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April 2, 2007
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IN
THIS ISSUE
Insurance
For 'Gravity Benders' Could Break Everyone Else
Last Chance To Apply For National
Provider Identifier
2007
MSMS House Of Delegates
Doctors' Night At
The Science Center, April 20
Mind,
Mood, Medicine
MSMS
Accepting BOM Nominations
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Click
Here To Contact Us
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Insurance
For 'Gravity Benders' Could Break Everyone Else
By PAUL NATINSKY
As physicians, patients and policy makers wrestle with a wide array
of potential solutions to America's growing health care cost
crisis, new challenges continue to present themselves...some
in the under the guise of health care reform.
Various universal health coverage
schemes have their supporters as do solutions featuring
medical savings accounts and low-premium catastrophic insurance
coverage.
But one plan that has recently
come to light seems fraught with danger. WellPoint, Inc.,
a marketer for Blue Cross and Blue Shield plans, is designing
bare bones, low-cost health insurance policies for so-called "young
invincibles," people in their 20s who face few serious
health risks and perceive themselves as invulnerable to
illness and its associated costs.
According to BusinessWeek Magazine
(March 19, page 84), policies titled "Part-Time Daredevil" and "Gravity
Bender" offer basic coverage for as little as $67
per month. WellPoint CEO Angela Braly touts the policies
as making inroads in covering the uninsured (a significant
portion of which are working people in their 20s). The
policies exclude some coverages, such as maternity benefits,
and feature limits of as few as four doctor visits per
year with deductibles as high as $5,000 ($10,000 for out-of-network
services), reported BusinessWeek.
Some critics consulted for the
article charged that Wellpoint's products provide too little
coverage for the money, despite the fact that they cost
about one-third as much as many employer-sponsored plans.
There are also criticisms that the scaled-down plans, if
successful in their marketing would "cherry pick" many
of the low-risk patients from the insurance pool, leaving
traditional plans and government payers caring for the
sickest patients and suffering rapidly increasing costs
and premiums.
WellPoint, which markets its
plans on Web sites such as www.Tonik.com and www.Soundhealth.com, can't
be dismissed as just a short-term fad or small player in
the market. The company weighed in at No. 2 on BusinessWeek's
list of best corporate performers for 2006 with sales of
$60 billion (up from $6 billion eight years ago). Wellpoint
has bought up a number of Blues Cross Blue Shield Plans
and the Indianapolis-based firm has made it clear, through
CEO Braly, that it will be a player in any health care
reform debate that takes place in the near future.
Perhaps the best policy angle
to take to stem this potential tide would be to force the
company to change the names of its plans. Perhaps the "God-help-you-if-you-get-cancer" plan
would be a good start; or the "Geez-I-didn't-plan-on-kids-until-later" program." The
best of all might be the "Send-The-Bill-To-Braly" benefit.
Feel free to send your suggestions
to us.
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Last
Chance To Apply For National Provider Identifier
The NPI compliance
date is May 23, 2007. However,
according to the Centers for Medicare & Medicaid
Services, once a physician obtains an NPI, it
may take up to 120 days to implement the NPI into current
business practices.
With this timeframe, it may
be YOUR
LAST CHANCE TO APPLY FOR AN NPI and
implement it without adversely affecting claims made in
HIPAA standard transactions.
MSMS is encouraging physicians
to apply for their National Provider Identifier (NPI) now.
The NPI is an Administrative Simplification mandate of
HIPAA. It is a 10-digit number that will be used to
identify physicians to their health care partners, including
all payers, in all HIPAA standard transactions. The
NPI will replace the identifiers physicians currently use
when submitting claims to the various payers. All health
care providers are eligible to receive NPIs. All HIPAA-covered
health care providers, whether they are individuals or
organizations, must obtain an NPI to identify themselves
in HIPAA standard transactions.
Physicians can
obtain an NPI by applying online at https://nppes.cms.hhs.gov or
by calling 800-465-3203 to request a paper application.
For more information, visit www.cms.hhs.gov/NationalProvIdentStand or
contact Stacie Saylor at MSMS at 517-336-5722 or ssaylor@msms.org
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2007
MSMS House Of Delegates
The
142nd annual MSMS House of Delegates meeting
will take place Friday, April 27 - Sunday, April 29, at
The Ritz-Carlton Hotel in Dearborn.
Last
year, more than 300 physician leaders, delegates,
and alternate delegates turned out to make policy in Michigan
during the 141st annual MSMS House of Delegates
meeting in Grand Rapids. Delegates and alternates considered
99 resolutions and 23 Board Action Reports on a host
of topics ranging from universal health coverage to
flu vaccine availability.
For
more information about the MSMS House of Delegates, visit www.msms.org/hod.
Or contact Jennifer Finney at (517) 336-5735 or jfinney@msms.org;
David Fox at (517) 336-5731 or dkfox@msms.org;
or Jeanne Miller at (517) 336-5726 or jkmiller@msms.org.
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By
JOSEPH WEISS, MD
Please set aside Friday evening April
20th from 5:30 p.m. onward. The Wayne County Medical
Society, in conjunction with the Oakland County Medical
Society, the Young Physicians Committee, and Alice Haidostian,
has reserved the Detroit Science Center for us. Members
of WCMSSM, their families and friends, will have the
Science Center exhibit: OUR BODY *The Universe Within
- for our viewing alone. In addition, we have admission
to the IMAX Theater presentation: OUR BODY.
The exhibit provides a unique view of human anatomy. The opportunity
of a personal showing allows a viewing without obstruction or hurry.
A physician will be able to undertake a visual dissection of the
body more thoroughly than possible in the anatomy laboratory of medical
school years. The chance to show anatomy to others is another plus.
The Center cafeteria will remain open for anyone who wants to take
a break in seeing the exhibit for coffee or a snack.
WCMS members have another reason to
attend. The Science Center is initiating a revamped
Health Science Exhibit Hall. It is worth physicians’ efforts
to take a long-term interest in the project. Attending
this event on Friday, April 20 will provide doctors
a sense of the role the Center can play in educating
the public. See what possibilities exist for learning
for yourself, your family, and your patients.
Note: tickets for the evening are $25/person. See the accompanying
application or contact Jason Riske at the WCMS (313) 874 1360 ext.
23 for further information.
To
sign up click here
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Mind,
Mood, Medicine
2007 Retreat for Women Physicians
- "Mind, Mood and Medicine"
Friday-Sunday, April 13-15, Kalamazoo
The MSMS Foundation is proud to announce that the 2007 Retreat for
Women Physicians will take place Friday-Sunday, April 13-15, at the
Kalamazoo Radisson. This year’s event, titled "Mood, Mind and
Medicine," will focus on the needs and interests unique to women
physicians, including life transitions for women, scope of practice,
epilepsy in women, sexual dysfunction, depression, and more.
Now in its fourth year, the Retreat for Women Physicians will provide
attendees with the opportunity to network with colleagues while learning
about topics that affect their personal and professional lives. Breakout
sessions covering a wide array of topics will allow attendees to
choose which sessions best suit their needs and interests.
The weekend also will include a number of recreational/non-medical
opportunities, such as spa services and a Saturday evening showing
of "The Women," by Clare Boothe Luce, at the Kalamazoo
Civic Theatre.
Registration begins at 8:30 a.m. and the daily program will run from
9:00 a.m. to 2:00 p.m. Cost is $200 for MSMS & MMGMA members,
$275 for non-members.
For more information or to register, visit www.msms.org/events or
contact the MSMS Registrar at (517) 336-5784 or abatten@msms.org.
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MSMS
Accepting BOM Nominations
The MSMS Committee on Licensure & Discipline
has begun the process of soliciting candidates who wish
to receive the recommendation of MSMS for appointment to
the Michigan Board of Medicine. On Dec. 31, 2007, the terms
of five Board of Medicine members will expire. Of those
five, four are eligible to be reappointed to a second four-year
term. One position will be vacant and require an appointment
by the governor. The Committee considers many key factors
(peer review experience, board certification, and involvement
in organized medicine) when selecting a candidate it believes
to be qualified to serve in this capacity. The Committee
will begin accepting candidates this month and will continue
to do so through the end of April so that the recommendations
may be brought to the July MSMS Board of Directors meeting
for final approval.
For more information or to obtain a nomination application, visit
www.msms.org/advocacy. Or contact Colin Ford at MSMS at (517) 336-5737
or cford@msms.org.
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Wayne County Medical Society
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