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As the holiday season approaches, it is appropriate to look back upon the year to measure our successes and contemplate how we might have done better On the plus side, we can all take great pride in the efforts of physicians during the September 11 attack and the bio-terrorism aftermath. From the physician who bicycled to Manhattan to assist in the immediate aftermath of the attack to the majority of physicians who responded to calls about anthrax prophylaxis, our profession serviced the interests of the public without any expectation of compensation. On the state level, we did get our second layer of malpractice insurance renewed and the "ancillary" providers of healthcare have not, in general, been granted the responsibilities reserved for physicians. Nationally, the House has passed legislation protecting physicians by limiting demands for refunds based upon extrapolation and giving physicians adequate time to make repayment arrangements. This bill also included provisions to assure that Medicare carriers give correct information to physicians. The Senate and President have yet to act on this bill. Unfortunately, many of the key legislative battles important to physicians have been delayed because of the September 11, attack and the war. The Medicare drug benefit, for example, went from the front burner to backroom after Sept. 11. Finally, we are still actively engaged in the battle to prevent the 5.4% decrease in our reimbursement under Medicare. As we move toward the end of the year and the Congressional recess, time is rapidly running out for this important reform. The new year will therefore bring challenges, some predictable and some unforeseen. We will again fight the legislative battles at the state level for malpractice reform and the second layer of insurance. We will again be called upon to defend the public against the less qualified providers of care. We will see the funding of medical education threatened by the decrease in state revenue related to the Sept. 11 attack and the downturn in the economy. Nationally, we need the Senate to pass and the House to sign the legislation discussed above. We also need to support expanded benefits for our Medicare patients including a drug benefit. Finally, if 2001 has taught us anything, we need to expect the unexpected and, at times, the unthinkable. Physicians have cared for people for thousands of years and our profession has undergone many changes over the centuries. Notwithstanding the changes and stresses, our profession remains a high calling still attracting more applicants than our medical schools can educate. We do live in "interesting times," but our ultimate success is assured by our dedication, our training, our diligence and the respect we have earned from society, as it was for generations of physicians before us. May we all have a happy and healthy Holiday Season and a peaceful and prosperous New Year.
Daniel J. Nicoll, MD
The following letter was received from the State of New York Workers' Compensation Board: November 26, 2001 While the Board in not aware of any specific instances where World Trade Center victims have been denied prompt access to appropriate care as a result of the recent influx of claims, we would nonetheless like to invite you to communicate to your membership that, as always, the Board welcomes the participation of additional qualified health care providers in our system and stands ready to assist the county medical societies in the expeditious processing of any authorization applications. In a similar manner, we wish to assure you that the Board has staff and resources available should your organization or its members have any particular questions or concerns relating to the treatment of individuals injured as a result of this terrible tragedy. Please do not hesitate to contact Mr. William Egan, Director of the WCB Bureau of Health Management, at 518-474-2686 for assistance with such matters. Thank you for your commitment to the care of New York's injured workers, particularly at this difficult time, and for your continued cooperation. Very Truly Yours,
Organized medicine scored a major victory on Tuesday, December 4, when the US House of Representatives unanimously passed (408-0) the Medicare Regulatory and Contracting Reform Act of 2001 (HR 3391). This amendment to Title XVIII of the Social Security Act provides regulatory relief and contracting flexibility under the Medicare Program. The legislation , if enacted into law, would overhaul the Medicare contracting process and increase the amount of information physicians receive from contractors about the federal health care program. The bill, would streamline various regulations that physicians consider onerous. For example, new Medicare regulations could not be published more than once a month; the timeline for promulgating new rules would be clarified, and substantive rule changes could not be applied retroactively. The legislation would also make billing dispute processes less punitive to physicians accused of filing improper claims, and create separate ombudsmen for physicians and patients to help them with billing issues. The bill would ensure that:
The legislation also includes provisions that would give the health care program's administrators greater flexibility in dealing with private contractors, including determining how they are hired and managed, and the bill would make the process more competitive. Furthermore, this would require contractors to conduct greater outreach to physicians about Medicare regulations, including providing them with written responses to inquires within 45 days. Your medical society is proud of its involvement with the Medical Society of the State of New York in this intense lobbying effort spearheaded by the American Medical Association because the resulting bill addresses nearly every issue the House was asked to address.
Physicians are reminded that, after December 31, 2001, they may no longer write prescriptions for certain controlled substances (Schedule II and some Schedule III and IV drugs) on their old triplicate prescription forms. After the date, physicians may only use the new single-part form for writing such prescriptions. These forms were implemented pursuant to legislation enacted in 1998, and have been available from the NYS Dept. of Health since May 1. Despite efforts by MSSNY to reduce or eliminate the fee for these forms, the cost remains at $12.50 for a book of 25 and $50 for a book of 100.
On November 25, the New York State Supreme Court (Albany County) issued a decision declaring the Clinical Guidelines for Office Based Surgery, issued by the NYS Dept. of Health, to be null and void. The ruling was issued in connection with a lawsuit brought by the NYS Association of Nurse Anesthetists (NYSANA). In issuing the ruling, Justice Bernard Malone granted NYSANA a permanent injunction prohibiting the NYS-DOH from publishing, distributing or enforcing the Guidelines. Justice Malone agreed with NYSANA, the New York law does not empower the DOH to regulate health care in private office settings. NYS is expected to appeal the ruling.
The US Senate recently unanimously approved a bill that would postpone the compliance deadline for HIPAA transactions and code sets standards by one year, to October, 2003. Similar legislation is under consideration in the House, and House and Senate staff members are expected to meet to discuss possible ways to reconcile the "very different" versions of the legislation. The Senate bill will not affect compliance for HIPAA privacy regulations, which was a concern of several groups that opposed the delay. Congressional supporters of the legislation aim to pass the bill by the end of the current legislative session. Several groups opposing the delay argue that such a delay would unfairly penalize hospitals and health systems that have worked to achieve compliance by the original deadline.
On November 26, the CDC released "Interim Smallpox Response Plan and Guidelines," which outlines CDC's strategies for responding to a smallpox emergency. The plan identifies pre- and post-event activities that would need to be taken by various federal, state, and local agencies. These include identification and notification of suspected cases, quarantine-related activities, and vaccine and personnel mobilization. The plan does not call for mass vaccinations in advance of a smallpox outbreak. To view a summary, go to: http://www.cdc.gov/nip/diseases/smallpox.
Despite strenuous MSSNY and specialty society advocacy, Governor Pataki has vetoed legislation (A.4395) that would have required No-fault insurers to cover care rendered to intoxicated drivers within 48 hours after an accident. Current law permits No-fault carriers to deny coverage of the costs of care for injuries to intoxicated drivers. While sympathetic to the concerns of physicians and other health care providers, the governor expressed concern regarding the potential impact of this legislation on the cost of automobile insurance. He stated that any proposal impacting auto insurance "should be considered only in the context of broad and meaningful No-fault reforms." One of the proposals put forth by the administration is Reg. 68, which would have, among many other provisions, reduce the number of days by which a physician must submit a No-fault claim from 180 to 45. This regulation was adopted by the State Insurance Department in September, but as a result of a lawsuit by MSSNY and other provider and consumer groups, has been stayed pending court proceedings in December. MSSNY will again seek legislation to ensure that physicians are paid for the essential care they render to intoxicated drivers should the legislature take up auto insurance reform in a special session in December or in January.
In response to our current efforts on a national level, Representatives in the US House of Representatives have introduced legislation titled "Medicare Physician Payment Fairness Act of 2001" to dramatically improve the physician Medicare payment update for 2002. This bill would change the payment update for 2002 from -5.4% to -0.9 %. Further, the bill would require that the Medicare Payment Advisory Commission (MEDPAC) report to congress no later than March 1, 2002 on replacing the flawed formula for determining the annual Medicare physician payment update. Physicians should also note that as of press time no Nassau County Congressman has signed on as a co-sponsor of this bill. Please contact your representative as soon as possible and urge him/her to co-sponsor HR 3351, the Medicare Physician Payment Fairness Act of 2001", and to act on HR 3351 before Congress adjourns for this year. You can find the address and telephone numbers of your Representatives on the NCMS web site at www.nacmed.org and going to the legislative update page or you can visit the MSSNY web site at www.MSSNY.org.
Peter Galvin, MD, Associate
Director of Medical Affairs for Peninsula Hospital Center, was the
honoree of the hospital's 94th Anniversary Ball, held in October. He is
being honored as an outstanding physician for both his exceptional
leadership and his continuing efforts to improve quality care at PHC. Bruce Gilbert, MD, Ph.D.,
recently won the $1,000 first prize in the SEAK 2001 Medical Fiction
Writing Competition for an excerpt from his medical thriller in the
works, tentatively titled Ethical Decision. Philip Marcus, MD,
has been named Associate Dean for Curriculum Development at the New York
College of Osteopathic Medicine in Old Westbury. He has previously
served as Chairman of the Department of Medicine from 1991 through 2001.
He has also recently completed the requirements for the MPH degree at
Johns Hopkins School of Public Health.
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