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Our World We live is a world of many dichotomies. As physicians we work in a period of great achievement and potential. The greatest achievements in medical care are yet to come. Over the past 2 years, the natural history of many conditions that we treat has changed. Many people still live normal lives when only a few years ago they would not have survived. The greatest breakthrough has just been completed with the final deciphering of the human genome, "The Script of Life". This opens up the greatest potential for understanding disease and possible treatments. Surely the greatest successes are yet to be developed. This should be an exciting time to practice. Why then, are many of my colleagues feeling dissatisfied? There are many reasons such as the volume of paperwork unrelated to direct patient care. Many other reasons exist, such as the limitation on income while practice costs continue to go up. Also, dealing with patients' growing expectations for their care is becoming a more time consuming effort. Physicians describe a rising volume in their offices and having to see more patients without reducing the time of each visit. The constant menace of malpractice suits without any meaningful tort reform in New York State is a major irritant to many of us. The recent debate on how to accomplish physician profiling has also raised concerns among physicians. This is especially true while trying to explain to consumers, the high volume of suits, reasons for small settlements and the inconsistency of HMO and hospital disciplinary activities. The bill just passed by the legislature but not yet signed by the Governor does not fully take into account all of these issues. We recognize that consumers have a right to meaningful, accurate data which is relevant to and probative of the question of physician competence. Profiling should clarify this issue with truly meaningful data. While your Medical Society has been successful in the opposition to the enactment of regressive liability measures which could increase the cost of medical liability insurance and medical care in general, we have yet to achieve meaningful tort reform. Certainly, this has been a continuing disappointment to us all. I believe that this too will change in the next few years as more consumer groups learn of the deleterious effects on the cost of medicine without tort reform. While many feel how hard it is to practice today, I feel inspired by the deciphering of the human genome, the instruction book of life. Our imaginations can fly with the loftiness of the possibilities for the future. In human genes we see all evolution laid out for us. The promise is without limit for a better tomorrow. The dichotomies which exist for us today may never be solved. But there is a great deal to be proud of in our roles as healers and what we can accomplish. I would like to again thank the membership of the NCMS who elected me President one year ago. Serving as your President has been an honor and a wonderful educational experience. There are many issues to deal with. We will continue to work diligently together to meet our goals for the best medical care for everyone in Nassau County. The NCMS will continue to lead the effort. Joseph I. Cohn, M.D.
MSSNY's Legal Counsel, Don Moy, has initiated action with DOH Commissioner Antonia Novello, MD, DrPH, regarding Oxford's recent demands that physicians pay exorbitant refunds based on so-called "Health Care Financing Administration benchmarks." MSSNY believes that about 300 physicians have received these threatening letters from Oxford, which call for the physician to agree to make payment within ten days; about 1500 others have received warning letters informing physicians that they will be monitored. MSSNY Requests Stay Mr. Moy has requested that the DOH stay all arbitration and collection proceedings until the DOH, the Attorney General and the State Insurance Department have had an opportunity to fully investigate the matter, MSSNY has also requested an urgent meeting with the DOH, which will include MSSNY, county medical societies, and attorneys representing physicians who have been told to refund money, as well as Oxford officials. According to Mr. Moy, Oxford's claim that these "benchmarks" represent HCFA's benchmarks is false, since HCFA has provided written notice that it has "no existing national benchmarks for payment purposes." MSSNY challenges that the data and methodology used by Oxford was, in fact, developed by Towers & Perrin, a consulting firm retained by Oxford. MSSNY also contends that using a statistical median cannot be used to "benchmark," since medical care is based on the individual care of each patient. "We believe that this policy will have a profound effect on all physicians and will adversely affect the treatment of seriously ill patients," Mr. Moy stated in his letter. Determination Violates Law MSSNY also maintains that Oxford's "retrospective determination" that the level of E & M service was medically unnecessary or improperly coded violates Article 49 of the Public Health Law. Article 49 does not permit a health plan to make an adverse determination on the basis of any benchmark or statistical median. According to the law, adverse determination must be made by a clinical peer reviewer, a licensed physician who is in the same or similar specialty as the physician under review. In one of the several cases reported to MSSNY, the physician was told that he owed Oxford $87,041 and that if payment was made in ten days, 75% of that amount would be acceptable. MSSNY strongly advises physicians who receive such letters from Oxford to seek the advice of an attorney before responding to the health plan.
Calling their actions an "imminent danger to public health," New York State Health Commissioner Antonia Novello, MD, DrPH, recently suspended the licenses of two physicians who provided government-funded breast cancer screenings for low-income women, alleging that they often billed for tests that never took place, The New York Times reported. Two Bronx physicians, who screened over 9,000 women in the past five years, were charged with failure to provide accurate diagnostic test, including incorrect machine adjustments, patient positioning and misreading of results. In five years, only 15 cancer cases were discovered by the physicians, and health officials contend that based on a statewide average, four times as many cases should have been found. The physicians provided screening services in their private office and received about $1 million from the Healthy Woman Partnership. The suspensions came after the state Health Department's recent implementation of a new statistical method for reviewing MDs who screen for cancer.
From the Long Island Regional Poison and Drug Information Center. In 1999 there were 105 deaths due to heroin reported on Long Island of which 36 were in Nassau County, according to the Medical Examiners Offices. This is a significant increase compared to previous years. The Long Island Regional Poison and Drug Information Center (LIRPDIC) had only 2 deaths reported over the last 3 years of 83 heroin overdoses seen in hospital emergency departments. This increase in heroin deaths is a tragedy since we have a life saving antidote naloxone (Narcan) readily available. Early signs of heroin overdose consist of central nervous system and respiratory depression. According to the Center on Addiction and Substance Abuse, heroin is being taken by other routes (snorting and smoking) giving the illusion of safety. More potent forms of the drug are also being used. The mean age of first time heroin users has also dropped according to the National Household Survey on Drug Abuse from 24.7 years in 1991, to 19.7 years in 1995 and 17.6 years in 1997. The Poison Center will be alerting organizations that can relay this information on to Heroin users that can initiate further investigations and institute measures to reduce this epidemic. For further information, contact the Long Island Regional Poison and Drug Information Center at 516-542-2323 or visit their web site at www.liprdic.org.
S.2990-E / A.5410-D, which would license psychologists, social workers, mental health therapists, creative arts therapists, marriage and family counselors and psychoanalysts and allow them to treat any mental illness with no input from a physician, was successfully blocked in both the Senate and Assembly again this year by the Medical Society of the State of New York. MSSNY, throughout the year, attempted to negotiate with the sponsors and the groups seeking licensure and had hoped to have a bill that would enable licensure of these practitioners. This was not achieved and MSSNY had to oppose the bill as written. It is nevertheless, expected that the same legislation will be introduced next year.
The American Medical Association, at their annual meeting, rejected a proposal that called for a moratorium on capital punishment. Dr. Jonathan Weisbuch, author of the original proposal, had asked the AMA to recommend that the National Governors' Association stop all executions until issues concerning the availability of DNA evidence and the quality of legal representation are resolved. However, AMA delegates voted in favor of a amended resolution that "supports the availability and use of all appropriate medical forensic techniques in the criminal justice system." Some physicians argued that capital punishment is a legal question, not a medical issue. Weisbuch disagreed, noting that physicians are often involved in the judicial process by providing expert testimony, gathering medical evidence and declaring executed prisoners dead.
New regulations for named-based reporting and voluntary partner notification became effective on June 1, 2000. Under the new regs., MDs, other providers, laboratories and blood and tissue banks are required to report a diagnosis of HIV infection or illness and a diagnosis of AIDS. While the partner notification process is voluntary on the part of the patient, the new regulations have made it clear that physicians are required to report the name of the spouse of a patient. For more information, call MSSNY at 518-465-8085.
While an all-out lobbying effort by MSSNY, county and specialty societies and individual doctors did not convince the State Legislature to abandon the physician profiling issue for another year, it was successful in defeating the original Gottfried bill (A.1401-C) which would have required all judgements and settlements, all HMO terminations and hospital privilege modification and/or disciplinary action related to a physician's "character and competence "to be reported on a physician's profile. After months of
pressure by powerful consumer and business groups, leading to the
introduction of at least seven different bills, the Senate and Assembly
agreed to pass a modified profiling bill. Even the compromise
legislation, which was opposed by MSSNY, passed the Assembly by only a
slim margin after almost 50 legislators voted against the measure. If
signed by the Governor, Senate Bill 8127 would require the posting on
the State's web site of all malpractice judgements paid by physicians
over a period of ten years. Settlement information would only be
published if a physician had paid three or more settlements within the
past ten years. The Commissioner of the Department of Health would be
able to publish individual settlements for physicians who have not met
the "threshold" if she determines in specific cases access to
the information is in the public interest. Hospital disciplinary
information would become part of a physician's profile but only if such
action was taken as a result of the quality of patient care delivered or
to be delivered by the physician. HMO disciplinary information will not
automatically become part of a physician profile under the agreed-upon
legislation. The Legislature did not, as had been
expected earlier in the session, attempt to attach legislation mandating
new office-based surgery guidelines to the profiling measure. We urge all physicians concerned with this legislation to contact the Governors office at 518-474-9390 to register opposition to the signing of this bill into law when it is presented to the Governor.
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