President's Message - Ellen J. Braunstein, M.D. |
My daughter asked me to define the word wistful for her. She was too lazy to look it up. I was too tired to get out of my chair. She opened her dictionary. I turned on my I-phone. Wistful; to sadly wish for, yearning or mourning. The sentence used for an example was, the old lady was wistful about her younger days. I sat back and thought of ways I could use it in a sentence.
I am wistful for the days of my youth when I had no responsibility to anyone. Oh yes, the pre-beeper days. I remember it just like yesterday, the days of medical school when my intern told me it will be the worst day of your life when the beeper is yours. The first time I held it, wow. It was cool. “Beep beep, beep beep,” it called to me. I pressed the button and numbers lit up. I went to the phone and dialed the number. Someone picked up, announced the location and I said, “It’s Dr. Brownstein.” A kind voice said, you mean Braunstein, and I said the “au” is pronounced “brown”. Hold on please, did anyone page Dr. Braunstein? A live person picked up immediately and medical repartee began. Ah, the good old days. Of course, what followed was me running down eight flights of stairs to the blood lab to type and cross match 2 units of fresh whole blood. I loved to stick pencils into the centrifuge to see if I could stop it. What fun! Then I would run up eight flights of steps, change IV bottles and begin to hang the first unit of blood on my patient. Of course, I would take out my stethoscope and listen for abnormal chest sounds before hanging the blood. Lasix stood by me along with a purple top tube for the Hb/Hct check after one unit.
“Beep beep, beep, beep,” it went off again. The number 4125 came up. The ER. What would be in store there for me? I ran down eight flights of steps and down two corridors to beat the other medical students. It was only 10 P.M. and if I got there first, I could possibly admit the patient and get two hours of sleep. Now, I’m even more wistful. I was only a medical student and with my intern, we could make a binding decision to admit and treat a patient.
I got to the ER moments before the other medical students. It was a middle-aged man with chest pain. I got to run the EKG, send off the first set of bloods for enzymes and admit him to the CCU. I stayed with him most of the night for fear that he might die. I never got my two hours of sleep. In fact, the next morning, the medical students had to have physicals. I remember “taching” away at 120 with a BP of 90/60. I had to explain to the physician in charge that I was up all night. “No problem,” was the response. I’ll see you after you’ve slept and we’ll check it then. Another decision made by a doctor all by himself.
The on-call room was always a challenge. It was either near a nursery or had the shower with mold on the floor. Such a tough choice to make. My favorite book then was House of God with the Gomer’s as my favorite characters. Good times, good times. The irony of wistful thinking is knowing that an important event in your life has passed. The sad part here is the present era. No one picks up the phone anymore to announce where you call. No one runs down to the ER to get the first patient so they can get two hours sleep. No one will ever pull an all-nighter to increase their HR and decrease their BP. But what I miss the most is making my own decision without having to check it with a person who never held a beeper. “Beep beep.” “Beep beep.”
C L A S S I F I E D A D S |
Although NCMS believes the following classified advertisements in this section to be from reputable sources. The NCMS does not investigate the offers made and assumes no responsibility concerning them:
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Reminder: Compliance Date of Red Flags Rule Is Nov. 1 |
In November 2007, the FTC issued a set of regulations known as the “Red Flags Rule,” requiring that certain entities develop and implement written identity theft prevention and detection programs to protect consumers from identity theft. Originally scheduled for a November 1, 2007 compliance date the FTC delayed the enforcement date of the Red Flags Rule until November 1, 2009. The new compliance date of November 1, 2009, which followed two earlier extensions to May 1, 2009 and then later to August 1, 2009, is a result of continued advocacy by the American Medical Association (AMA), MSSNY and other organizations.
AMA Objects to FTC Interpretation of Physician Practices as Creditors |
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Since the Red Flags Rule was issued, the AMA has objected to the FTC’s interpretation that physician practices are “creditors.” The FTC states that this delay is intended to “give creditors and financial institutions more time to review the guidance and develop and implement written Identity Theft Prevention Programs.” The “Red Flags Rule” applies to any institution considered a “creditor.” A creditor is defined as “any person who regularly extends, renews, or continues credit; any person who regularly arranges for the extension, renewal, or continuation of credit; or any assignee of an original creditor who participates in the decision to extend, renew or continue credit.”
The FTC, however, considers a medical practice that accepts insurance or allows payment plans to be a “creditor” and subject to the “Red Flags Rule”. For example, the FTC believes a physician is a creditor if he/she does not regularly demand payment in full, either in advance or at the time services are rendered, and instead bills a patient after services are rendered. The FTC also believes a physician is a creditor if he/she agrees to bill a patient’s health insurance first, but holds the patient ultimately accountable for any non-covered portion of their fee, as is routinely the case with respect to co-pays, deductibles and services not covered by insurance.
For more information, including a model policy developed by the AMA, go to MSSNY's website at MSSNY.org.
Nominations being accepted for Academy Fellows |
The Academy of Medicine Credentials and Awards Committee is accepting nominations for 2010 Academy Fellowship. You have the opportunity to nominate an Academy member colleague whom you believe has contributed to the their specialty, their community, to medicine and to the Academy.
For information on the nominating procedures, contact Chris at 516-832-2300 ext 13 or at chris.nassaumed@verizon.net.
Is Your Web Site Linked to Ours? |
Is Your Web Site Linked to Ours?
As a member benefit, you can now have your web site linked to ours. Increase visibility and access to your practice at no cost to you as a member of NCMS.
HERE IS WHAT YOU WILL FIND AT WWW.NACMED.ORG
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Nassau County Medical Society's web site has all this information for you at your fingertips.
MMM - Madonna Management Services, Inc. |
Eye On Albany |
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Governor Declares H1N1 Emergency
A statewide resurgence of 2009 H1N1 influenza cases, coupled with a national delay in delivery of 2009 H1N1 influenza vaccine led Governor Paterson to declare a public health disaster emergency for the entire state of New York on October 29, 2009. This included implementation of the State Disaster Preparedness Plan and authorization of all necessary state agencies to take appropriate action to assist affected local governments and individuals to protect public health and safety.
NYS Dept. of Health Commissioner Richard F. Daines, MD, responded immediately with a letter to all physicians and other healthcare providers advising them that he was authorizing the administration of vaccines with thimerosal to individuals who normally should not be given vaccine with more than trace amounts of mercury, pursuant to Public Health Law 2112 (2) and (3) enacted several years ago. ]Vaccine with thimerosal can, therefore be given to pregnant women and children under age 3 until May 1, 2010 – provided informed consent is obtained from the patient or the patient’s parent or person otherwise authorized to consent.
Commissioner Daines based his decision on the fact that there have been delays in delivery of both the 2009 seasonal trivalent vaccine and thimerosal-free 2009 H1N1 vaccine, plus the disappointing news that NYS would not receive a sufficient supply of either vaccine for the entire season. The waiver of Public Health Law 2112, therefore, pertains to all influenza vaccines.
Delays in the delivery of thimerosal-free H1N1 vaccine have also spurred statewide complaints. The CDC has reported that substantial supplies of the pediatric thimerosal-free formulation will not start to be shipped until mid-to late November. Even when it does become available, however, the NYS per-capita allotment of the vaccine is 378,000 doses, which is only enough to vaccinate 26% of the estimated 723,851 (based on 2007 census data) children in NYS who should receive two doses of the vaccine. Fear of the new vaccine, as reported in the press, may decrease the demand for the vaccine, but every person who is not vaccinated is both a potential carrier and victim of the disease.
The Commissioner emphasized that the need to protect pregnant women and young children from influenza NOW, while the disease is rapidly spreading across the state, far exceeds unproven concerns about the use of thimerosal.
CMS Announces Payment, Policy Changes for Physicians' Services to Medicare Beneficiaries in 2010 |
The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings. Today’s action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. CMS is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.
In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.
CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.
Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.
The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:
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Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010. The final rule with comment period outlines what these programs will entail, how they will be paid under the MPFS and the criteria for covering these services.
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Increasing the Medicare share of payments for out patient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.
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Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.
The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods.
In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.
The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment period, please see: www.federalregister.gov/inspection.aspx#special
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at: www.cms.hhs.gov/apps/media/fact_sheets.asp
10% Monthly Rental Discount |
New York Providers: Medicare Part B Billing and Payment for Influenza Vaccine (Flu Shot), H1N1 Vaccine and Pneumococcal Polysaccharide Vaccine (PPV) - UPDATE 10/02/09 |
For Lease |
