. As we move on
process, as boldly as we like, is exceptional.
now, to focus on developing our strategic goals, the broad
In order to embrace this opportunity as an organi- brush strokes with which we paint the future, we invite your
zation and to promote policies that reflect the will of our thoughts. The Medical Society is what we collectively make
membership, NHMS, in partnership with the University of it; everyone’s input is critical is shaping our priorities and
New Hampshire Survey Center has developed a brief 28 actions.
question survey, designed to learn physician opinions and
Please direct any suggestions regarding the work to
values related to change in the structure and funding of
date to me at seddon.savage @dartmouth.edu and I will for-
healthcare. We hope that each of us will take 5-10 minutes
ward to the strategic planning group which includes Oge
to complete the survey so that we can accurately assess the
Young, Beth Smith, Gary Sobelson, Marc Sadowsky and
weight of our opinions on directions for healthcare reform.
Charlie Blitzer. Feel free to contact me anytime with other
Many who have sample-tested the survey found it poses
thoughts on NHMS and our work together.♣
some thought provoking questions which should, at the
very least, stimulate lively discussion, but can potentially
propel us in new directions. You should be receiving the Warm regards to all,
survey within the next 2-3 weeks with opportunities to
complete it online, by email or in hard copy. Seddon
Results of the Healthcare Reform survey will be
presented at the upcoming NHMS Annual Scientific Meet-
ing at the Margate Hotel on Lake Winnipesauke to be held
Friday and Saturday October 26th and 27th. The meeting
will have three sessions focused on different topics; atten-
dees can register for any or all of them. The location was
chosen to allow easy day tripping from anywhere in the
State and to provide comfortable accommodations for over-
nighters. There will be a half day session Friday morning
on Pain and Prescription Drug Abuse, a half-day Friday
afternoon dedicated to improving Community Based Care
of Returning Iraq and Afghanistan Veterans and a full day
on Saturday devoted to examining options for healthcare
reform “Quality Healthcare for All’.
We are privileged to have former Surgeon General C
Everett Koop provide opening remarks for the Veteran and
Healthcare Reform sessions and Dr James Wright, Presi-
dent of Dartmouth College will speak at dinner Friday eve-
ning on his initiative to improve educational initiatives for
injured Veterans which has earned him
continued on pg. 10
How to Choose the Best Merchant "Do you have problems swiping credit cards? The swiping
Account for Your Business mechanism may be worn down. This may cost you 1% - 2%
more per transaction!
The first thing that you need to know is that ALL credit card
When searching for a merchant account, it's easy to be- processing companies have the same cost (interchange) that is
come overwhelmed by the myriad of merchant account dictated by Visa/MasterCard. The only difference in processors
providers, banks, resellers, and the like who are vying is integrity, profit margin and customer service.
for your business.
Interchange is a 22 page document that has pricing based on the
type of card and the way you take that card. Types of cards
range from debit/check cards, consumer cards, rewards cards,
Some seem to be offering nearly identical services at world cards, and corporate cards to name only a few. To only
similar prices, while others seem to be offering a totally disclose one rate within a pricing structure is deceptive and the
different feature-set at an entirely different price than primary reason most merchants are being overcharged.
their competitors. So which is the right provider for
Ways to tell whether or not you are getting overcharged on your
credit card processing:
Rates and fees depend on the type of business you have,
whether you are swiping cards or keying cards, which • Is there a separate category for Rewards or World cards?
card types you are accepting, and more. • Have you seen your Mid-Qualified and/or Non-Qualified
totals rise significantly?
It is important to understand that varying rates will be
applied to your processing activity as a function of the • Do you have a rate without a transaction fee?
type of card, the manner in which the card is processed, • Are you going through your local bank?
and your adherence to required processing rules.
• Have you been told that you have to “upgrade” your current
The lowest rate, and the rate you should receive most equipment?
frequently, is your Qualified Rate. To receive the Quali-
• When you called to negotiate rates, did your bank say you’re
fied Rate on a given transaction, certain criteria apply
already getting a great deal?
including, but not limited to, swiping the card if you are
a swiped merchant, or keying the card with Address
Verification Service (AVS) if you are a keyed merchant. Does your statement indicate fees but does not include the dollar
It is also essential that you close out (batch) your termi- amount of the transactions that correspond to those fees? If so,
nal each and every day. this is a way to hide what rate you’re paying on keyed and cor-
The Mid-Qualified Rate will apply to certain card types National Average Processing Rates
and is a rate you should expect to be assessed with some
regularity. Most cards that fall into this category are re-
ward cards, point’s cards & world cards. Qualified - 1.79% +.25 2.59% +.25
Mid-Qualified – 2.59% +.25 3.09% +.25
The Non-Qualified Rate is a premium priced rate as-
signed to certain card types, such as cards issued by Non-Qualified – 3.79% +.25 4.59% +.25
non-U.S. banks and corporate cards. In addition, if the Statement fee – $10.00 Gateway fee – $20.00 + .10
merchant fails to batch daily, all card activity will be
downgraded to this rate. To minimize costs, ALWAYS
The information supplied in this article was supplied by Paymerica
batch each and every day. LLC, a corporate affiliate of NHMS.
How would you like to know that the payment you re- For more information and a complimentary cost analysis, call 1-877-
ceived is good and will be in your account, ready for 729-6370 Ext. 500♣
you to use, in 48 hours? Taking credit cards will give
you the peace of mind that you don’t have with personal NH Musculoskeletal Institute
checks. 8 Category 1 CME
Could this be happening to you?" Here are some ques- January 25-26, 2008
tions to as: Stoweflake Mountain Resort & Spa, Stowe, VT
Do you enter a zip code when you key in credit cards? Registration fee INCLUDES hotel
By entering this information you can save at least .5% Program info available at: www.nhmi.net
on each transaction! Contact: Laura Decoster, 603-627-9728, firstname.lastname@example.org
The New Hampshire Medical Society Corporate
Affiliates Offer the following services
Accounting Apparel & Services
Billing Services Business Management
Credit Card Processing Electronic Medical Records
Financial Health Insurance
Dental Insurance Malpractice Insurance
Legal Services Office Supplies – Printing
Pharmaceutical Quality Improvement
Staffing Solutions Technical
Telecommunications Vaccine programs
WE HAVE A WINNER!
Cindi Maiocchi, Office Manager at General Surgical Specialists of NE wrote to us about the Corporate Affiliate she deals
with and was the lucky winner of $100.
Just wanted to let you know that our practice uses several of your Corporate Affiliate members. We use the following:
Affiliated Healthcare Systems Anthem BCBS Kilbride & Harris NEEBCO Solion Sulloway and Hollis
I find the owners and employees at Kilbride & Harris to be professional, helpful and courteous. During renewal time for
our malpractice insurance I will speak with Chip Harris or Allison Morris on a daily basis for weeks. They are always will-
ing to help and I never feel that I am bothering them with my questions. I would highly recommend them to anyone, in
fact I have recommended them to several practices.
Clark Houx and Kami Cunningham at NEEBCO have given us great service over the years. Kami is a terrific representa-
tive and is always ready to answer my questions and if she cannot she will find the answer elsewhere and call or e-mail
within more than a reasonable amount of time.
The people at Sulloway and Hollis are just as helpful, professional and courteous as the above entities. They will answer
questions by e-mail or phone and are always ready to help.
We use Solion and Affiliated Healthcare for supplies and have been extremely happy with their services. They always go
the extra mile.
NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org
Dudley J. Weider, M.D./NH Medical Society Scholar- DHHS Announces New Tamper-Resistant Prescription
ship Fund Continued from pg 1 Pad Requirement for Medicaid Outpatient Drugs
Courtney Warner, Dartmouth Medical School 2009,
Keene, New Hampshire
Concord, NH – The New Hampshire Health and Human
“My name is Courtney and I recently started my second Services (DHHS) announced today that as of October 1st, health
year at Dartmouth medical School. My first year here at
medical school went wonderfully– I enjoyed the chal- care providers in New Hampshire, must, as mandated by federal
lenging material, and still can’t believe how much I law, use tamper-resistant prescription pads when prescribing
have learned and grown as a person in one year. It was
also great to meet and form friendships with my class- Medicaid outpatient drugs. According to the Centers for Medi-
mates, as well as get involved in various community care and Medicaid Services (CMS), the federal agency that ad-
service opportunities and activities. I volunteered last
year to teach 5th graders about tobacco prevention, and ministers Medicare and Medicaid, the intent of the newly man-
also spent time at Mascoma Clinic in addition to taking dated requirement is to reduce the number of unauthorized, im-
electives in Medical Spanish and Palliative Care. After
a great summer of research in the Radiology Depart- properly changed or counterfeit prescriptions.
ment at Dartmouth Hitchcock, I am happy to be back
and continuing on with my medical education.
Until leaving for college, I lived with my parents and As outlined in the guidelines issued by CMS, the new tam-
three younger sisters in Keene, NH. We have always per-resistant pad requirement does not apply to:
been very close and my parents are excited that Hano-
ver is only a short drive from Keene. I high school, I • refills of written prescriptions presented at a phar-
was involved in soccer, basketball and the United
macy before October 1st, 2007;
Church of Christ youth group. My first exposure to
volunteering in a hospital was through a youth group on • prescriptions that are transmitted to the pharmacy
one of our annual mission trips. Working in a rural
medical center in Puerto Rico as a freshman in high verbally, by fax or electronically; or
school sparked my interest in a career in medicine.
• prescriptions paid for by a managed-care entity.
After attending Keene High School, and spending a
summer studying psychology at St. Paul’s School in
Concord, NH, I decided it was time for a shift from a
“We have made health care providers and pharmacists
small, rural community. I attended McGill University
in Montreal, Quebec and received a Bachelor of Sci- aware of the new guidelines but we also want to make sure
ence in Anatomy and Cell Biology in May, 2005. Be-
that people who have their prescriptions covered by Medicaid
sides enjoying the vibrant and international culture in
Montreal, I was very active ii the McGill Rotaract are aware of the changes,” said Nicholas Toumpas, Acting
Club, a student international and community service
organization. For my last two years in Montreal, I
served as Vice President Financial on the Rotaract Ex-
ecutive team. I also spent time studying languages and
culture in Montreal, particularly French & Spanish. “We want them to know,” continued Toumpas, “that
During my summers, I worked in clinical research at a
medical devices company, studying therapeutic hypo- there is a provision in the guidelines that allows for the emer-
thermia and safe ways to induce it en route to the emer- gency filling of prescriptions written on non-tamper resistant
pads.” An emergency fill for a prescription may be done as
I am happy to be in Hanover, appreciate the natural long as the prescriber provides a verbal, faxed, electronic, or
beauty and serenity of the Upper Valley. I love the sup-
portive community of this area and look forward to pur- compliant written prescription within 72 hours after the date
suing my medical education at Dartmouth Medical on which the prescription was filled.
Continued on pg. 7
On October 1, 2007, a prescription pad must
contain at least one of the following three characteris-
tics in order to be considered tamper- resistant or risk
not being reimbursed for Medicaid outpatient drugs:
• one or more industry-recognized features de-
Northeast Family Medicine Conference
signed to prevent unauthorized copying of a
completed or blank prescription form;
Primary Politics Meets
• one or more industry-recognized features de-
signed to prevent the erasure or modification of
New Hampshire Academy of Family
information written on the prescription by the
November 30– December 2, 2007
• one or more industry- recognized features de- Highlander Inn
signed to prevent the use of counterfeit pre- 2 Highlander Way
scription forms. Manchester, NH 03103
By October 1, 2008, the new prescription pads Call 603-224-1909 or email
must contain all of the above three characteristics to be
Catrina.Graves@NHMS.org for details
or to register
valid for Medicaid reimbursement.♣
Initiatives to Improve Quality of Care in Your Practice
Holiday Inn 172 N. Main St. Concord, NH 03301
October 10, 2007 8am-4pm
Call 603-224-1909 or email
Catrina.Graves@NHMS.org for details or to register
Sponsored by NHPS
NHMS SCIENTIFIC ASSEMBLY
Facing Challenges with Conviction
Prescribing Opioids, treating veterans & changing the system
Friday and Saturday, October 26th and 27th
The Margate Resort on Lake Winnipesaukee
Call 603-224-1909 or email Mary.Pyne@NHMS.org for info or to register
Art in Medicine
David Coursin. Physician, Painter, Poet.
Dr. David Coursin suspects that many doctors
would find a sense of renewal in pursuing some form of
creativity. Coursin, a Concord psychiatrist who directs an
acute care unit of the New Hampshire Hospital, believes that
“any self-absorbing activity, with a trance-like, meditative,
centering dimension to it can help us hold onto our humanity
in the swirl of all that we have to deal with.” For him, creat-
ing art and poetry are important balances to days spent eas-
ing human suffering and trying to orchestrate effective and
compassionate care in an imperfect system.
His airy studio is an energetic collage of paintings,
drawings and three dimensional forms, with a computer
desktop displaying pairings of his images and poems. In one
corner, hangs an abstract painting in Rasta green, black, red
and yellow, that he has run several times through a table saw
and reassembled in strips tilting slightly in varied angles and
planes, mounted on, not in, a wooden frame. Against a work
bench leans a series of large acrylic paintings that experi- quality.After several years of exploring art on his own, he
ment with deconstruction of elements of the human form, found himself yearning to study classic forms and tech-
lightly reminiscent of Picasso. Several old drawers-become- niques of painting. He began studying with Jim and Beth
sculptures are integrated with assorted found objects and Aponovich at the NH Institute of Art and flourished in
mounted on the walls. On an easel, a large, brightly colored their style of teaching which included painting along side
painting unites a still-life of ceramic vessels, a coconut , a their students. Watching them create expansively, make
flower and grapes with a reproduction of the classic Sistine occasional mistakes, start over, find unexpected forms in
Chapel image of God departing. God and the landscape into errors and ultimately succeed in completing their works,
which he flees hover between existence in the painting and he says, was inspirational. With their support and mentor-
existence in a painting within the painting; regarding it one ing he gained skill and confidence. In 1996, he and family
has the sense of moving back and forth through several reali- – Laura and their two children then in their teens - moved
ties. On a bench rests a notebook filled with 150 poems, to simpler but ample quarters, in large part so that he could
written one a day over consecutive days. Other diverse crea- take a job that would allow him to focus more time and
tions fill most available wall-space, table surfaces and much energy on his art work. This was a leap of faith, but he has
of the floor. A relaxed seating area with worn couch and not regretted the move.
comfortable chairs reflects, however, that the solitude of It is a continuing challenge, however, to find bal-
creation is balanced from time to time with warm gatherings ance between his medical work and his art. With a deep
with friends. commitment to practicing both with excellence and care, it
Coursin was drawn in to his artwork in the early is difficult to maintain each within its boundaries. But it is
1990s. One day his wife Laura asked gently why she was also clear that one nourishes the other. Coursin finds his
always the one to send a card to his mother on her birthday. art work allows him to be kinder in his interactions with
He responded by purchasing a stack of art cards from various his patients; without it he perceives he would be more im-
museums and a computer program that prompted him to re- patient, cynical and not as humanly available. And after
member events of importance. He soon found himself buy- an intense day in medicine, he often retreats to his studio
ing special pens to write his notes, then began decorating the to paint or to write and frequently experiences that forms
cards with doodles and drawings, then sought out special and colors, or words, evolve spontaneously, seemingly
papers to make the cards himself. He was in an art supply born out of the resonance of that day. Sometimes, the ac-
store one day, buying card materials, when he saw a barrel of cumulated energy of a period of focused work in medicine
paints, one tube for a dollar. He bought 25 tubes and some compels his art in new directions; it was after months spent
brushes and was off and painting. He first experimented on a intensively researching and writing an article on the evolu-
stack of shirt cardboards, then created body-size swirling tionary origins of social behaviors that he was inspired to
shapes on a large appliance container flattened and pinned to turn for a while from painting into a burst of expressions in
the basement wall. Soon he discovered that rolls of Tyvec poetry. Coursin hopes one day to give undivided work
lying around his garage from recent construction were a ex- energy to his art, but for now the demands of medicine
cellent substrate for his painting. Tyvec has remained one of appear to drive a synergy that richly informs his creations.
his favorite media; white and cheap, stretched over masonite Readers can contact Dr. Coursin at email@example.com.♣
it serves as canvas of any size; crumpled or worked with -Seddon Savage
pasty materials, it develops texture and has a sculptural
It is striking how little room Have you had that fleeting glimpse
the dead take up. of many swaying
With how they occupy our in glory's choir?
minds and hearts Have they turned with you at the door to the bakery
They should go on for miles or looked up from a book in your kitchen
And this view of the Mississippi when the whisper of a smell brought it all back,
from 34,000 feet with winds out of the southwest the needles on the red cedar stood out clear
says the pilot and particular in that side-light of a sun setting
and visibility coming into Jackson into dark clouds
clear and sunny at 73 degrees coming out of the east.
on just another day of the earth is turning How often have you listened in on how the others talk
Would be one of grave sites tightly stitched after your own passing?
over the contours of our heartland is watershed I hear these conversations daily
in a vast quilting of souls. and wonder if it is the same for you.
How many times have you talked to one today alone?
by David Coursin
continued from pg. 3
New Hampshire Medical Society Prsrt Std.
7 North State Street PAID
Concord, New Hampshire 03301-4018 Permit No. 1584
Proposed New Hampshire Medical Society
Vision, Mission and Values 2007
NHMS envisions a State in which personal and public health are a high priority, all people have access to quality healthcare, and physicians
experience deep satisfaction in the practice of medicine.
The mission of NHMS 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.
Altruism We will act with unselfish regard for the welfare of others
Integrity We will conduct our activities in an atmosphere of openness and honesty. Members, officers and staff will uphold the
highest standards of personal ethics.
Inclusiveness We will seek out and respect individuals with diverse perspectives and opinions to enrich our work.
Humanism We will embrace the art of medicine and the importance of the person in all that we do.
Science Our work will be grounded in principles of knowledge that can be studied and evaluated.
Respect We will treat other individuals and professions with due consideration
Activism We will take action to address issues of importance to our mission.
Excellence We will aim for the highest level of quality in our work and seek to continually improve our organization.
Comments and suggestions from members are sought on the emerging vision, mission and values statements of NHMS.
Please send to firstname.lastname@example.org