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November 2, 2009 |
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IN THIS ISSUE
Editor's Column: String Theory And Health Care
Reform
Physician Tax Defeated In State Senate
Red Flags Rule Enactment Delayed Until June
Blue Cross Blue Shield Association Data Breach
Alert
Henry Ford Hospital CEO Steps Down
Domestic Violence Conference Shines Light In Dark
Corners
Blues' 'Afterhours' Codes Benefit Physicians
Children's Holiday Party Contributors 2009 |
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Editor's Column: String Theory And
Health Care Reform
By JOSEPH
WEISS, MD
Most of us have heard of String Theory – the idea that basic
particles of matter vibrate in at least 11 dimensions. Scientists in
the field of theoretical physics are at work to derive a
mathematical model to bring these 11 dimensions into the world of
practical and experimental physics. To date, no formulas have met
the mark.
Physicians have
no problem understanding the difficulties facing our colleagues in
theoretical physics. We are wrestling with our own 11 dimensions, or
possibly more, trying to reconcile them into one coherent plan that
could direct us. So far, no health economist, medical care
theoretician or interested politician has found a satisfactory
scheme.
We have our own
cost, quality and care incompatibilities. We face increasing expense
in our offices and equipment; the bill for an updated medical record
system alone likely will cost $50,000 per doctor, with upkeep of
$2,000 or more a year. At the same time, we have little certainty
that we will see the Sustainable Growth Rate (SGR) Formula replaced.
Chances are Congress will set the SGR aside and give us another ½
percent increase for our claims. For us, choice means specialty of
our choice and at least for students and residents that decision
will rest on what insurers will pay.
In Michigan, our
strings must tie together the threats of scope-of-practice expansion
by chiropractors campaigning endlessly to do more and the
restrictive influence of the medical liability climate, which pushes
us to circumscribe our own scope of practice. Furthermore, we have
not integrated other health personnel such as nurses, physician
assistants, technicians and other health care workers into the
medical community as much as observed them enter and take up
squatter’s rights.
We are admonished
by critics for our failure to practice evidence-based medicine. Yet
much of our practice must remain a response to the unique character
of the individual patient rather than seeing that individual as
another pixel on the health calculation’s bell-shaped curve.
The most
difficult of the vibrating strings is our business model. Our future
business model likely will include the necessity for the medical
community to group in a regional way with a central authority. Will
solo practices remain, or will physicians work in small groups or
twos, threes or fives? Will the business unit be the size of Henry
Ford or Beaumont Hospital? Will the scattered physician offices that
represent us now be merged into an IPA (Independent Physician
Association) model? Or is there some form of business we turn to
that is not yet understood, like a health cooperative?
So far, String
Theory has physicists tied up in knots. Physicians should not also
become so strung out over requiring symmetry in every aspect of
medical life. In my opinion, the most important area on which to
reach a consensus is our future business model; the one I favor is
the IPA. It is the one most likely to provide the organization that
insurers will demand and the independence that individual physicians
will need.
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Physician Tax Defeated
In State Senate
The Michigan
State Medical Society Oct. 28 thanked Senate Majority Leader Mike
Bishop for his leadership and the full Senate for its overwhelming,
bipartisan vote against an ill-conceived tax on Michigan's health
care system.
"During the past
two weeks the Michigan Senate heard significant input regarding this
legislation and today wisely voted 32-4 to reject a tax on
Michigan's health care system that would have led to serious,
unintended consequences including reduced access to health care for
all Michigan citizens," said MSMS president Richard E. Smith, MD, a
Detroit obstetrician/gynecologist. "We thank the Democratic and
Republican senators who voted against this bill for their political
courage in a difficult time to take a bad idea off the table."
"Even though
Michigan's Medicaid program has been under-funded for decades and
we've had to fight nearly every year to avoid further cuts, members
of the Michigan State Medical Society have continued to treat
Michigan's most vulnerable patients," Doctor Smith said. "We are
physicians who care. We will continue to work with legislative
leaders and the governor to develop a sustainable Medicaid program
in Michigan."
The 3 percent tax
on physicians' gross receipts would have resulted in physicians
retiring earlier, moving to other states or dropping out of the
Medicaid program entirely, according to a recent email survey of
MSMS members. Young physicians-in-training said it would have been
one more reason along with Michigan's poor economy to leave the
state once their training was completed. Others pointed out the tax
would have made it nearly impossible to recruit new physicians to
the state.
An MSMS coalition
of more than 50 specialty societies, county medical societies,
Michigan Medical Group Management Association, MSMS Alliance and a
number of national specialty societies opposed the tax.
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Red Flags Rule
Enactment Delayed Until June
On Oct. 30 the
Federal Trade Commission announced that the Red Flags rule is
delayed until June 1, 2010, reported the American Medical
Association. The AMA has been urging the FTC and Congress that
physicians are not "creditors" and should not be subject to the
rule. The AMA reports it is pleased that the FTC has granted another
delay. For more information on the FTC's decision:
http://www2.ftc.gov/opa/2009/10/redflags.shtm
According to an
FTC press release from July, “The Red Flags Rule is an anti-fraud
regulation, requiring “creditors” and “financial institutions” with
covered accounts to implement programs to identify, detect, and
respond to the warning signs, or “red flags,” that could indicate
identity theft. The financial regulatory agencies, including the
FTC, developed the Rule, which was mandated by the Fair and Accurate
Credit Transactions Act of 2003 (FACTA). FACTA’s definition of
“creditor” includes any entity that regularly extends or renews
credit – or arranges for others to do so – and includes all entities
that regularly permit deferred payments for goods or services.
Accepting credit cards as a form of payment does not, by itself,
make an entity a creditor. “Financial institutions” include entities
that offer accounts that enable consumers to write checks or make
payments to third parties through other means, such as other
negotiable instruments or telephone transfers.”
In Nov. 2007, the
Federal Trade Commission (FTC) issued a set of regulations, known as
the “Red Flags Rule,” requiring that certain entities develop and
implement written identity theft prevention and detection programs
to protect consumers from identity theft. Originally scheduled for a
Nov. 1, 2008 compliance date, the FTC has now delayed the
enforcement date of the Red Flags Rule until Nov. 1, 2009. The
now-extended compliance date of Nov. 1, 2009 followed two earlier
extensions to May 1 and then later to Aug. 1. The AMA reports the
extensions are a result of continued advocacy by the AMA and others
who continue to object to the applicability of this Rule to health
care providers and other professionals.
Since the Rule
was issued, the AMA has objected to the FTC's interpretation that
physician practices are "creditors" when they accept insurance and
bill patients after services are provided or if they allow patients
to set up payment plans after services have been provided. The FTC
states that this delay is intended to "give creditors and financial
institutions more time to review this guidance and develop and
implement written Identity Theft Prevention Programs."
While the AMA
intends to continue to make the case to Congress and the agency that
the FTC should republish the rule so that there is sufficient
opportunity to formally comment and state the AMA's objections to
physician inclusion in the program, the AMA has prepared a guidance
document, along with sample policies, so that members can
incorporate a simple identity theft prevention and detection program
into their existing compliance and HIPAA security and privacy
policies.
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Blue Cross Blue
Shield Data Breach Alert
Editor’s Note:
The following is a message from AMA President J. James Rohack, MD.
You may have
heard reports about a data breach at the Blue Cross and Blue Shield
Association (BCBSA) involving provider identifiers. We are working
with BCBSA to recommend steps that it can take to help mitigate the
risk of identify theft resulting from this data breach.
The breach
involved a data set containing names, addresses, taxpayer ID
numbers, and NPI numbers of physicians and other health care
professionals. The data is used in performing internal matching
analyses to compare BCBS provider networks to the networks of other
health plans for employer groups. Since some practitioners use their
Social Security number as their taxpayer ID number, BCBSA is taking
steps to protect these physicians.
It is important
to understand that the identifying information was not the intended
target of the theft. The data set was stored on a laptop that was
stolen from a car, which was one of several cars in the immediate
vicinity that were vandalized. There is no reason to believe that
the thief intends to use the data to commit identity theft. However,
as a precaution, BCBSA is offering credit monitoring services to
those providers whose Social Security number was exposed.
Local BCBS Plans
in each area are in the process of sending out notifications to
affected physicians . If you receive a letter from your local BCBS
Plan offering credit monitoring services, we encourage you to take
advantage of those services that BCBSA is providing through
Experian. Utilizing these services will help BCBSA monitor trends to
see if identity theft may be occurring as a result of the breach and
could help locate the source of any such identity theft. If you have
not been notified directly or if the letter you receive does not
include the offer of such services, then it was determined that your
Social Security number was not exposed.
We also encourage
all physicians to be vigilant in protecting themselves from those
who may try to use their identity as a physician to submit
fraudulent prescriptions or fraudulent claims. If you receive any
suspicious calls or reports erroneously suggesting that you have
ordered or prescribed certain goods or services, you should follow
up promptly, and notify your local BCBS plan immediately if you
confirm that your identity has indeed been stolen.
If you have
questions about the data breach, please contact your local BCBS Plan
at their regular customer service number. AMA staff will continue to
be in contact with BCBSA and will provide further information as it
becomes available.
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Henry Ford Hospital CEO Steps Down
Tony Armada,
president and CEO of Henry Ford Hospital and Health Network,
Detroit, is resigning next month to become president of Advocate
Lutheran General Hospital, Park Ridge, Ill., reported Modern
Healthcare citing an internal memo from Henry Ford Health System.
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Domestic Violence
Conference Shines Light In Dark Corners
By PAUL
NATINSKY
Numbers regarding domestic violence are startling and appropriate
diagnosis and intervention continue to present a challenge to health
care providers and others who attempt to help victims.
Domestic
Violence: What Every Health Care Provider Needs To Know, packed the
auditorium at the Kresge Eye Institute in Detroit Oct. 29. Attendees
heard from seven speakers and a panel during the full-day program.
That women are
far more likely than men to be victims of domestic assaults likely
is common knowledge; but the fact, reported by the US Department of
Justice, that nearly 25 percent of women and 7.6 percent of men
surveyed for a study published in July of 2000 said “they were raped
and/or physically assaulted by a current or former spouse,
cohabitating partner or date at some time in their lifetime.” Based
on these statistics, approximately 1.5 million women annually are
raped and/or physically assaulted by an intimate partner.
“I had hoped I
would see dramatic changes in 50 or 60 years. I’ve seen changes and
hope, but not the dramatic changes I’d like to see,” said Judith
Barr of First Step, a group dedicated to preventing domestic and
sexual violence.
Barr said
domestic violence knows no boundaries. She said one-in-three women
worldwide are victims, and that abuse affects people from all races,
cultures, religions, income and educational levels. It’s a myth that
the wealthy and educated see a lower incidence of abuse, it’s just
less likely to be reported, said Barr.
She related the
story of a woman who, literally, spent the night in a doghouse in
the November chill at the behest of her abusive husband. She called
First Step and Barr, who was new to her job at the time, tried to
keep the woman on the phone and pass her along to a senior
counselor. The woman said she did not want to file a report but just
tell someone about it and hung up before Barr could get further
involved. Before the woman hung up Barr learned that she had two
adult sons from whom she was keeping this abusive treatment a
secret.
Physicians and
health care professionals, much like social workers, are faced with
ferreting out cases of abuse, often with frightened and reticent
victims as their only resource. The consequences can be devastating.
Barr said 80 percent of physical assaults against women are reported
during pregnancy. She said many victims demonstrate symptoms of
post-traumatic stress disorder, a debilitating mental condition
similar to that suffered by soldiers returning from combat.
Many women are
reluctant to leave abusive relationships, and with good reason.
Women who leave batterers are 75 percent more likely to be killed by
the offender than those who stay, a statistic quoted by several
speakers.
The American Bar
Association states other reasons women stay in abusive
relationships. In some cases it’s an economic issue; the abusive
spouse controls the finances and in some cases prohibits the victim
from working or handling money. Other reasons include pressure to
stay in the relationship from other family members, including
children, religious issues and sometimes love for the abuser.
Despite the
challenges, health care professionals can help victims. According to
First Step, “Even if a victim is not ready to leave the relationship
or identify the batterer, physicians can recognize and confirm to
him or her that this is a serious problem that must be solved.
Emergency physicians can let victims know they are not alone, they
don’t deserve to be beaten and help is available.”
The American
College of Emergency Physicians (ACEP) recommends directly
questioning patients about domestic violence if the following
medical findings appear:
-
Central
pattern of injuries
-
Contusions or
injuries to the head, neck or chest
-
Injuries that
suggest a defensive posture
-
Types or
extent of injury that are inconsistent with the patient’s
explanation
-
Substantial
delay between when the injury occurred and when the patient
sought treatment
-
Injuries
during pregnancy
-
Pattern of
repeated visits to the emergency department
-
Evidence of
alcohol or drug abuse
-
Arriving in
the emergency department as a result of a suicide attempt
Other clues to
abuse include a “secretive, fearful or even hostile” patient
demeanor or a partner to the patient who answers questions for the
patient or refuses to leave during the patient interview or exam,
said Crystal Arthur, MD, Medical Director of the Department of
Emergency Medicine at Detroit Receiving Hospital.
When there are
indications of abuse present, physicians can ask several SAFE
questions. SAFE is an acronym for Stress/Safety, Afraid/Abused,
Friends/Family, and Emergency Plan. Specific questions include: Do
you feel safe in your relationship? Have you ever been in a
relationship where you were threatened or afraid? Are your friends
or family aware that you have been hurt? Are they able to give you
support? Do you feel you have a safe place to go and the resources
you need in an emergency?
While there is a
requirement in most states, including Michigan, that health care
professionals report injuries suspected to have resulted from
violence of any kind, there are questions about how safe it is for
victims if health care professionals automatically and immediately
report suspected cases directly to law enforcement agencies.
The American
College of Emergency Physicians’ position: “ACEP opposes mandatory
reporting of domestic violence to the criminal justice system.
Instead, ACEP encourages reporting of domestic violence to local
social services, victims’ services, the criminal justice system, or
any other appropriate resource agency to provide confidential
counseling and assistance, in accordance with the patient’s wishes.
In jurisdictions that have mandatory reporting requirements, persons
reporting in good faith should be immune from liability for
compliance.”
The National
Domestic Violence Hotline: 1 (800) 799-SAFE
First Step 24-Hour Helpline: 1 (888) 453-5900
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Blues' 'Afterhours'
Codes Benefit Physicians
In the Medicine section of the CPT book, there are codes
for Special Services, Procedures and Reports. These codes can be
reported in addition to an associated basic service (i.e.,
evaluation and management code).
There are three codes that Blue Cross Blue Shield (BCBSM)
will reimburse for services rendered outside the normal business
hours.
·
99050 – Services provided in the office at times other than
regularly scheduled office hours, or days when the office is
normally closed (eg, holidays, Saturdays or Sunday), in addition to
the basic service.
(BCBSM defines
regular office hours as 8:00 a.m. – 5:00 p.m.)
·
99051 – Services(s) provided in the office during regularly
scheduled evening, weekend, or holiday office hours, in addition to
basic service
·
99053 – Services(s) provided between 10:00 PM and 8:00 AM at 24-hour
facility, in addition to basic service
These bullet points are the exact nomenclature from the CPT
book.
The key point is that these services are paid in
addition to the basic service as an incentive for physicians to
be available for patients in the “off” hours, so to speak. The idea
is that it might keep patients out of the ER for non-emergency
services because their physicians are not available for them after
work or on weekends.
-- Stacie Saylor, MSMS
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Children's Holiday
Party Contributors 2009
The following is
a list of contributors to the WCMS Foundation’s 24th
Annual Holiday Party for underprivileged children. This year’s event
is Dec. 5 at the New Detroit Science Center. For more information,
or to contribute, call (313) 874-1360 or visit
www.wcmssm.org
Barbara & Adrian
Sheremeta
Fred R. Nelson,
MD
Ronald E.
Trunsky, M.D. & Judy Jenkins Trunsky
Michael R.
Harbut, MD
Dorothy M.
Kahkonen
Dr. and Mrs. H.
Michael Marsh
Lisa T. Cooper,
MD
Volna Clermont,
MD
Robert Brent, MD
William Knapp, MD
Nancy Goll
Elizabeth Edmond,
MD
Martin Daitch, MD
Benjamin Ramos,
MD
Peter Cracchiolo
Robert Borchak,
MD
Julian Alvarez,
MD
Beth Ann Brooks,
MD
Dr. & Mrs. Sajal
Choudhury
William L. and
Betty G. Knapp
Drs. Safwan
Halabi & Razan Asbahi
Joe Weiss &
Marilyn Shapiro
Dr. & Mrs. George
C. Hill
Neela Sripathi
Homer M.
Smathers, MD
Sidney Baskin, MD
John C. Somogyi,
MD
Charla Blacker,
MD
Todd R. Williams,
MD
Iris and Fred
Whitehouse
Joseph M. Beals,
MD
Stephanie Flom,
MD
Dr. & Mrs. Mark
F. Pezda
Eudoro Coello, MD
Christopher W.
Hughes, MD & Debra J. Hughes
Claus Petermann,
MD
Richard D.
Cieslak, MD
Daniel S. Moore
Drs. Peter &
Alice Watson
Drs. Rachel and
Brian Silver
Kathleen
Yaremchuk, MD
Anne-Mare' Ice,
MD
John M. Malone,
MD
Anne Nachazel, MD
Eastside Surgical
Specialists
Paul Mazzara, MD
Dr. Richard
Pollard
Michael G.
Taylor, MD, FACS
Drs. Kenneth &
Deborah Granke
Aaron Lupovitch,
MD
Keith P. Bartold,
MD
Rev. William and
Dr. Mary Logan
Scott Monson, MD
Arthur J.
Frazier, MD
M. Natacha
Umlauf, MD
Phyllis A.
Vallee, MD
Michael
Schaldenbrand, MD
Heidi R.
Gunderson, DO
Paul J. Sullivan,
MD
S.V. Mahadevan,
MD
Indu & Bala Pai
Chris and Janet
Bush
Eve M. VanEgmond,
MD
Taufiek Alhadi,
DO
Gwendolyn H.
Parker, MD
Dr. Ray and Mrs.
Marcia Littleton
Drs. Daniel &
Margarita Morris
Dr. & Mrs.
Laurence E. Stawick
Dr. & Mrs. John
Calwell
S. Rao Talla, MD
Ghaus M. Malik,
MD
Eastlake
Pediatrics PC
Vernon F. Strand,
MD and Jane P. Strand
Martin H. Daitch,
MD
John Kurtz, MD
Dr. & Mrs. Dan
Michael
Mohammed
Arsiwala, MD - Livonia Urgent Care
Margaret Dowling,
MD
Dr. S. Maitra
George Mogill, MD
Dr. MaryJean
Schenk & David Fry
Dr. Grace Engler
& Ms. Anna Fedor
Dr. & Mrs. Donald
M. Ditmars Jr.
James A. Rowley,
MD
Sion Soleymani,
MD
Madjid
Mesgarzadeh, MD
Dr. & Mrs. Allan
Dobzyniak
Helene C.
Dombrowski, MD
Drs. Lalitha and
Babu R. Vemuri
Robert G.
Borchak, M.D.
Patricia A.
Kolowich, MD
Joan & Bob
Allaben
Advanced Family
Health Care
Marcie Treadwell
& Gregory Goyert
Dr. Michael
Sandler
Tom & Nancy Coles
William G.
Nutting, MD
Dr. & Mrs. Edmund
M. Barbour
Dr. Philip C.
Hessburg
Ron & Diane
Strickler
Joseph Mark
Tuthill, MD
Deloris Ann
Berrien-Jones, MD
Vincent C. Yu,
M.D.
Andrew J.
Mitchell, MD
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