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We are made aware of the changes in the health care environment in everything we read and do. We read about it in news articles and medical journals. We hear about it on television and from our leaders in medicine. Most of all, we live it daily in our own practices. Physicians' discussions seem to center themselves on what has happened to us instead of on constructive ideas on how to respond. We now need to refocus our professional activities in response to the changing and more difficult and complicated health care environment. Market-based medicine is changing doctors into wage laborers subject to control by the managers of health plans. The New York Times, on Sunday, November 14, presented on its front page, "New Doctors Step into a Turbulent World". Many of the doctors starting postgraduate training today seem more ready to become salaried laborers. In this new environment, administrators are more apt to set policy while the physicians still carry the professional risk. Physicians who become physician administrators eventually evolve into strictly business-minded administrators. Physicians are loosing control over their working conditions. We are certainly a smaller part of policy-making and implementation Managed care has given us more non-patient work while increasing costs and stress. Professional revenues have fallen as overhead costs increase. The general perception of health care is that it is too expensive and of lesser quality than it should be, while 44 million people are uninsured, which includes 11 million children. Employers have rebelled against paying higher and higher costs for medical insurance, so they sponsor what costs them less. Too many physicians view themselves as victims. As "Big Business" so well knows, this is not the best way to present ourselves in the market place. The decision not to change will result in the gradual disintegration of our practices. What we all must do is reposition ourselves as practicing physicians in the changing market place. We need to keep our base values of treating the sick, while being willing to change our current mode of doing business. We need to better embrace the concept of quality improvement in delivering care and managing chronic disease risk while lowering costs. Management skills should be improved. Practice management also requires business planning. These are skills that all practicing physicians need to learn and embrace. It is not possible to maintain our incomes or be paid more for doing things the same way. In the long term, the solution will not be just to see more patients. We need to learn more successful business skills to further develop our practices to maintain income. We further need to resist payer attempts to devalue our services through reduced coding procedures and lack of recognition of our case management work. Perhaps more of us should opt out of the managed care plans which are too restrictive, low paying, and require too much nonmedical time for us and our office staff. I would like to see more cooperation between the hospitals and their physicians. I personally feel that hospitals already treat their medical staff as wage laborers or disregard us. Hospital administrators should consider using their physicians more constructively when considering new policies. We should mold ourselves as successful
corporations do, always aiming at success. The victim mentality should
be laid to rest. All physician groups need to be active in the search to
provide better ways to provide medical care in this market-based
environment. The climate in which physicians practice will improve as we
embrace these new concepts. Our ethical system holds in the highest
regard those who feed the hungry and heal the sick. We should continue
to be the leaders in health care in the next century.
The Health Care Financing Administration (HCFA) is urging physicians to utilize the last days of 1999 to test their claims submission systems for Y2K readiness by ensuring compliance with the claims processing systems of their local Medicare carriers. Submitters should create a reasonable number of future-dated test claims, i.e. January 1, 2000 or later, (minimum of five) that are reflective of typical claims submitted by physician-specific practices. (NOTE: Physicians will need to contact their computer hardware manufacturers for instructions on how to change the system date in their computers for testing purposes). Testing rates of physicians are very low in New York. HCFA is seriously urging everyone to contact his or her vendor and test as soon as possible Because you can enter the year 2000 does not mean you can effectively communicate date in a millennium compliant manner. Further delays can cause an increased administrative expense and possible payment delay. There are less than 40 days left! Physicians interested in Y2K testing may contact their local Medicare carriers at the following telephone numbers for guidance and instructions:
Following the directions laid down at the 1998 House of Delegates, the Medical Society of the State of New York (MSSNY) Task Force on Collective Bargaining met this week with AFL-CIO labor leaders, including unions directly involved with representing physicians. Exploratory discussions focused on the advantages and disadvantages of affiliating with an existing union as opposed to establishing a separate union organization similar to the new AMA operation. Also discussed was the concept that any organizational effort would have to respect the fact that physicians would not subscribe to any type of job action detrimental to patients. The Task Force, which has multiple charges anchored in helping physicians to cope in the managed care environment, also heard a presentation on establishing group practices. The Task Force will be meeting in the coming months with HMOs and various New York State agencies and expects to have a report issued in early 2000.
MSSNY President John Ostuni, MD, MSSNY EVP, Charles Aswad, MD, key legal and staff members met recently with officials of the New York State Insurance Department to demand a stop to the arbitrary "bundling" of services Empire BC/BS has instituted. MSSNY alleges that Empire is not properly reimbursing many physicians since the carrier, in effect, decided to issue partial payment of CPT-coded services that are provided at the same time other services are provided. "This approach makes absolutely no sense, " says MSSNY General Council Donald Moy. "The physician can frequently provide more effective medical services when a patient comes in with a specific complaint and a procedure can be instituted. Realistically, Empire BC/BS is encouraging multiple visits so the physician can be adequately reimbursed. This is not in the patient's interest and it is not in the taxpayer's interest. It is also a gross perversion of why the CPT codes were established in the first place." Moy also points out that New York State law calls for health care carriers to describe the methods under which payments to physicians are calculated but Empire BC/BS refuses to reveal how they arrived at the "bundled" payments. The issue is also being taken up with the New York State Attorney General. ARE YOU A VICTIM OF INSURANCE CARRIER "BUNDLING"? If your practice has received insurance carrier payments which have been inappropriately "bundled", please report this to the NCMS Peer Review Committee. The Committee is working in close concert with several carriers and is able to assist members in adjudication of disputed payments. It is also important that we be able to document cases of inappropriate "bundling" in order that these problems can be brought to the attention of both the carriers and the governmental agencies assigned to prevent this practice. Your reports must be in writing and mailed to:
Governor Pataki recently signed four important public health issues that were actively supported by your medical society.
For more information on these and pending bills in the New York State Legislature, call Martha McNeil, MSSNY Division of governmental Affairs at 518-465-8085.
MSSNY President John Ostuni, MD testified on November 12 at the Assembly Committees on health and Insurance Public Forum held in Manhattan on November 12. Among the issues touched upon in his testimony were:
According to Washington reports, a year-end deal between Congress and the White House has hospitals, nursing homes and other Medicare providers getting an additional $16 billion in payments over the next five years and $27 billion over the next ten. For the physician community, a Medicare payment update of 5.4% has been incorporated in the bill,,, the biggest across-the-board increase since the physician RBRVS system began in 1992. The Hospital Association of New York (HANYS) estimates that for New York State, the Medicare deal will amount to a restoration of $400 million from the $.4 billion in cuts, which had been built into the 1997 federal budget. About $200 million of the restoration is slated for the Outpatient Prospective Payment System and another $165 million for Indirect Medical Education. There is no change in Direct Medical Education funding for 2000.
The Credentials and Awards Committee of the Academy of Medicine invites all members of the Academy to consider nominating a fellow Academy member for Fellowship in 2000. You have the opportunity to honor as Fellows, those of your colleagues who have contributed their time and effort to their specialties, their communities, to medicine and to the Nassau Academy of Medicine. Please consider the achievements of those whom you believe to be outstanding in these areas. Nominees must be current members of the Nassau Academy of Medicine. Your input and prompt cooperation will be very much appreciated. Send your nominations in writing to:
The age of electronics has taken another step forward...or perhaps back- ward with the announcement that California-based medicine On line (www.medicineonline.com) will offer physicians the opportunity to bid on providing elective, non-emergent surgical procedures. Consumers seeking procedures will log onto the service, post a description of the surgery desired and provide health and background information. The surgery request is then posted on the web site in an encrypted and confidential section and the firm "begins processing bids from its global network of participating physicians." Participating physicians have 72 hours to respond.
The Occupational Safety and Health Administration (OSHA) has issued a new directive that provides guidelines to OSHA's compliance officers in enforcing the bloodborne pathogens standard. OSHA first issued the bloodborne pathogens standard in 1991 because of a significant health risk associated with occupational exposure to blood and other potentially infectious materials that may contain bloodborne pathogens that cause disease. The November 5, 1999 directive, which is entitled "Comprehensive Directive CPL2-2.44D," updates a directive issued on March 6, 1992, which was entitled "OSHA Instruction CPL2-2.44C." The new OSHA directive is important because in providing guidelines to OSHA'a compliance officers, the directive reflects OSHA's interpretation of the bloodborne pathogens standard. The standard itself has not been revised since its issuance in 1991. A spokesperson for OSHA stated, however, that OSHA will review the standard to determine whether revisions to the standard are appropriate. The CPL2.2.44D can be accessed from the OSHA home page at http://www.osha.gov under the "Directives" link. Copies can also be obtained from the OSHA publications office by calling 202-693-1888.
The Medical Liability Mutual Insurance Company (MLMIC) announces that, for the third consecutive year, the Board of Directors has voted to declare a 15% dividend for physician, surgeon, and physician extender policyholders who are insured for their primary level professional liability coverage by MLMIC on January 1, 2000. Distribution of the dividend will take place as follows: • Physicians, surgeons and physician extenders who renew their policies for the period of July 1, 2000 through June 30, 2001 and who are insured for professional liability by MLMIC on January 1, 2000 will receive a credit of 15% (of their 1999-2000 premium) applied to their renewal policies. • Those policyholders who are insured by MLMIC on January 1, 2000 and who don't renew their coverage for the 2000-2001 policy year will receive a payment equal to 15% of their 1999-2000 premium, by September 30, 2000.
In order to meet the needs of the membership and to be able to respond to telephone calls more quickly, the Society and Academy have installed a new telephone system. In short, the main telephone number will remain the same: 832-2300. All departments and staff will now be assigned a specific extension off the main number. They are as follows:
A Roledex Card with all department and personnel extensions was mailed out with the November meeting notice. Please look for it and keep it handy.
The Nassau County Medical Society is pleased to welcome the following new members who were elected at the September 28, membership meeting:
Our congratulations to all these new members. We encourage you to become active participants in the activities of the Society through committee membership and grassroots efforts.
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