A cornerstone for the 21st Century is to improve medical care for all Americans. The President and the Department of Health and Human Services have established specific goals. One pillar of this ambitious program is to eliminate disparities in healthcare experienced by racial and ethnic minorities. This vision includes a commitment to further identify and address underlying causes of higher levels of disease and disability in racial and ethnic minority communities. These include poverty, lack of access to quality health services, prevention programs, and better understanding of cultural diversity in addressing medical needs.

Numerous medical reports have given evidence that there are health status disparities based on race and ethnicity. Disparities have been identified in a wide range of medical conditions from cancer treatment, organ transplantation, joint replacement , cardiac care, and immunization, to name a few. There has been notable progress made, for sure. There is still a need for improvement for African Americans, Hispanics, Native Americans, Alaska Natives, and Pacific Islanders as compared to the American population as a whole. These groups are expected to grow in the future, underlining the need to help improve their healthcare status.

Focusing on disparities in health status has further importance as changes take place in the way health care is delivered and financed. Eliminating disparities will require renewed efforts at preventing disease, promoting health, and delivering appropriate care. This process will require improved collection and use of data to identify high-risk populations and monitor the effectiveness of health interventions.

Six areas in which racial and ethnic minorities experienced disparities in healthcare and outcomes are: 1) infant mortality, 2) cancer screening and management, 3) cardiovascular disease, 4) diabetes, 5) HIV infections/AIDS, and 6) immunizations.

I will address one of these issues as it affects Nassau County. In our county, programs to address infant mortality exist, but need to be greatly expanded in order to reduce the existing disparities in infant mortality based on race. Generally, infant mortality has declined in Nassau County as it has across the U.S. In 1996, the infant mortality rate (IMR), the number of deaths per 1,000 live births, was lower in Nassau County than the Upstate rate and the national rate. Neonatal mortality is the number of live infants that die during the first 28 days of life. The neonatal mortality rate in Nassau County has also declined and our county's statistics are better than the Upstate rate. However, the risk of an infant dying is greater for blacks than whites in Nassau county. The nation's IMR for blacks is generally higher than the white IMR. The IMR for blacks in the county is higher than the national average for blacks, while the IMR for the county's white population is lower than the national average. The 1996 county health statistics revealed an IMR of 3.8 for whites and 16.7 for blacks. Nationally the IMR in 1996 was 6.0 for whites and 14.2 for blacks. In Nassau County the Hispanic IMR was similar to the white rates. Infant mortality is a problem for teenagers for all races in Nassau County.

The Nassau County Medical Society is currently becoming involved in the process of addressing ways to improve the infant mortality rate in the African American population. This is a long term undertaking and as physicians in Nassau County we are committed to the improved healthcare status of all the people in our county.

Joseph I. Cohn, M.D.

On December 17, 1999, an agreement was reached by Governor George E. Pataki, Senate Majority Leader Joseph Bruno, and Assembly Speaker Sheldon Silver to extend Health Care Reform Act (HCRA) for 3.5 years. The agreement contained significant programs supported by MSSNY:

• Expansion of the state subsidized health benefits for small business;
• Expansion of the Child Health Plus program to include parents;
• Continued funding for Graduate Medical Education;
• $.55 tobacco tax increase to finance smoking cessation programs and create health insurance programs for the uninsured.

Governor Pataki's Budget 2000-2001 included a number of public health initiatives supported by MSSNY:

• $113 million for women's health care needs: breast cancer prevention, osteoporosis and genetic screening.
• $425 million statewide anti-smoking initiative.
•  $165 million to assure safe public drinking water.
•  $2.5 million to prevent spread of West Nile Virus and other infections.

But not accomplished in HCRA 2000, or in the Governor's Budget is reform of the Medicaid System. New York has the most costly Medicaid System in the United States, approaching $30 billion per year - which systematically excludes 3.5 million patients from seeing private physicians and forces them to receive episodic, emergent care in an institutional setting. Government officials may decry the over utilization of emergency rooms - but their funding policies assure such a result.

Physicians have not received an increase in reimbursement under Medicaid in 30 years - and it wasn't a mistake, it was done on purpose. The same service in a physicians office reimbursed at $7.00 is $86.00 in an emergency room. This isn't good economics, it isn't good healthcare policy and it certainly isn't good medicine.

HCRA made major steps in decreasing the number of uninsured in New York State, but one group of uninsured have still not gotten full recognition - the mentally ill. MSSNY continues to support mental health parity legislation.

I recently introduced MSSNY's legislative program in Albany, which includes Medicaid reform, mental health parity legislation, the state action doctrine to allow collective bargaining for physicians, civil justice reform, workers' compensation improvements in addition to a broad public health agenda.

There is an enormous amount of work to be done "Beyond HCRA 2000". As a medical society, we must continue to be focused on our goals, and advocate for our physicians in the media, before the legislature and our state government officials, and in the courts if necessary. As members, we must stay informed, stay united and challenge our county and state medical leadership to do more.

John A. Ostuni, MD
President, MSSNY

HCFA has announced that the MEDPARD (Participating physician/supplier) directory will NOT be available this year in hard copy format. A MED- PARD equivalent will be available through the Internet that will include all participating providers.

The directory will be available in mid-February via the Web site. To access this information from the Empire Medicare Services home page:

www.empiremedicare.com

• Click on the BENEFICIARIES link or page.
• Scroll down until you see the Medicare participating physician/supplier directory (MEDPARD) link.
• Click on New York. You are now at the MEDPARD site and are given the option to click on a particular county.
• Utilize the search/find and type in exactly what you wish to find. You can make a search for a specific physician/supplier and/or specialty

MSSNY's Annual Legislative Day presents a unique opportunity for doctors from across the state to interact with their state legislators, MSSNY staff and each other. A morning legislative briefing by key members of the state legislature will begin at 8:30 AM and be followed by a luncheon with guest speakers. The day will conclude with time set aside in the afternoon for visits with local representatives. Persons interested in attending should call MSSNY's Governmental Affairs Office at 518-465-8085.

The New York State Department of Health (DOH) will now update its web site list of disciplined physicians on a weekly basis, instead of monthly. The primary goal of this new policy, according to DOH Public Affairs, is to help HMOs avoid listing unlicensed physicians in their directories of physician providers. Consumers will also have more timely information when making personal health care decisions. The change in DOH policy was in response to a discovery that 22 HMOs operating in New York were offering elderly and handicapped Medicaid patients the services of 27 physicians whose licenses to practice medicine had either been suspended, surrendered or revoked.

The information that will be posted is the same as what has been available to all members of the public on the DOH web site in the past. Only final decisions will be listed. The names of physicians whose cases are still pending will not be included. Also, the names of physicians who voluntarily surrender their licenses, either on their own, or as a result of counseling with CPH, will not be listed on the DOH site.

In related actions, both Republican and Democrat leaders have announced plans to introduce a law in the state legislature which would require the DOH or notify HMOs immediately when a physician loses a license, just as it currently notifies hospitals.

Medicare is promoting the influenza and pneumococcal vaccinations for Medicare patients. Both vaccines are Medicare Part B covered services. Neither the $100 annual deductible nor the 20 percent coinsurance apply.

The fee/schedules/approved amounts are as follows

• CPT Code Amount
• Flu Vaccine 90657 $1.60
• 90658 $3.32
• 90659 $3.32
• Administration G0008 ***
• Pneumo. Vacc. 90732 $11.36
• Administration G0009 ***

*** The fee schedule for the administration of both the flu and pneumococcal vaccines vary by locality:

• Locality 1 $6.05
• Locality 2 $5.67
• Locality 3 $4.85

The ICD-9 diagnosis code for the flu shot is V04.8; the diagnosis code for the pneumococcal vaccine is V03.82.

If the physician does not accept assignment, the NYS Balanced Billing Law applies. Therefore, the patient may not be billed more than 105% of the Medicare approved amount.

H.R. 1304, the "Quality Health Care Coalition Act of 1999" gained 8 more cosponsors in the House, bringing the total to 192. Congressional markup of the bill is expected on March 8. Passage of this bill would modify antitrust laws to foster quality health care for patients by allowing health care professionals to jointly negotiate the terms of their contracts with health care plans. Physicians are urged to call their Congressional representatives to enlist their support of this bill.

Presented by NYS Dept. of Health, MSSNY and Nassau County Medical Society. The program will review utilization overrides, restricted recipient program, drug utilization review, billing, claims processing, electronic eligibility verification. Program qualifies for Category II - self-directed study - CME credit.

Pre-registration is required.

A program to foster recognition of this serious medical issue, which affects tens of thousands of Americans. Program includes and overview, new approaches to prevention, developments in epidemiology, diagnosis and clinical management, efficacy of treatment protocols, infection control practices. One (1) hour of Category I CME credit. Pre-registration is required.

A panel of experts will make short presentations on common problems facing the practitioner each day. Come and be updated on the latest regarding prevention, treatment and answers to any questions you may have. One (1) hour of Category I CME credit.

For information on registration and attendance at any of these programs, please contact the Nassau County Medical Society at 516-832-2300 ext. 13 or 14.

Henry Partridge, MD, was recently named Director of Surgery at South Nassau Communities Hospital. A member of the hospital staff for 24 years, he served as acting director for one year prior to this appointment. Dr. Partridge was also recently voted "Teacher of the Year" by chief residents in surgery at Nassau County Medical Center.

Rama Raju, MD, has been appointed Medical Director at Peninsula Center for Extended Care and Rehabilitation in Far Rockaway. Dr. Raju is Board Certified in Internal Medicine and a certified Medical Director. He has served as the President of the Medical Staff at Island Medical Center and most recently, he held concurrent positions as Director of Internal Medicine at Island Medical Center and Medical Director at Wedgewood Care Center in Great Neck.

William Benjamin, MD, a Life member died on December 2, 1999. He is survived by his wife, Marilyn, four children and five grandchildren. A memorial service was held at 3:00 PM on January 9 at the Unitarian Universalist Congregation in Manhasset.