News Bulletin - May, 2000 - Nassau County Medical Society

President's Message

Joseph I. Cohn, M.D.

STAND UP AND BE HEARD

Your voice can only be heard if you step up to the table and speak up. The House of Delegates, the governing body of the Medical Society of the State of New York, spends considerable time discussing and debating resolutions which, when passed, form the policy objectives of the MSSNY and Nassau County Medical Society. The resolutions formulate position statements on a wide spectrum of issues which are important to physicians, and to improving medical care in New York State. These issues include legislative matters, tort reform, public health, professional education, socio-medical economics and governmental affairs. Also debated are positions concerning managed care and health care policy.

Many successes have been achieved. We should be proud of our leadership in public health and fostering patients' rights to mention only a few. More time and work will be needed to obtain meaningful and long overdue tort reform.

Physician grassroots efforts are critical to the ultimate success of our policies. For this to happen we need more people to speak up. We need also to present our best efforts as the real advocates for improving health care for all New Yorkers.

Our strengths are dependent on the participation of our membership. All physicians must realize that the cost of doing business should include Medical Society dues. There is no other organization that represents doctors on the broad spectrum of issues which are important to being a doctor today, regardless of your practice mode. These extend from public health care policy to profiling.

Your support is needed now for The Campbell Bill in the House of Representatives. This is Bill HR 1304. If passed and enacted, it will allow independent physicians to come together to collectively negotiate contract terms with HMOs and other insurers. This means you could negotiate issues such as hospital length of stays, payment terms, appeals processes, and the definition of "medical necessity"!

This work can only happen if physicians continue to support the Nassau County Medical Society and MSSNY.

Joseph I. Cohn, M.D.

Phone Scam Alert

Members are asked to be alert to a telephone scam that is occurring in Nassau County. Individuals are calling people at random claiming to be AT&T service technicians conducting a test on area telephone lines. To complete the test, the person called is asked to touch "9-0-#" and then hang up.

The telephone company is advising persons not to comply with this request. By pressing "9-0-#", you give the caller complete access to your telephone line which enables them to place long distance calls billed to your number.

Please be aware. DO NOT PRESS 9-0-# FOR ANYONE! For further information or if you have been victimized by this scam, call your local telephone carrier.

Academy Elects New Fellows

At its March meeting, the Board of Trustees of the Nassau Academy of Medicine elected the following members to Fellowship in the Academy:

ALLERGY		Raphael Strauss, MD

ANESTHESIA		Peter Boulukos, MD
ANESTHESIA		Edward Gross, MD

DERMATOLOGY		John Garofalo, MD
		Joseph Onorato, MD
		Marvin Tankel, MD

GASTROENTEROLOGY		David Eskreis, MD

INTERNAL MEDICINE		Vincent Anzalone, MD
		Neil Dash, MD
		Robert Fuentes, MD
		Lewis Lebetkin, MD
		Ronald Menzin, MD
		Herbert Roth, MD
		Perry Wallach, MD

OPHTHALMOLOGY		Mark Flugman, MD
		Arthur Gold, MD
		Jodi Luchs, MD

PEDIATRICS		Steven Cogan, MD
		Andrea Leeds, MD
		Harold Levine, MD

PSYCHIATRY		Ruth Waldbaum, MD

RADIOLOGY		Kenneth Crystal, MD
RADIOLOGY		David Dorfman, MD

UROLOGY		Robert Sunshine, MD

These physicians will be honored along with those elected in 1999 at the biannual Fellows Dinner to be held on Wednesday, October 11, 2000, at the Westbury Manor.

Lyme Disease Update Now Available

Copies of the revised Nassau County Department of Health bulletin Lyme Disease and Other Tick Related Illnesses are available at no cost to health care providers for distribution to their patients. The Bulletin provides information to patients about Lyme Disease and other diseases in this area that are caused by bites from infected ticks.

The bulletin provides strategies to prevent disease, describes the proper way to remove ticks and lists the early symptoms of Lyme Disease. Ehrlichiosis, Babesiosis, and Rocky Mountain Spotted Fever. The updated bulletin also includes recommendations for the use of Lyme Disease vaccine.

Health care providers can contact the Nassau County Department of Health at 516-571-2006 to obtain copies of the Lyme Disease and Other Tick Related Illnesses bulletin.

Counsel Needs Evidence In Suit Against HMO

MSSNY and the AMA have joined a New York physician and his patient in a class action suit against Metropolitan Life Insurance Company and United Healthcare Corporation.

All parties are claiming that both companies used flawed and invalid data in order to reduce reimbursement rates and medical services. The suit has major implications for both physicians and patients as to what carriers are obligated to pay under the definition of "usual and customary."

This litigation is an important step in assuring patients and physicians what they should expect as reimbursement.

If you think you are being shortchanged by these carriers on "usual and customary" charges, please call MSSNY's Legal Counsel Don Moy at 516-488-6100 ext 320.

NY MDs to be Investigated for Charging for Samples

Doctors in at least seven states accepted free samples of a cancer drug and then billed insurers for hundreds of dollars per dose. In February, the US Attorney in Massachusetts filed a case against the doctors in US District Court in Boston. It is part of an ongoing investigation by federal and state prosecutors into the pricing practices of the drug industry.

Prosecutors claim that the drugmaker, TAP Holdings, gave physicians Lupron, a prostate cancer drug, so the doctors could "pay past-due bills owed to TAP." The filing argues that an Indiana urologist, and other unnamed doctors, accepted free samples of the drug, then billed insurers $400 to $500 per dose. Over a three-year period, the urologist allegedly billed government and private health plans for $40,000 to $70,000.

According to documents filed with the court, investigators are also reviewing the billing practices of urologists in six other states including New York.

Insurance Industry Mobilizes Against Campbell Bill

The American Association of Health Plans (AAHP), the health insurance industry's trade and lobbying group, is mobilizing members to deluge Capitol Hill with calls and letters in opposition to the Campbell Anti-trust Bill (H.R.-1304) which would allow non-employed physicians to collectively negotiate contract terms with HMOs and other insurers. The AAHP does not want its monopolistic power challenged by having to negotiate with health care providers on a level playing field.

All physicians are urged to contact their US Representative to voice their support for H.R. 1304 as a means to return clinical decision-making authority and patient protection safeguards to the hands of physicians. To obtain your Representative's address look in www.nacmed.org/legislative update.

AMA to use Apelon for Next Generation of CPT Codes

The AMA has announced that it will collaborate with Apelon, Inc. to develop a new computer-friendly structure for the Current Procedural Terminology (CPT) coding system. Due to be introduced in 2001 as part of the process to phase in CPT-5, the improvements are designed to:

Support the emerging needs of computer systems, electronic medical records and research databases;
Allow easy electronic interchange;
Increase user understanding of the links between related codes;
Provide deeper analysis and greater clinical detail of specific areas of interest, and;
Enable electronic representation of the CPT book, eventually with browser interface.

Meeting the goal of expanding CPT's capacity for use in computer applications meant the CPT would need to evolve into a machine-readable system that allows better integration with computer-based medical records and greater use in analysis of health care data.

For more information on the CPT-5 project, visit

http://www.ama-assn.org/med-sci/cpt.htm

Collective Bargaining Bills Now in Both Houses

With the recent introduction of Senate Bill S.7541 introduced by Senate Health Committee Chair, Kemp Hannon, Physician Collective Bargaining "State Action" legislation now exists in both houses of the New York State Legislature. The bill, a companion to the proposal introduced earlier this session by Assemblyman Ronald Canestrari (A.9484) would allow collective negotiations by health care providers and is designed to restore fairness in the contracting process between physicians and large managed care plans by allowing doctors to join together to negotiate contract provisions. This legislation would not authorize strikes or boycotts of health benefit plans by physicians.

By allowing physicians to conduct some collective negotiations, while being closely monitored by the state, this legislation would give physicians greater ability to advocate for patients in contract negotiations. Similar to the legislation signed into law by Texas Governor George W. Bush, this bill creates a system under which the state would closely monitor those negotiations and any negotiations involving fee-related matters would only be permitted when an individual managed care plan controls a substantial share of the managed care market.

Bill Would Indemnify Volunteer Physicians

Senate Health Committee chairman, Kemp Hannon introduced legislation (S.7389) to indemnify physicians from liability exposure who provide care free of charge to the uninsured. The bill was referred to the Senate Health Committee and represents a critical component of MSSNY's Physician Volunteerism Pilot Project which is designed to establish free primary care medical programs in Schenectady and Queens Counties. The bill is a companion bill to Assembly Bill A.8905 introduced last session and currently pending in the Assembly Health Committee. Senator Hannon also carries other legislation that addressed the other necessary component of the program - waiver of the biennial registration fee for volunteer physicians.

This legislation has been reported from the Health Committee in the Senate and remains in the Ways and Means Committee of the Assembly. Physicians are encouraged to voice their support for the passage of both these proposals by sending a letter of support to their elected legislators.

The Senate version was strongly opposed by organized medicine because it did not contain any of these essential items. All physicians are encouraged to contact their federal representatives to urge them to support the House version of the patients' rights bill.

Holds National Databank Hearing

Office-Based Surgery Reporting Bill Introduced

A.8917-B (Gottfried) has been amended and is somewhat improved from the original bill, but is still problematic for physicians. The bill would require all health care practitioners performing surgery to report, on at least a quarterly basis, any incident in the course of or affecting office-based surgery which, if it occurred in a hospital, would be reportable. The writers have, however, added authorization to refer information in an incident report to the Office of Professional Medical Conduct (OPMC) or the Office of Professional Discipline (OPD), as well as to any governmental agency that has jurisdiction. We are concerned that this latter provision could mean reporting to a District Attorney's office for possible criminal action. The bill requires the Commissioner of Health to maintain data on all "surgeries" and "complications" which is far more expansive than the information which practitioners are required to report. There is companion legislation currently in the Senate as well. The Senate bill number is S.5834-A (Goodman).

Members are urged to call their representatives to voice strong opposition to the passage of this legislation.

You can find your Assembly and Senate representative's address, telephone number and e-mail address on the NCMS web site at www.nacmed.org/legislative update.

Organized Medicine Wins Medicaid Fee Increase

For the first time since the inception of the Medicaid program thirty-five years ago, the Legislature has adopted a significant increase in physician primary care and specialty care fee-for-service reimbursement. The fee for certain primary care evaluation and management services will increase from as low as $7.00 to $30.00. This increase will aggregate approximately $80 million dollars. An aggregate of $8 million allocated to targeted fee increases for specialty care is also included.

These fee increases will go into effect on October 1. MSSNY and the county medical societies, along with specialty societies will work with the Department of Health and the Division of the Budget to provide assistance as appropriate rate increases are implemented.

Other State Budget items include:

Expansion of Prenatal Care Assistance Program (PCAP)
"Get Tested and Treated" HIV Program
Expansion of the EPIC program for the elderly
$4 million for expanded cancer research

Feds Delay Implementing Data Bank Reforms

The Health Resources and Services Administration (HRSA) has announced their intention to issue a second notice of proposed rulemaking regarding Medical Malpractice reporting requirements. The HRSA wants to reform reporting standards to require hospitals which make malpractice payments to identify physicians involved with the claim.

The issuance of a second notice, which requires a public comment period, means that the revised proposal will not be published until the end of the year, with final implementation delayed until 2001. Both MSSNY and the AMA have indicated their serious concern with respect to the accuracy of fairness of identifying individual physicians in malpractice cases lodged against institutions.

In Memoriam

Charles Brody, MD, a Life member of the Society died on March 29. Dr. Brody was a member of the Society since 1951. Dr. Brody was a 1950 graduate of the University of Buffalo Medical School. Dr. Brody was instrumental in the opening of Franklin Hospital in 1963. He is survived by his wife, Ethel, two children and four grandchildren.

Harry Charles Essig, Jr., MD, a Life member of the Society died on May 1. Dr. Essig joined the society in 1956 following graduation from the University of Buffalo School of Medicine in 1948 and following completion of his resident and internship programs at Meadowbrook Hospital from 1948 through 1956. Dr. Essig practiced general surgery in Levittown.

Julian Greenberg, MD, a member of the society since 1967, died on April 3. Dr. Greenberg was a 1956 graduate of the University of Geneva and practiced Internal Medicine in North Woodmere. Dr. Greenberg was Director of the IM Dept. at Franklin Hospital Medical Center.

Arnold Lurie, MD, a Life member of the Society died on April 5, in Lake Ariel, PA. Dr. Lurie was an active member of the Society since joining in 1960. He served for many years on the Board of Censors and was active in other capacities while he maintained his Internal Medicine practice in Baldwin. Dr. Lurie remained active in the Society following retirement. He is survived by his wife, Kay.

May 2000

In the News This Month...

President's Message

Phone Scam Alert

Academy Elects New Fellows

Lyme Disease Update Now Available

Counsel Needs Evidence in Suit Against HMO

NY MDs to be Investigated for charging for samples

Insurance Industry Mobilizes against Campbell Bill

AMA to Use Apelon for Next Generation of CPT Codes

Collective Bargaining Bills Now in Both Houses

Bill Would Indemnify Volunteer Physicians

Organized Medicine Wins Medicaid Fee Increase

Feds Delay Implementing Data Bank Reforms

In Memoriam