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There is something very special about the Christmas season. Chestnuts roast on open fires, Jack Frost nips at one’s nose, and every one awaits the arrival of Santa Claus, with lots of toys and goodies on his sleigh. But there is a much more universal message to be found from this December. Almost every one of us will celebrate a holiday commemorating one miracle or another: Ramadan, Christmas Chanukah, Kwanza - happy and meaningful holidays all; time to share life’s bounties with friends, family, and with those less fortunate. It is a time to spread cheer and good will to all mankind, and it is a time to revel in the lights, foods, and warmth that transform the cold dark nights into wonderful, spiritual times. As physicians, we are part of a large and very diverse community and are privileged to share with and extend our knowledge to people of all religions, share time, and ethnic beliefs. And make no mistake, it is a true privilege. I know all too well the difficulties of medical practice and the frustration that you all feel. And I know full well the level of discontent prevalent in our medical community. Indeed, we are all in it together. Despite everything, though, the time has come to open my bag of gifts and to share with you my best wishes for a joyful holiday season and for a happy, healthy, and wonderful new year for you and yours. Sincerely, President Nassau County Medical Society
Historic Victory for Patients and Physicians Legislation now goes to President Bush for signature into law On Tuesday, November 25, 2003, the United States Senate gave final approval to the Medicare Modernization legislation, which the Medical Society of the State of New York, working in close cooperation with the American Medical Association, had strongly advocated Congress to approve. The vote was 54-44. This action follows approval of the legislation (H.R. 1 / S. 1) by the House of Representatives on Saturday, November 22 by a vote of 220-215. When signed into law, this bill will establish a new prescription drug benefit for seniors, increase Medicare payments to physicians in New York by an average of $4,400 per year, institute regulatory reforms within Medicare, allow voluntary (not mandatory) electronic prescribing standards, and allow continuation of ICD-9 coding, saving physician offices money. This action comes after some of the strongest and intense organized grassroots activity by physicians across the country that has ever been seen. Now, that the Congress has acted positively in response to organized medicine’s strong requests to pass the Medicare legislation, please log onto http://capwiz.com/mssny/issues/alert/?alertid=2212506&type=CO to thank those members of Congress who supported patients and physicians. Those members who voted “YES” with patients, the Medical Society and the AMA were:
Those members who voted “NO” to providing a prescription drug benefit to seniors and increasing physician Medicare payments were:
In response to the positive action by Congress, Donald Palmisano, MD, JD, President of the American Medical Association said “The AMA applauds Congress for giving America’s seniors and disabled greater access to prescription drugs and medical care and increased choice under Medicare. We look forward to President Bush’s signature on this historic bill and to a stronger Medicare program for our nation’s seniors.” For additional background information, log onto www.ama-assn.org/grassroots
In light of the severe influenza season and the strong demand for influenza vaccine, the AMA/CDC has asked all state medical societies to ascertain how many physicians have run out of influenza vaccine and cannot get more (eg, because their supplier has sold out). If you did not receive the questionnaire via email, please visit the MSSNY website at MSSNY.ORG to complete the questionnaire.
Federal officials announced Wednesday that a federal grand jury in Alexandria, Va., has returned a 108-count indictment against 10 people, including several doctors and pharmacists, and three companies for allegedly illegally selling controlled substances over the Internet. According to the indictment, which was unsealed on December 3, when customers ordered drugs online, they could choose the type, quantity and dosage. Customers received the drugs without ever seeing a doctor in person, and the defendants allegedly distributed the drugs without performing mental or physical exams, getting patient histories or monitoring patient responses. In addition, when customers filled out an online medical questionnaire, the questionnaire “provided default answers that, if left unchanged, ‘qualified’ customers to receive drugs,” according to the indictment. The indictment alleges that the defendants sold nearly 5.9 million doses of drugs — mainly weight loss medications such as Bontril, Ionamin, Phentermine, Adipex and Meridia — through Web sites between December 1998 and October 2001. They also face the possible forfeiture of more than $125 million in earnings from the illegal sales (AP/Wall Street Journal 12/4). The FDA, FBI and Drug Enforcement Administration also were involved in the case. ”Drug trafficking in cyberspace is just as harmful to public safety as drug trafficking on street corners,” US Attorney Paul McNulty, said, adding, “The advent of the Internet does not mean doctors and pharmacists can bypass rules concerning the dispensing of prescription drugs.”
Effective December 1, the Workers Compensation Board (WCB) will be streamlining its procedures for responding to situations of carrier non-response to a physician’s request for authorization for specialized care to an injured worker. The goal of the new procedure is to provide a more prompt and certain resolution of the authorization process, and to eliminate the ability of carriers to object to an Order of the Chair deeming treatment authorized once issued. In 2002, the WCB implemented procedures to more quickly intervene when a physician seeks authorization for non-emergency care for an injured worker that costs more than $500, and the carrier does not respond within 30 days of the authorization request (Care under $500 does not need authorization). Under the procedure, the physician completes a WCB MD-1 form, and submits the form to the WCB and the carrier. If the WCB deems the application appropriate, it issues an “Order of the Chair” that the care requested is “deemed authorized.” However, the carrier could still object to the Order within 10 days. In some cases, this resulted in a rescission of the Order deeming treatment authorized, or multiple appeals of the Order, all the while care was needlessly delayed. As a result, this invited confusion in physicians and patients over whether treatment was, in fact, actually “authorized”. Effective December 1, physicians will be required use a revised MD-1 form. The physician will still be required to send the form to both the Board and the carrier from whom authorization was sought. The individual mailing the form will also now be required to sign a statement on the form stating that they sent a copy of the form to the carrier. However, as of December 1, when the physician submits the MD-1 form to the Board and the carrier, the carrier must respond within 10 days. If they do not respond within that time, or they respond within 10 days but the response is without merit, the Order is final and cannot be challenged. If the objection has merit, then the issue will be referred to an expedited hearing process. Importantly, physicians should be aware that, after December 1, only the new MD-1 form can be used. It will continue to be available directly from the WCB website at http://www.wcb.state.ny.us/content/main/forms/md-1.pdf. Physicians should also be aware that, because of these hassles, MSSNY continues to pursue legislation that would increase from $500 to $1,000 the cost of care threshold that triggers the obligation of the treating physician to obtain authorization from the carrier.
The Nassau Academy of Medicine's Education Committee is in need of members willing to meet about once a month to help plan and implement CME and other educational programs for the membership. If you can help, please call the Academy offices at 516-832-2300 ext 13.
The Credentials and Awards Committee of the Academy of Medicine invites all members of the Academy to consider nominating an Academy colleague for Fellowship in 2004. Send your nomination in writing to the attention of the Credentials and Awards Committee at Nassau Academy of Medicine, 1200 Stewart Ave. Garden City, New York 11530.
Statement Prepared Abby J. Greenberg, MD Nassau County Department of Health conducts daily surveillance of area hospital emergency rooms to determine trends in the number of visits and hospitalizations for flu-like illnesses and pneumonia. As of December 8, 2003, there has not been any unexpected increased incidence of visits for flu-like illnesses or pneumonia. Area physicians are reporting seeing some patients with flu-like illnesses. Currently in New York State, almost one-third of the individuals reported to have flu-like illnesses are young children under the age of 5 years. The percentage of young children with flu-like illnesses has significantly increased since early October when the majority were older children and young adults ages 5 – 24 years. At least one dozen laboratory confirmed cases of Influenza A have been reported in Nassau County, although the specific strain has not been isolated. Physician vaccine supply is variable. As of December 8, 2003, some practitioners report that their supply has been completely used, while others still have vaccine remaining. Following media reports of large numbers of Colorado residents ill with influenza and five deaths of children in Colorado, local public demand for vaccine has increased. At this time, the recommendations for vaccine use remain the same. With limited supply, priority should be given to those in the highest risk categories. All people 50 years of age and older should get vaccinated against influenza every year.
Despite strong protests from MSSNY, physicians are
receiving in the mail a letter from the New York State Department of
Health (DOH) detailing how DOH will be implementing the
Medicare-Medicaid crossover payment cut enacted in this year’s State
Budget. Beginning December 11, when physicians bill the state for the
Medicare deductible and co-insurance for care rendered to “dual
eligible” patients, physicians will be required to submit two separate
claims. The procedures for how these amounts should be billed are set
forth in the letter. Moreover, DOH notes in its letter that, with regard to the recoupment of overpayments made between July 1, 2003 (the effective date of the crossover cut) and December 10, 2003, the recovery of these overpayments will be made over several payment cycles during the first quarter of 2004. Importantly, with regard to previously paid deductibles, the letter notes the following: “because the current payment system cannot distinguish between coinsurance and deductible amounts, the retroactive adjustment process noted above will also recoup payments made for the deductible. Therefore, after the retroactive adjustments are processed, to receive the appropriate full payment for a deductible, the provider must resubmit an adjusted claim for the deductible amount.” MSSNY has expressed to the highest levels of the Legislative and Executive branches its serious concern about this DOH effort to recoup previously (and properly) paid deductibles. These were not included as part of the Crossover cut, and the fact that they are to be subsequently re-paid after the physician has returned that part of the initial payment is grossly unfair. MSSNY is also examining the legality of such action. MSSNY also continues to work with a number of similarly affected provider and patient groups to urge the Legislature to repeal the entire unfair crossover payment cut retroactive to July 1, 2003. Such relief, however, if it comes at all, may not be forthcoming until negotiation of the 2004-05 State Budget is concluded. In order to advance our advocacy efforts, physicians are urged to continue their grassroots activity on this issue, including:
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