|
Beaumont Lecture: Doctor
teaches blind to “see”
By PAUL NATINSKY
Managing Editor
It almost seems like something out of science fiction. Imagine a blind
man “seeing” a ball roll across a table and reaching out to stop it – using
a camera wired to sensors on his tongue!
Well, 200 physicians saw a video of this feat, courtesy of Paul Bach-y-Rita,
MD, at this year’s WCMSSM-sponsored 83rd Annual Beaumont Lecture, Nov.
5 in Troy.
Dr. Bach-y-Rita, a Professor of Rehabilitation Medicine at the University
of Wisconsin Medical School, has been conducting successful experiments
since the 1960s on what is best decried by the title of his lecture: “Sensory
Substitution for Vision Based on Late Brain Plasticity.” In other words,
teaching the blind to see using alternative pathways.
“The brain is enormously plastic,” said Dr. Bach-y-Rita. “As little as two percent
of remaining undamaged tissue can serve as the basis for total brain reorganization.”
In the case of “sight,” a surprisingly small number of contact points
are placed on tongue. The electronic impulses are transmitted to the
tongue cuing the patient about which direction an object is moving. It
works like a form of radar.
The sensations are not painful. Dr. Bach-y-Rita said they have the feel
of champagne bubbles on the tongue. He said the sensations are not annoying
or distracting. As a matter of fact, they become unnoticable after the
patient has worked with the sensors for a while.
Much like when a blind person uses a cane to navigate, the sensations
that come back through the stick become a substitute for the brain’s
use of sight stimuli. The brain adjusts or “reorganizes” and understands
the sensations as sight impulses.
Sight is not the only disability that can be ameliorated by Dr. Bach-y-Rita’s
methods. He has worked with patients who suffer from balance deficiencies,
facial paralysis, and touch insensitivities. He said he can find an alternate
pathway to the brain for any patient who has a sensory deficit.
Dr. Bach-y-Rita continues to try and bring his therapies and research
into the medical mainstream. He moved from being a pure academic to becoming
a medical doctor and from research into clinical settings. But the progress
of acceptance is slow despite the fact that the treatments are inexpensive
and can be conducted in informal settings.
“We can’t claim that we don’t have the money for these programs, because they
are very inexpensive,” he said.
2004 WCMSSM Children’s Holiday Party Contributors
Drs. James & Sophie Womack
Dr. & Mrs. Robert C. Hawley
Dr. John and Sheila Roarty
Dr. & Mrs. Daniel B. Michael Marjorie Stewart Gagliardi, MD
Dr. & Mrs. Gordon M. Murray in memory of Dr. & Mrs. A.A. Ulmer
Henry and Maralyn Domzalski
Metropolitan Eye Center-Dr. James W. Klein & Associates
Hassan Amirikia, MD
Dr. & Mrs. Reginald Harnett
Drs. George and Nadya Kazzi
Michael Kleerekoper, MD
Dr. & Mrs. Francis Nazareno
Rosser Mainwaring, MD
Drs. Guat and Dionisia Sy
Taufiek Alhadi, DO
Frank P. Bongiorno, MD
Robert A. Songe, MD
Jeff & Wendy Page
Dr. & Mrs. Ron Strickler
William Davis, MD
Wilbur & Rebecca Smith
Orlando S. Sison, MD
Robyn Arrington, Jr., MD
Dr. & Mrs. E.C. Bush
Dr. & Mrs. A. Michael Prus
Alan & Edna Drucker
Fred Nelson
Darlene & Hugh Henderson
Nathan Segel, MD
Vern & Jane Strand
A.T. Lebamoff, MD
Dr. & Mrs. Philip Wolkok
Catherine Nordby, MD
Drs. Munther & Beth Ajlouni
Dr. & Mrs. Harold E. Usndek
Dr. & Mrs. Gilbert B. Bluhm
Richard & Edna Shin
Mrs. Nicole Price
Richard F. Heldt, MD
Nancy E. Gregory, MD
Dr. & Mrs. James G. Fordyce
James and Anita Leisen
Robert G. Borchak, MD
Karen Chapel, MD
James A. Rowley, MD
Dr. and Mrs. George Shade
Jacques M. Rosenfeld, MD
Jean Jaffke-Whitney, MD
Vincent Yu, MD Halim Haber, MD
Mazen Khalidi, MD
Joan & Bob Allaben
Helen A. Papaioanou
Dr. Alex P. Kelly, Jr.
Suzanne White
Henry W. Lim, MD
Drs. Lisa and Scott Langenburg
Abdelkader Hawasli, MD, FACS
Elizabeth Secord
Joseph M. Beals, MD
Dr. Richard and Gail Smith
Rosemary Bannon
Henri Pierre-Jacques, MD - Orthopaedic Specialist
Dr. & Mrs. Edward Jankowski
Andrew J. Sulich, MD
Timothy A. Brennan, MD
Robert G. Borchak, MD
Natalia M. Tanner, MD
Dr. William G. Nutting, MD
Clarence H. Schultz, MD
Lest we forget Pearl Harbor
By GILBERT BLUHM, MD
Today, Dec. 7 63 years ago, cannot be forgotten by some of us!
Japan attacked Pearl Harbor!
WWII began for the USA. There was nothing about it in the Wall Street
Journal or the Oakland Press today.
That fact surprised me. Why should anyone NOT want to remember it? Hawaii
remembers.
I remember clearly that Principal Carl Porter called my seventh grade
to join everyone in the High School Auditorium. We listened to President
Roosevelt at noontime Dec. 8, announce by radio the dastardly attack
which "will be remembered in infamy." The next four years
featured a Selective Service Draft, Civilian guards at a nearby electric
power plant, rationing, heartaches for those families who lost loved
ones in war battles, and the atomic bomb.
Subsequently, after being drafted as a physician for the Navy during
Korean "war", there was a Medical Corpsman who was at Pearl
Harbor during the Japanese attack. He was 17 years old at that time.
His description was not unlike scenes in the movie "Tora, Tora,
Tora" made in the late 1960s. The Executive Officer where I was
stationed also had harrowing experiences when the Yorktown Aircraft Carrier
was destroyed in the Pacific Ocean.
December 1975 was my first visit to Pearl Harbor and trip to the Arizona
Battleship Memorial as well as the Veterans’ Cemetery on Oahu. These
were a few of my indelible memories of the aftermath of Dec. 7, 1941.
I shall not forget "Pearl Harbor."
UAW PPO vouchers create confusion
In a letter dated Sep. 9, 2004, BCBSM stated that it would not take action
against physicians who choose to bill patients their full office visit
rate instead of the discounted "PPO" rate for enrollees in
the new UAW PPO contracts.
Despite that statement, the BCBSM vouchers will not identify which patients
are in the new auto PPOs – and because the new UAW PPOs are not the only
claims processed on the NASCO system, physicians who are billing their
patients full charges may inadvertently take write-offs for patients
they may not have intended to take write-offs for.
Physicians will need to identify those patients in the new auto PPOs
in their computer system so that it shows up in their payment posting
screens. This way, the staff person posting the rejection will know whether
or not to take a contractual write-off.
When an office visit is processed for the new Ford, DaimlerChrysler and
GM PPOs, no payment is made to the physician by BCBSM. The payment voucher
shows the physician's charge in one column, the PPO approved amount in
another column, and the PPO approved amount in the subscriber liability
column (since BCBSM assumes patients will be charged the PPO rate).
In the message that explains how the claim was adjudicated, it states
that there is a subscriber co-payment, but it does not indicate that
it is one of the new UAW PPOs. The only indicator that a claim may be
for a patient in one of the new UAW PPO plans is if the approved amount
is the same as the subscriber liability. Even then, the practice would
need to verify whether that patient has a deductible, since some plans
pay office visit charges only after the deductible has been met.
If your practice is using an electronic posting function, you will need
to work through your vendor to address this issue.
For more information about reimbursement issues, contact Stacie Saylor
at MSMS at (517) 336-5722 or ssaylor@msms.org.
Editorial: What Is Ahead
By JOSEPH WEISS, MD
Editor
The Bush administration can claim another four years. Not
only did Bush win the presidency, but the Congress contains a
clear Republican majority. In addition, the federal judiciary
all the way up to the Supreme Court, is cast in a conservative
state of mind.
We will face a federal government that, for the next four years, will
remain dedicated to the marketplace as the arena for solutions to health
care problems. The federal government's attitude will be to let the people
decide. Government funding to the states, including Michigan, will adopt
the same attitude. That is, states likely will obtain block grants for
health care. States will receive a specific amount of federal money and
each state will decide how to spend it. Given the budget deficit, the
amounts provided to the states are likely to be limited and long term,
i.e. be smaller than states deem necessary and be given without increase
for a four- to six- year period.
The Medicare Modernization Act just passed this year is not likely to
undergo change, particularly with the increased Republican majority in
the House and the Senate. Changes for tort reform are good, but opportunity
for improving prescription coverage or decreasing drug cost for the elderly
is unlikely. The administration will no doubt do more to help the development
of private Medicare. Even with the looming budget deficits, the possibility
is good that Bush will increase subsidies to private health insurers
to further the cause of taking Medicare out of the government realm and
into private hands.
How will this political environment play out for us practicing medicine
in Southeastern Michigan?
We are likely to feel the effects in the following ways:
To ask for more money for Medicaid will both waste our resources and
antagonize politicians. We will need to work with Michigan Medicaid as
it now stands. The state's present job-loss climate only compounds the
problem of limited funding by the federal government.
-The Detroit/ Wayne County Authority will need great acumen in its effort
to gain federal funding. The problem is made worse as Michigan did not
go for Bush in the November election.
-We will see more implementation by health insurers of strategies that
will "Pay for Performance." The health care sector will take
up the mantra of applying business methods to medicine. The experiment
of incentive pay will intensify as backers of the concept push to gain
the efficiency outsiders believe medical care lacks.
-Michigan Blue Cross will pursue its present course to increase control
over doctors. The Blues have reason to believe that the present atmosphere,
both in public and in the courts, will support its aggressive efforts
to box in the medical community.
Given the above, our strategy is clear. First, we must organize with
even greater intent than in the past. Lobbying in Washington will take
on great meaning both for federal funding and administrative interpretation
of the Medicare Modernization Act. The role of lobbying in Washington
of our sub-specialty societies will be of particular importance. Physicians
fees will not significantly improve, the only improvement in reimbursements
will come from increases in what Medicare will pay for procedures.
Second, we must accept that the burden of caring for the uninsured will
continue to fall on us.
Finally we will need patience as we will be dealing with a federal administration
that will continue to be secret, dogmatic, rigid and disciplined.
WSU names medical school dean
Dr. Robert R. Frank, associate professor of medicine
and associate dean for academic and student programs at the Wayne
State University School of Medicine, has been named interim dean,
effective Oct. 25. He succeeds Dr. John Crissman, who stepped
down recently as dean.
Dr. Frank has been a member of the School of Medicine faculty since 1977
and, as associate dean, has guided the shaping of a comprehensive medical
curriculum. He also is currently leading a drive to raise funds for construction
of a new medical education building at the school.
"We are pleased that Dr. Frank has agreed to lead the School of Medicine
during this exciting time of transition and progress," said Wayne State
University President Irvin D. Reid. PhD "His longtime association with the
medical school, as both a faculty member and key administrator, further equips
him for this important role as interim dean."
According to Nancy Barrett, Wayne State provost and senior vice president
for academic affairs, Dr. Frank will provide the necessary leadership
to maintain the school's missions of education, research and patient
care while a national search is conducted for a permanent dean.
I am confident that Dr. Frank will provide the vision and direction to
keep the school on its charted path of growth during this interim period," Barrett
said.
Dr. Frank's major clinical interests are in geriatrics and end-of-life
care. He was the chief of medicine at Detroit Receiving Hospital from
1983-1985 and he co-founded the Palliative Care Service at the hospital.
He earned a bachelor's degree in biology from Brandeis University and
entered Wayne State University as a medical student in 1968. He served
his internship and was chief medical resident at Detroit General Hospital.
Wayne State University is a premier institution of higher education offering
more than 350 academic programs through 12 schools and colleges to more
than 33,000 students in metropolitan Detroit.
Search Committee Announced
Nancy S. Barrett, WSU provost and senior vice president for academic
affairs, announced the School of Medicine Dean Search Committee.
Dr. Gary Abrams, chair of the WSU Department of Ophthalmology, has agreed
to chair the search. The following faculty, hospital affiliates and student
have agreed to serve:
-Richard Cole, executive vice president and chief administrative officer,
Detroit Medical Center ;
-Joseph Dunbar, chair, WSU Department of Physiology;
-Robert N. Frank, professor (with tenure), Department of Ophthalmology;
-Chris Gappy, student, School of Medicine ;
-David Kessel, professor (with tenure), Department of Pharmacology;
-Mary Kramer, associate publisher, Crain's Detroit Business;
-Gwen Mackenzie, executive vice president and chief operating officer,
Detroit Medical Center ;
-Stephen Migdal, professor (clinician-educator), Department of Internal
Medicine;
-John C. Ruckdeschel, president and chief executive officer, Karmanos
Cancer Institute;
-Maryjean Schenk, chair, Department of Family Medicine;
Beverly Schmoll, dean, Eugene Applebaum College of Pharmacy and Health
Sciences;
-Jack Sobel, professor (with tenure), Department of Internal Medicine;
-Bonita Stanton, chair, Department of Pediatrics;
-Ronald Strickler, OHEP, chair, Obstetrics and Gynecology, Henry Ford
Health System; and
-Judith Whittum-Hudson, professor (with tenure), Department of Immunology/Microbiology.
Final Medicare fee schedule includes drug repricing and billing
information on new Medicare benefits
Compiled by: Medical Group Management
Association, Government Affairs Department
www.mgma.com, govaff@mgma.com
The Centers for Medicare & Medicaid
Services (CMS) released a 842-page pre-publication version
of the 2005 final Medicare physician fee schedule on Nov. 2.
This annual publication includes payment rates for covered
services as well as changes to Medicare policy. Importantly,
the rule includes the 1.5 percent increase in average Medicare
physician reimbursement for 2005. This increase represents
the minimum amount approved by Congress in last year's Medicare
Prescription Drug, Improvement and Modernization Act (MMA)
as a result of extensive advocacy by the Medical Group Management
Association (MGMA) and others. Without this mandated minimum,
physician practices would face a 3.3 percent cut for 2005.
The Agency provided a chart of how the revisions to codes and the payment
update affect providers by specialty and type. The chart and a link to
the pre-publication document are available on the MGMA Web site in addition
to a full-analysis of the rule.
Early estimates for drug rates
posted by CMS
Beginning Jan. 1, outpatient drugs will be reimbursed at 106 percent
of the average sales price (ASP). In a separate rule, CMS established
that pharmaceutical companies will report each quarter their 12-month
average sales prices, which include volume discounts, prompt-pay discounts,
cash discounts, free goods that are contingent on purchase requirements,
chargebacks and other rebates. The third-quarter sales data will be used
to set the annual reimbursement rates for physician-administered drugs
paid under the ASP formula. MGMA anticipates the final reimbursement
rates to be published in mid-December.
In concert with the fee schedule release, CMS supplied providers with
estimates for reimbursement rates of several top drugs used by Part B
providers. These rates were taken from second-quarter data and are not
final. These second quarter drug reimbursement rate estimates are posted
to the CMS Web site.
The final fee schedule rule also includes revisions to drug administration
codes and billing rules, in addition to details on a one-year demonstration
project for oncology practices. For calendar year 2005, Medicare will
provide additional reimbursement to oncology practices that measure and
treat pain, nausea, vomiting and fatigue in chemotherapy patients. CMS
has established 12 new G-codes for practices to report these services.
One-time physical
and screening for cardiovascular disease and diabetes covered
Jan. 1 for Medicare beneficiaries
The 2005 Medicare Physician Fee Schedule final
rule includes new preventive benefits for patients approved in
the MMA, including a one-time physical for new Medicare enrollees,
diabetes screening and cardiovascular screening blood tests.
MGMA will continue working with CMS to ensure that clear coverage
guidelines are distributed to the provider community.
New Medicare beneficiaries enrolled on or after Jan. 1, 2005, will be
eligible for a screening physical during the first six months of their
enrollment. Previously, Medicare covered no physicals. Under the new
benefit, enrollees may receive a physical examination, including measurements
of height, weight, blood pressure, visual acuity and an electrocardiogram,
but excluding clinical laboratory tests. The services will be billed
under a new code: G0344, Initial preventive physical examination, and
one of several new G-codes for the provision of the electrocardiogram.
Screening for diabetes is another new benefit mandated under the MMA.
CMS proposed covered current procedural terminology (CPT) codes as CPT
code 82947 Glucose; quantitative, blood (except reagent strip), CPT code
82950 Post glucose dose (includes glucose) and CPT code 82951 Glucose;
tolerance test (GTT), three specimens (includes glucose). The final rule
further defines factors for people at risk of diabetes and those with
problematic glucose levels. The new benefit will be available Jan. 1
to eligible persons, not to exceed two screening tests per year.
The MMA expands Medicare coverage of cardiovascular screening blood tests
beginning Jan. 1, 2005, to include cholesterol levels and other lipid
or triglyceride levels. In the rule, CMS specifies that covered tests
include a 12-hour fasting lipid panel consisting of total cholesterol,
high-density lipoprotein cholesterol and triglyceride levels. The agency
defines the benefit coverage period as one screening test every five
years.
Physician scarcity
areas will give certain rural providers a 5 percent bonus
payment
Some Medicare physicians providing services in
newly defined "physician scarcity areas" will be entitled
to a 5 percent bonus payment beginning Jan. 1. Under the MMA,
primary and specialty care physicians practicing in "scarcity
areas" will automatically receive the bonus based on the
zip code of the site of service and paid quarterly.
Primary care physicians eligible for the scarcity area bonus payment
include general practice, family practice, internal medicine and obstetrics/gynecology.
All other physicians will be considered specialists and eligible for
the specialty care bonus payment. Dentists, chiropractors, podiatrists,
optometrists and all nonphysician practitioners are ineligible for these
payments.
The Centers for Medicare & Medicaid Services (CMS) identified zip
codes for the bonus payments and posted them to their Web site. The lists
identify areas that will automatically be assessed the 5 percent payment,
as well as areas that partially fall into designated scarcity areas.
Providers should further investigate if they qualify for the bonus payment
and use the modifier -AR for claims identification. Anesthesia services
(CPT codes 00100-01999) must use an -AR modifier to receive the bonus
payment.
Certain Medicare services are not eligible for the bonus payments. These
include the technical component of covered services, incident to services
and therapy services. When billing a service that has a professional
and technical component, claims billed globally will be returned as unprocessable
for the bonus payment. Eligible services must be billed separately as
a professional and technical component for payment.
To ascertain if your practice
is eligible:
1. Determine whether the zip code for the site of service
is listed on either the primary or specialty care scarcity area
by referring the lists posted on the CMS Web site. If your zip
code is listed, your practice will be automatically assessed
an additional 5 percent bonus for claims on or after Jan. 1.
2. If your zip code is not listed, determine whether the county for the
site of service is listed. If your county is listed, use the -AR modifier
to identify claims eligible for the bonus payment.
CMS restricts therapy
services to
professionals with therapy training
In the 2004 proposed Medicare physician fee schedule,
the Centers for Medicare & Medicaid Services (CMS) solicited
comments on qualifications for practitioners performing therapy
services incident to a physician's professional services. The
Agency in the 2005 proposed rule responded to the comments received
and proposed to limit the coverage of services performed incident
to the service of a physician, physician assistants, clinical
nurse specialist or nurse practitioner. The final rule released
on Nov. 2 adopts this policy change, effective on or after March
1, 2005.
-For incident to physical therapy services, the provider must meet the
Medicare definition of a physical therapist or supervised physical therapist
assistant. No state licensure to practice physical therapy is required.
-For incident to occupational therapy services the provider must meet
the Medicare definition of an occupational therapist or supervised occupational
therapist assistant. No state licensure to practice physical therapy
is required.
-For incident to speech language therapy services the provider must meet
the Medicare definition of a special language pathologist. No state licensure
to practice physical therapy is required.
The proposal will not prohibit practitioners, including physicians, physician
assistants, clinical nurse specialists or nurse practitioners who perform
services under their own benefit and are licensed within the State to
perform therapy services. In a clarification, CMS notes that athletic
trainers were never considered qualified professionals to render covered
Medicare services. They also modified the regulatory language to make
clear that physician assistants, clinical nurse specialists and nurse
practitioner may perform therapy services incident to a physician's professional
service if licensed by state law.
Get more information
Learn more about the affects of the 2005 Medicare physician fee schedule
final rule on group practices by participating in the Medicare Update
2005 MGMA Webcast on Dec. 2. Identify specific changes in coverage
policy, including the new Welcome to Medicare physical, new codes
recognized by Medicare, restrictions on physical therapy and more!
Find FREE resources to ease the implementation of the 2005 fee schedule
changes and prepare your practice for significant changes in billing
requirements.
Evaluate the coding and payment implications of the drug payment changes
for your group practice by participating in the Prescription Drug Coding
and Reimbursement Under Medicare MGMA Webcast on Dec. 21. This audio
will present a straight-forward explanation of the new government rules
establishing the average sales price (ASP) drug payment formula, drug
administration code changes and new billing guidance. Participants will
take away tools to help plan for the impending changes to survive the
significant decrease in revenue anticipated Jan. 1, 2005.
For more information, visit mgma.com or register today by calling 877.ASK.MGMA
(275.6462, ext. 888)
Letter from the Medical Reserve Corps
The Medical Reserve Corps (MRC) is a nationwide, community-based organization
that was developed by US President George W. Bush in response to the
events of September 11, 2001. In the MRC, various public health and health
care professionals such as physicians volunteer their services and educate
residents of various communities how to live healthy and productive lives.
This organization is sponsored by the Office of the Surgeon General,
in cooperation with the White House's USA Freedom Corps and the Department
of Homeland Security's Citizen Corps.
Recently, a local branch of the MRC called Detroit Medical Reserve Corps
has been formed. We are inquiring if physicians of the Wayne County Medical
Society would be interested in volunteering their time and medical expertise
to educate our audience on various healthcare issues.
If addition information is warranted about the MRC, please visit the
Website www.medicalreservecorps.gov.
You can reach me via the above sources of contact. I look forward to
hearing from you.
Thank you for your time and consideration.
Sincerely,
Apryl Brown
MRC Coordinator/Director
|
