|
|
PHYSICIAN PROFILING There is presently wide support among consumers for physician profiling and providing open access to this information. The case for profiling became stronger after the recent series in the DAILY NEWS. A prior series in NEWSDAY also provoked strong public reaction supporting public access to physician profiles. Likewise, in the physician community profiling raises strong reactions. Most information in a profile would be biographical. It is the remainder of the information on disciplinary actions and malpractice data and the way this would be presented that presents controversy. Presently there is broad support for healthcare consumers' rights to open access to all information about physicians. Both houses of the New York State Legislature and both parties have expressed support for physician profiling. Suggestions have been made to help consumers understand subspecialty differences in malpractice rates. Suggestions have been made for the use of thresholds, which would then trigger release of malpractice data. Hopefully, there would be some explanation of settlements of small sums paid to settle a case. Hospitals, HMOs, insurance companies and even the legal community understand that small sums are sometimes the cost of settling cases without any admission of fault. I am concerned that many consumers could feel that any potential charge of malpractice might be considered to have some validity. The legislation should include a method of expunging errors in a profile in a timely fashion. Physician concerns on fairness in profiling need to be made clearly and quickly to our elected officials in Albany to ensure that the legislation likely to be passed is accurate and fair to all. Consumer pressure on the state legislature is great. Please contact your elected representatives and express your opinion. Joseph I. Cohn, M.D.
The Office of the Inspector General (OIG) of the Department of Health and Human Services issued a Special Fraud Alert on February 23, 2000 titled "Rental of Space in Physician Offices by Persons or Entities to Which Physicians Refer". "We have received reports that some suppliers whose businesses depend on physician referrals are paying excessive rent for office space to their physician-landlords to keep referrals flowing," stated Inspector General June Gibbs Brown. The OIG warned that the anti-kickback law prohibits anyone from knowingly and willfully receiving or paying anything of value to influence the referral of federal health care program business, including Medicare and Medicaid. Violations of the law are punishable by up to five years in prison, criminal fines up to $25,000, administrative civil money penalties up to $50,000 and exclusion from participation in federal health care programs. The following are "safe harbor" requirements, all of which must be met:
Compliance with the "safe harbor" requirements means that the OIG will not challenge the arrangement as promoting an illegal kickback arrangement. The failure to comply with safe harbor regulations, in itself, does not necessarily mean that the arrangement is illegal, but, any person acting outside of a safe harbor acts at his/her own risk that the arrangement may be challenged by the OIG. The Fraud Alert is on the OIG's web site at:
MSSNY's General Council Don Moy, expressed his concern to Senator Charles Schumer in a March 6 letter regarding the recent seizure of 3,000 files from a group of cardiovascular surgeons in Syracuse as part of an FBI Medicare fraud investigation. Although the facts of the case have yet to come to light, MSSNY "is compelled to protest the manner that the medical files...were seized by the FBI... The seizure of these records seriously jeopardized the ability of the physicians to provide continuing care and treatment to their patients and seriously endangered the health care of their patients." Apparently, the FBI is charging the physicians an exorbitant amount to obtain copies of the seized files, an action to which MSSNY also vehemently objected. "We do not believe that it is acceptable to require physicians to pay $25,000 to $30,000 to obtain copies... from the FBI...and contravenes the presumption of innocence to which the physicians are entitled... We are concerned that in this case, the investigation in itself was punitive." Mr. Moy contends that having free copies available to the physicians would not compromise the investigation. He concluded his protest with "An investigation should not threaten the ability of the physician to provide continuing care to patients. A physician may ultimately be vindicated, but the harm to the physician's medical practice caused by an unduly intrusive investigation would likely be irreparable."
In other United HealthCare news, the insurer is requiring patients to buy certain antidepressant medications in larger pills that they can split in half to receive the daily dose. Under a new policy, patients taking Zoloft, Paxil and Celexa will need to purchase the 100-mg tablets and split them in half to get the 50-mg dosage. United officials say that the move is intended to help reduce the rising costs of popular prescription drug medications. Currently, a 100-mg pill of Zoloft costs $.07 more than the 50-mg tablet. United said the move will reduce the cost of a month's supply of the medications from $70.20 to $36.15. Lee Newcomer, MD, Senior Vice President for Health Policy at United
said. "It seemed to be a painless way to keep drug costs
down." United recently sent letters to doctors, members and
pharmacies outlining the new nationwide policy. However, critics are
saying the plan "has taken penny-pinching by HMOs to new
extremes". The Assembly recently passed a bill that would require no-fault auto insurance carriers to make payment to a physician or other health care provider who treats the injuries of a person within 48 hours after the injury, despite the fact that such person was injured as a result of DWI. An identical bill awaits action in the Senate Alcoholism and
Substance Abuse Committee. Senate Health Committee Chairman Kemp Hannon introduced legislation (S.6741) that would establish a mechanism to create physician profiles in New York State. The bill creates a subcommittee within the State Hospital Review and Planning Council (SHRPC) to determine what information about physicians should be made available. In particular, it would require that malpractice judgments be made available as part of a physician's profile but only where the frequency of judgments taken against a physician exceeds a certain threshold to be determined on a per specialty basis by the SHRPC. Importantly, the bill does not include a requirement that malpractice settlements, hospital disciplinary actions and HMO disciplinary actions be made available to the public through the physicians profile. We have historically been committed to making available all
appropriate and meaningful physician information to patients. We have
opposed, however, and will continue to oppose releasing information,
which is or could be seriously misleading. The Hannon Bill presents a
more reasoned and comprehensive approach than other measures which have
been introduced in New York State and enacted in other states. The New York State Insurance Department (SID) formally proposed a regulation that would require physician practices, IPAs and other health provider groups that enter into significant risk sharing arrangements with HMOs and other insurers to demonstrate sizable financial reserves. Specifically, the regulation would require a provider group that projects to receive $250,000 or more in annual capitation from an individual insurer to post a security deposit of 12.5% of such estimated annual capitation, with the security deposit to total $100,000 if the provider is an IPA or a hospital. The reserve may consist of securities, a letter of credit, or provider stop loss insurance, provided that the stop loss insurance cannot account for more than 50% of the required reserve amount. MSSNY has articulated to SID, DOH and Governor Pataki's office its great concern with the potential economic impact of this proposal on IPA's and group practices. MSSNY is concerned that HMOs and other insurers will take advantage of their inherent negotiation strength to force physicians to accept contracts that involve significant capitation, thus requiring the physician, group or IPA to post a staggeringly large security deposit. Comments should be sent to:
The State Senate recently passed legislation that bars insurers from refusing to provide life or non-cancelable disability insurance coverage based solely on an individual's family medical history or genetic predisposition to contract cancer. The measure (S.968), expands a 1993 law that prohibits insurers from discriminating against breast cancer patients by refusing to underwrite them. The bill prevents insurers from using the results of genetic tests or information about family history of diseases to deny or cancel insurance coverage. Upon passage the bill was sent to the Assembly.
Harold Reilert, MD, a Life member died on February 20, 2000 in Royal Palm Beach, Fl. Dr. Reilert was a member of the Society since 1946. Robert Jon Riechers, MD, a Life member of the Society died on February 4, 2000. Dr. Reichers was a member of the Society since 1967. He was a practicing ophthalmologist in Glen Cove prior to retirement. He is survived by his wife, four children and three grandchildren. |
|
|
|
|
|
|
|
