Fall 2001 - the Illinois Society of Anesthesiologists

Transcription

SEPTEM B ER/OCTOB ER 2001
ISATODAY
◆
◆
◆
◆
◆
◆
◆
OFFICIAL PUBLICATION OF THE ILLINOIS SOCIETY OF ANESTHESIOLOGISTS ◆ VOLUME NO. 34 ISSUE NO. 2
2001 Midwest Anesthesia Conference
President’s
Message
Thomas W. Cutter, MD
T
he 38th Annual
Scientific Meeting and
Exhibition for the
Illinois Society of
Anesthesiologists was an
unqualified success. Worldfamous speakers from both
coasts, Canada, and places in
between delivered a rich and
diverse program. Topics
included current issues with
muscle relaxants, the future of
ASA President Elect Barry Glazer, MD (left) and Robert
blood substitutes, pediatric
Stoelting, MD, the 2001 Ralph Waters Awardee.
anesthesia, the new COX-2
The Friday evening reception, held at the
analgesics, the application of EEG monitor95th located in the Hancock Building, was
ing intraoperatively, staffing issues, and
also well appreciated. Perhaps the fondest
monitoring. New medications discussed
memories were generated by the President’s
included muscle relaxants, inhaled anesthetDinner, held at the Field Museum and hostics, volatile analgesics, and cardiac support
ed by Sue, the Tyrannosaurus Rex. Besides
drugs. In addition, Dr. Stoelting talked about
signifying the changing of the guard as Dr.
the new risks of anesthesia and delivered his
Jeffrey Apfelbaum turned over the reins to
perspective on views in anesthesia as he
incoming president, Dr. John Paul McGee, it
received the 2001 Ralph Waters Award.
Keeping with tradition, the ISA Resident
continued on page 6
Section held its annual Jeopardy
Tournament. While all teams distinguished
I N S I D E T H I S I SS U E
themselves, special recognition goes to
University of Illinois (Najmeddin
President’s Message........................... 1
Beyranrand, MD, Shweta Reddy, MD, and
Editor’s Notes ....................................... 2
Angelito Sajor, MD) for winning the tournaCalendar of Meetings......................... 3
ment.
Fall Meeting 2001 Speakers ............ 3
The social functions were also well
MAC Moderator Reviews .................. 6
attended and received. The two luncheons
Report of ASA Dist. 14 Director...... 8
enabled the attendees to have a chance to
enjoy each other’s company, as well as to
HIPAA Is Coming to
Your Hospital ........................................ 11
gain more insight into the anesthesia prod2001 End of Session Report............ 12
ucts and services offered by the exhibitors.
IMAPAC Contributors ......................... 15
A Journey of a
Thousand Miles
Begins with One
Step
John Paul McGee, II, MD
F
or my first column as President I
would convince you that the
strength of our society must be as
much in its members as in its leadership.
With the proposal from Mr. Thompson
and Health and Human Services to retain
physician direction of anesthesia, we have
gained time to participate in our govermental processes. We must show our support for this new rule during the comment period, and we must cultivate relationships with our Illinois state representatives since the new rule will encourage
direct appeal to the Governor. We must
bear witness to the fact that anesthesia is
the practice of medicine, and that the
medical care of the anesthetized patient
involves planning, coordination of
resources, medical interpretation of data
and rapid response to situations during
and after the anesthetic. We do much
more than operate an anesthesia machine
or perform techniques, for most of the
changes we treat have their basis in the
physiologic responses to the surgical
processes as modified by the patient’s
continued on page 4
ISATODAY
S E P T E M B E R / O C TO B E R 20 01
editor’s
notes
Political
Meandering
and the
Practice of
Anesthesiology
in Illinois
2
opportunity for their respective party.
Senate majority leader,“Pate” Philips (R)
and House Minority Leader, Lee Daniels
(R) and their counterparts, Speaker
Madigan (D) and Senate Minority Leader,
Emil Jones (D) will have their plans ready
in July. Consensus is unlikely and the
Illinois “Supremes” will be called upon to
judiciously create the compromise that will
determine the political landscape of
Illinois for next decade. The State Supreme
Court is designed to be apolitical.
However, the current Court favors the
Democrats. Soon, the legislative map will
Hugh C. Gilbert, MD
elcome to the summer of 2001.
This edition of ISA Today is
devoted to a review of the MAC
meeting, and introduction of the newly
elected ISA Board, and committee
appointments. To those of you who have
agreed to serve on an ISA committee
please accept our thanks. Committee
appointments are often political. The ISA
tries to maintain balance based on our
regional makeup. I am struck by the similarity of our process to the process of
redistricting. The census of 2000 has been
tabulated and now the states are in the
throes of redistricting. According to the
2000 census, Illinois has a population of
12,439,042 and will lose one seat in the
U.S. House due to national redistricting.
Redistricting is the method Americans use
to preserve the one person one vote system that ensures equal representation. One
would think the process would be simple:
find out how many people live where and
divide up the populace using a predetermined denominator. On every level, redistricting defines our politics. Many a legislator have been gerrymandered into political oblivion.
The Illinois general assembly is composed of a Senate (59) members and a
House (118) members. Both the
Republicans and the Democrats are working furiously to construct redistricting
maps that preserve power and enhance
W
sitting on the sideline is a prescription for
disaster.
Physicians have political agendas.
Nationally, anesthesiologists are supporting S. 1052, the Patient Rights legislation
that tightens liability provisions for insurers but doesn’t open physicians and
employers to increased risk of lawsuits.
Physician supervision of advanced practice anesthesia nurses remains a major
political battle that needs to be concluded
rather than deferred. Our specialty is vulnerable because anesthesiologists have not
supported the appeals by their professional organizations for political action.
Census, consensus and redistricting are
the process by which public policy is
renewed. It appears that the judiciary will
have an important role. Perhaps anesthesiologists should pay more attention to judicial elections.
ISATODAY
Hugh C. Gilbert, MD, recipient of the
2001 Distinguished Service Award at the
recent Midwest Anesthesia Conference.
be reworked to equalize representation.
Redistricting has political fallout. The
demographics of the census must be
applied. Between 210,000 and 211,000 citizens should reside in each of the fifty-nine
Senatorial districts. The final map will
have significant political consequences.
Aspiring politicians will examine the
strengths and weaknesses of elected members and the composition of their new districts and determine the possibility for an
election win. Representatives in the House
are the most vulnerable to a challenge. The
process requires time, energy, a political
organization and MONEY. Political action
by physicians will intensify in the next
several years. Aspiring politicians will
need grassroots support. All politicians
need financial support! Anesthesiologists
must become politically savvy. Now is the
time for action. Each of us should meet
with our legislators and representatives as
ISA TODAY is a quarterly publication of
the Illinois Society of Anesthesiologists, a
component society of the American
Society of Anesthesiologists.Views
expressed by various authors are not
necessarily those of the ISA. Letters to the
Editor and all comments should be
directed to the ISA office, 20 North
Michigan Avenue, Suite 700, Chicago,
Illinois 60602; 312.263.7150.
The ISA does not claim any responsibility
for the contents of advertising and the
acceptance of advertising does not in any
way constitute endorsement or approval
by the Society of a product, service or
company. Advertising rates and
information can be obtained by calling the
ISA.
Editor: Hugh C. Gilbert, MD
Editor: Janet M. Torpy, MD
Staff Editor: Mary Hines
ISA Officers:
President: John Paul McGee, II, MD
President-Elect: Timothy Lubenow, MD
Immediate Past President: Jeffrey
Apfelbaum, MD
Vice President: David M. Rothenberg, MD
Secretary: Usha Rani Nimmagadda, MD
Treasurer: Julian Chestnut, DO
ISATODAY
This is clearly demonstrated in a June
15, 2001 Chicago Tribune article describing
a jury award of $1.5 million to the family
of an 85 year old cancer patient. The family asserted that the patient’s doctor did not
prescribe enough pain medication during
the patient’s final days. The Berkeley,
California judgement coupled with a similar North Carolina case with 10 times the
award indicates that lawsuits for the
undertreatment of pain have become
vogue. It is interesting that physicians and
acute care hospitals are now held accountable for the failure to properly manage
pain as well as the consequences of overdose. The article suggests that legal experts
believe lawsuits based on the undertreatment of pain will become more frequent.
Anesthesiologists are often consulted in
situations where pain control has not met
expectations. We have developed programs
for consultation and management of pain
based on scientific, humanitarian and ethical principles. Frequently, the services rendered are undercompensated. HCFA and
JCAHO mandates require acute care facilities to develop strategies and programs for
pain control. While the rhetoric espousing
the importance for enhanced pain management has reached critical levels, our
specialty has been slow to respond to the
political ramifications of mandates. While
I fully acknowledge our value as consultants, I am struggling with the issue of new
responsibilities mandated to anesthesiologists based solely on our interest and
expertise. Is it my department’s responsibility to police the wards and stamp out
undertreatment of pain? Is there indemnification for anesthesiologists who are
called upon to consult and treat the most
difficult (potentially dangerous) situations.
Will we be mandated to oversee our hospitals’ global pain practices? Are we held
responsible for oversight and or even privileging “licensed practitioners” who practice at our hospitals?
The possibility for political gerrymandering of pain management is very likely
to be a hot button item. I have concerns
that anesthesiologists may have to ramp
up their exposure in pain medicine in
response to the JCAHO mandate. While I
welcome the opportunity to provide comfort and safety to patients in need, I am
concerned that the opportunity is fraught
with significant risk. This issue was apparent when a plaintiff’s attorney asked me if
my department was responsible for verifying the injuries; I became increasing aware
of the danger of JCAHO dogma. In my
opinion, our specialty needs to develop a
clear strategy regarding the expectations
imported by government or accrediting
agencies. If we do not prepare for opportunities, we will most certainly be challenged
by virtue of the need. Anesthesiologists are
readily available and are well trained to
consult and treat pain. We must establish
our own boundaries and determine how
we can represent our specialty’s unique
skills in our institutions without becoming
the “pain hospitalist” who are consulted, at
large, for expedience. ◆
ISA 2001
Calendar of
Meetings
October 6, 2001
Board of Directors Meeting
ISA Headquarters
20 North Michigan Avenue, Suite
700, Chicago, Illinois
October 13 - 17, 2001
ASA Annual Meeting
New Orleans, Louisiana
November 17 - 18, 2001
Fall Meeting
Wyndham Drake Hotel, Oak
Brook, Illinois
March 3, 2002
Board of Directors Meeting
Westin O'Hare Hotel, Rosemont,
Illinois
April 19 - 21, 2002
Midwest Anesthesia Conference
Fairmont Hotel, Chicago, Illinois
Fall
Meeting
NOVEMBER 17-18, 2001
WYNDHAM DRAKE
HOTEL, OAK BROOK, IL
SATURDAY, NOVEMBER 17
What You Should Know About
the Potential Hazards of
Neutraceuticals in the
Perioperative Milieu
Jessie Leak, MD
Preoperative Laboratory Testing
Michael Roizon, MD
Acute Normovolemic
Hemodilution
M. Ramez Salem, MD
Acid-Base Problems: A Solution
Recipe
Sherif Afifi, MD
JCAH Standards for Pain
Management
Kenneth Branton, MD
Preemptive Analgesia
Brian Ginsberg, MD
Managing Stress: Physician
Health and Well-Being
Jessie Leak, MD
Difficult Pediatric Airway
Melissa Wheeler, MD
SUNDAY, NOVEMBER 18
Real World Cases
Bernard Wittels, MD
James Columbo, MD
Pierre Le Van, MD
Peggy Wheeler, MD
Current Concepts in
Cardiopulmonary Resuscitation
Cora Wahl, MD
Legal and Ethical Pitfalls in
Anesthesia
Timothy Mc Donald, MD
3
ISATODAY
President’s Report
continued from page 1
4
underlying disease state. The patient
events that require treatment are rarely
explained by the anesthetic alone. This is
the practice of medicine, and the reason
physicians have specialized in this branch
of medicine since Simpson and Snow. We
need to make this clear one person at a
time, to our patients, our legislators, and
the general public. Below are my remarks
to the ISA House of Delegates last May.
They express my continuing belief in the
importance of Medicine in anesthesiology
with a basic structure borrowed from
President Lincoln, another Illinois figure
who strove to maintain the strength of his
society with the help of its individual
members.
Four score and fifteen years ago, our
physician forefathers brought forth in this
nation a new specialty, conceived in zeal
for patient safety, and dedicated to the
proposition that anesthesia is the practice
of medicine.
Now we are engaged in a great uncivil
war, testing whether this specialty, or any
specialty so conceived and so dedicated,
can long endure. We meet yearly to testify
to this central proposition. We dedicate a
portion of that meeting as a tribute (the
Ralph Waters and the Distinguished
Service Awards) to those who here gave
much of their lives that this specialty
might live in support of that proposition. It
is altogether fitting and proper that we
should do this.
But, in a larger sense, we cannot dedicate, we cannot consecrate, we cannot hallow, this proposition. The dedicated physicians, living and dead, who struggled to
establish this specialty, have consecrated it
far beyond our poor power to add or
detract. Our countrymen will little note,
nor long remember, what I write in this
column, but they can never forget what
physician-directed anesthesia has done for
their loved ones and the progress of medicine. It is for us, in active practice, to be
dedicated to the unfinished work that our
anesthesia forefathers have thus far so
nobly advanced. It is rather for us to be
here dedicated to the great task remaining
before us - that from these honored physicians we take increased devotion to that
concept for which they gave so much of
their time and personal identity, that we
"Now we are engaged in
a great uncivil war,
testing whether this
specialty, or any specialty
so conceived and so
dedicated, can long
endure."
here highly resolve that these honored colleagues shall not have striven in vain; that
this component society shall have a new
birth of commitment, and this specialty of
medicine, by medicine, and for patient
safety, shall not perish from the catalog of
medical specialties.
Or, to use a more modern idiom, our
cheese has been moved! And most of us
want to look at the empty spot and complain that practice is not what it was, that
we are unappreciated by our surgical colleagues, our patients, and our society. Well,
“Cherchez le fromage!”We must look for
new cheese! For the foreseeable future,
some of it will be in the keeping of our
elected officials in Springfield and
Washington, where the first steps of our
search for new cheese must be directed.
Scope of practice issues and licensing
details are decided at the state level. Our
representatives in Washington and
Springfield have heard from professional
lobbyists, orators, and spokespeople. They
do not want to grant audiences to nonconstituents. They do want to hear from
their voting constituents - and they haven’t
been hearing from very many anesthesiologists.
While a few of our colleagues have
been very active and vocal, they are as
sounding brass and tinkling cymbals
without an extensive string section that
only the full orchestra can provide.You are
each a member of this orchestra. Every
one of us must play if we are to make convincing music. The first step I want you to
take is to meet with your state representative and senator. I want you to share a
very important piece of you. I want you to
tell them why you believed then, and
believe now, that your medical degree (MD
or DO) was worth using in anesthesiology.
Our representatives have been told that a
nursing degree is sufficient - nursing lobbyists, spokespeople, and many constituent anesthesia nurses have told them
this. Our representatives need to hear the
real complex story - that anesthesia is the
practice of medicine - and they need to
hear it from more than the handful of
anesthesiologists they have been listening
to for ten years.! They already know their
opinions! They need to hear from anesthesiologists who are their constituents. They
need to know that our membership is
behind what our spokespeople have been
saying. The more precise you can be, the
more anecdotes you can provide that illustrate the medical judgment that you have
used in the care of your patients, the better. There is nothing you can do that is
more important than establishing this
simple personal relationship with your
state governmental representatives.
Some of you will enjoy the process
enough to want to do more, and indeed
there is much to be done: but a journey of
a thousand miles begins with a single
step. Other important steps are financial
support of your representative’s candidacy,
supporting political action committees
(ASAPAC and IMAPAC) and repeated contact regarding impending legislation.
There is still more that can be done: but
the most important step is the first step.
Then the next step is possible. This
process will be as important to you as the
continuing education you undertake to
maintain your license, and it will continue
ISATODAY
throughout your career. We anticipate introduction of a bill within two years to allow
independent practice of anesthesia nurses.
We will need everyone’s help to convince
our state legislators of the critical input of
medical judgment for the safety of all levels
of patients receiving anesthesia services.
Our legislators will, whether we like it or
not, be the judges of how completely anesthesia is the practice of medicine.
St. Luke recorded Jesus’ warning concerning a man on his way to go before the
judge to determine a disputed matter. He is
advised to settle the matter with his adversary on the way, because the judgment is
uncertain, and he may be handed over to
the bailiff and thrown into prison. The
warning is especially pertinent in Cook
County. However, on the question of
whether anesthesia is the practice of medicine, there can be no compromise for us.
We will go before the judges. We could lose.
That’s why I need your help! ◆
Anesthesiologist
Named Fishbein
Fellow at JAMA
From an interview with
Janet M. Torpy, MD
ach year, the Journal of the American
Medical Association (JAMA) selects
one physician as the Morris
Fishbein Fellow in Medical Editing. This
July, Janet M. Torpy, MD become the current Fellow.
Dr. Torpy is the first anesthesiologist to
assume the Fellowship in its twenty-four
year history. Named for Morris Fishbein,
MD, a long-term editor at JAMA (19241949), the Fellowship immerses the recipient in the milieu of JAMA, with its United
States circulation of 400,000 (forty-eight
issues per year).
E
Dr. Torpy edits the Abstracts section
and also is responsible for the Contempo
Updates section.
“The work stimulates thinking, allows
me to stretch my intellectual capacity and
use problem-solving skills,” Dr. Torpy
explained.“I’m exposed to the literature of
many specialties as part of my position, as
well as cutting edge scientific work that is
presented to JAMA.”
Dr. Torpy works with the editorial staff
of JAMA and will spend time with the
copyediting and journalism departments.
“I am amazed at the complexity of the
production process. We work far ahead of
publication dates, due to the peer review
process each article must undergo.”
Dr. Torpy has been an ISA member
since 1998 when she joined Rockford
Anesthesiologists Associated of Rockford,
Illinois. Dr. Torpy serves as Co-Chair of
the ISA Committee on Communications.
◆
5
ISATODAY
2001 MAC
6
also served to recognize the many members of the Society who have contributed
so much over the past year.
The political activities were also productive and further served to encourage professional communication among
Society members and to continue our
mission of advancing and furthering
patient safety in the practice of anesthesiology in Illinois through education, representation, and advocacy of the Illinois
anesthesiologists.
We would also like to recognize many
exhibitors and donors. Without them, this
meeting could never have attained the sta-
MAC Moderator
Reviews
KEY MESSAGES FROM THE
FRIDAY SESSIONS
Moderator: Usha Rani
Nimmagadda, MD
Safety and Economic Issues in
Current Practice with Muscle
Relaxants
John Savarese, MD, New YorkPresbyterian Hospital, Cornell Campus,
presented two lectures. The first lecture
was on safety of relaxants and economic
issues in current practice.At the outset he
suggested to practice anesthesia in modern
thinking. He said that it makes clinical,
economic and medicolegal sense to use
short and intermediate acting muscle
relaxants even during long procedures
when extubation is to be carried out at the
end. This he explained due to the
decreased “period of risk,” the interval
between the point where fade is no longer
perceptible by palpation or TOF stimulation and where ventilation, head lift, jaw
clench and swallowing are clinically nor-
tus it did. Deserving special recognition
are Pharmacia, Astra Zeneca, and Abbott
for their record-setting support and to
Baxter for its consistent support and its
special attention to residents in the funding of the Anesthesia Jeopardy
Tournament. ◆
MAC Exhibit Hall
buzzed with attendees.
Pharmacia (left) was
the host of the Friday
evening reception.
mal, with shorter and intermediate relaxants compared with longer
acting drugs.
Clinical and Basic Pharmacology of
GW280430A, Rapacuronium, and
Mivacuriun
The second lecture was about clinical
and basic pharmacology of GW280430A,
Rapacuronium and Mivacurium. Dr.
Savarese discussed the many advantages of
the new ultra-short acting non- depolarizing relaxant, GW280430A which is still in
experimental stages. It has the advantages of
succinylcholine without the many side
effects of that drug. Its duration is only five
to eight minutes due to a chemical degradation process. Dr. Savarese then discussed the
reasons for the voluntary discontinuation of
Rapacuronium by the manufacturer. Lastly
he described the advantages such as short
onset and duration without accumulation
on infusion, and disadvantages such as histamine release on rapid administration of
Mivacurium.
Is There a Blood Substitute in My
Future?
Michael F. O’Connor, MD, University of
Chicago, gave a lecture on blood substitutes.
He described the qualities of an ideal blood
substitute and their potential applications in
medicine. He discussed the advantages and
disadvantages of two major classes of oxygen carriers and then reviewed various
products that are under development. Some
of the oxygen carriers are in phase III trials
and the manufacturers are claiming they
will be applying for FDA approval within
one year. Once approved, in addition to
other uses, blood substitutes can be most
effectively used during hemodilution for
elective surgery which may allow the entire
blood volume to be banked.
Moderator: Suanne M. Daves,
MD
COX-2 Analgesics: Basic
Considerations and Clinical Potential
Evan Kharasch, MD, University of
Washington, began his lecture on the COX2 analgesics by reviewing the
prostaglandin synthesis pathway and the
structure and function of the two forms of
cyclooxygenase, COX-1 and COX-2. Stating
that results of animal studies have shown
that COX-1 inhibition is not analgesic and
that its inhibition leads to the side effects
of GI ulceration and platelet dysfunction,
he made the point that COX-2 inhibition is
ISATODAY
Reference Committee Members: (L to R, first
row) Aisling Conran, MD and Maria
La Porta, MD; (second row) Mark Krause,
MD, Chair Robert Doty Jr., MD and Kornel
Balon, Jr., MD.
7
Attendees enjoy the luncheon served between sessions.
the therapeutic target to relieve pain and
inflammation. There is great potential for
use of these selective agents in the perioperative period and several clinical studies
were cited. They may be able to provide
an additional tool for postoperative pain
management with the advantage over the
nonselective NSAIDS due to their lower
side effect profile Two COX-2 analgesics
are currently available, celecoxib and rofecoxib, and the first parenteral COX-2
inhibitor, parecoxib, has been submitted
to the FDA for regulatory approval.
Concern about the potential for renal
impairment in hypovolemic patients was
discussed both in Dr. Kharasch’s lecture
and during the question and answer session. Renal effects of cyclooxygenase inhibition seem to be somewhat nonselective
and mediated both the inhibition of COX1 and COX-2. COX-2 inhibition does
appear to have much less effect on renal
function. Questions regarding the cost of
paracoxib and the impact this would have
on the acquisition of the drug in our practice were addressed by Dr. Kharasch.
Studies investigating the added value of
fewer side effects with these agents are
beginning to take shape and would
impact the economics of bringing these
agents onto our formularies.
Should We Be Using New Carbon
Dioxide Absorbents?
Dr. Kharasch began this lecture by discussing the issues that have been raised
regarding carbon dioxide absorbents and
their role in anesthetic degradation. These
issues include 1) the degradation of
sevoflurane to the haloalkene “compound
A” 2) the degradation of desflurane, enflurane, and isoflurane to carbon monoxide
3) the degradation of all inhaled anesthetics and the subsequent reductio of
inspired concentrations of these agents
and the attendant clinical and economic
consequences. Several in vivo and in vitro
studies have shown that absorbents with
diminished strong base concentrations
cause less anesthetic degradation, less
compound A, and less carbon monoxide
formation. Two such carbon dioxide
absorbents may soon be available.
One audience member asked how we
can best avoid this anesthetic degradation
until newer absorbents become available.
Suggestions by Dr. Kharasch included
methods to avoid desiccating (drying out)
the absorbent on our anesthetic
machines, which seems to compound the
problem of anesthetic degradation; for
instance, turning off oxygen flow through
the machine when it is not in use and per-
haps routinely changing the absorbent on
Monday mornings. Some anesthesia
machines have the fresh gas flow placed
after the CO2 absorbers and this is probably of some benefit in avoiding rapid desiccation of the CO2 absorbent.
Monitoring Depth of Anesthesia
Laverne Gugino, PhD, MD, Harvard
Medical School, gave a lecture that focused
on the approach for developing a quantitative EEG multivariate-based algorithm for
assessing anesthetic induced changes in
levels of arousal and hypnosis. He outlined
the methods involved in developing the
Patient State Index (PSI). The utility of this
monitor may best be seen in its potential
to lead to faster arousals from anesthesia
as well as decreased use of hypnotic agents
compared to standard practice.
Audience question pertained to the differences between the Bispectral Index and
the Patient State Index. Dr. Gugino state
that he did not have access to the algorithm employed in the development of the
BIS and therefore, could not comment on
differences in the development of these
two monitors. ◆
ISATODAY
Report of
ASA District 14
Director
ASA to Change
Leadership
Positions
T
8
he ASA Board of Directors met in
Chicago August 18-19, 2001. During
the weekend updates from the officers and Mr. Scott from the Washington
Office, reports
were heard regarding the CMS (formerly known as
HCFA) proposed
rules for participation which are now
on hold pending a
new proposed rule
Susan L. Polk, MD
◆
calling for anesthesia nurse supervision unless a State governor opts out of the
rule. The comment period is due to expire
on September 4 and the new rule finalized.
ASA emphasis, during the latter part of the
summer, was focused on letters to CMS in
support of the new proposed rule, efforts to
convince the American Hospital
Association to reverse their opposition to
anesthesia nurse supervision, and inception of state efforts to convince governors
that opting out of the rule would result in a
threat to patient safety.ASA continues to
ask Congress and HCFA to require a study
of the impact on safety where supervision
rules were discarded.ASA is using 11 lobbying firms, an advertising agency and a
media consulting firm, and has spent $2.5
million so far this year.What a tremendous
amount of resources! Nonetheless, the battle continues and cannot be abandoned.
ASA members were soundly congratulated on their successes to date, but continue to be asked for letters, PAC contributions, and continued vigilance in home
states.As a state society, Illinois has a poor
record of contributions to ASAPAC this
year. This is not the time to slack off. Please
seriously consider what you can contribute
to YOUR future and help ASA in its mission to ensure patient safety in the future.
On the Baltimore front, the five year
study of the work value part of the fee
schedule continues, with ASA proving we
are undervalued and CMS agreeing but not
raising it yet. Stay tuned.
The most controversial piece of business before the Board this time was the
report of the Task Force on Structure and
Governance outlining several suggested
changes to ASA leadership positions. The
report will constitute the business of a fifth
Reference Committee of the House of Delegates in October. Members interested in
how the ASA works are urged to review the
proposals of the task force and the actions
of the Board, and provide their views by
testimony at Reference Committee 5.
A full copy of the Board Reports can be
requested by email [email protected] follows is a summary of the
reports, recommendations and action
taken on them by the Board. Nothing is
final until passed in the House, therefore
your input is important.
The Administrative Council consists of
all the officers. The current Scientific
Council will be renamed the Division of
Scientific Affairs, will be headed by the Vice
President for Scientific Affairs, and will
consist of the Sections on Journals,Annual
Meeting, Clinical Care and Education and
Research.An additional Section on
Subspecialty Societies will be created and
will also be contained within this division.
The position of first Vice-President will
be renamed the Vice President for
Administrative Affairs. This person will
head the Division of Administrative Affairs,
which will consist of the Sections on
Administration and Representation. The
Administrative Council was instructed by
the Board to clarify the ascension to first
Vice President, as it was not made clear in
the recommendations.
A new office,Vice President for
Professional Affairs, will be created. That
officer will preside over a new Division of
Professional Affairs, which will consist of
the Sections on Professional Standards and
Professional Practice.
The Section on Fiscal Affairs will be
eliminated and the Treasurer and Assistant
Treasurer will attend all section meetings.
Each of the nine sections will have a
section Chair, as the current sections on
Education and Research and Clinical
Affairs do now. The Editor-in-Chief will
chair the Section on Journals. Only the
Section on the Annual Meeting will have a
Vice-Chair. The President will appoint the
section chairs annually except for the journal editor. Some committees will be shifted
around to report to different sections.
The Board agreed with the Task Force
that the Committee on Standards of Care
should be eliminated because the practice
parameters committee currently performs
its tasks. The Board noted that the member information needs currently provided
by that committee should to be assigned to
another committee.
A new Committee on Professional
Education Oversight will replace the current committee on continuing education
strategic planning.
Subspecialty society representation in
the House will continue as presently, but
their presence in ASA will become more
institutionalized by specifying the
President and President Elect of each represented subspecialty society will constitute the membership of the committee on
anesthesia subspecialties.A meeting will
take place during every March ASA Board
meeting with the President and President
Elect of ASA and representatives of each
seated subspecialty society. The ASA
President-Elect will solicit committee
appointment recommendations from each
society.
AAPD, SAAC and AUA presidents will
be formally invited to each ASA Board
meeting. They will meet formally with the
ASA President and President-Elect at each
August Board meeting. They will be
solicited for committee appointments as
well.
ISATODAY
The committee appointment process
will be formalized. Section chairs and
committee chairs will be asked for input.
The Board recommended further study
of the size and composition of the Board of
Directors. This includes whether to eliminate some officer positions and to have a
director from each state.
The Speaker and vice Speaker of the
House of Delegates will preside over Board
meetings and not have votes.
Each member of the Governing Council
of the Resident Component will have a voting seat in the House of Delegates, not to
exceed five.
In other business, the Board:
• Referred a resolution that ASA develop
a generic web site for component societies to the Committee on Electronic
Media and Information Technology.
• Approved an educational membership
category for Anesthesiology Assistants
who are members of AAAA. This
includes the Journal, admittance to the
annual and other meetings and all
other benefits of ASA membership. The
cost will be the same as what ASA
charges other affiliate members.
• Approved $15,000 to develop a web
based demographic database survey
instrument that will eventually replace
the mailed one, which has a 45%
response rate.
• Heard the report of the Committee on
Communications which listed recent
activities including new patient education brochures on sedation and office
based anesthesia, booths at surgeons
meetings, media activities and
spokesperson training workshops
(Illinois had the biggest one last year in
conjunction with the Midwest
Anesthesia Conference). The Board
approved their recommendations for a
celebration of the 100th anniversary of
ASA in 2005 and for a $1000 Media
Award to be presented at the Annual
Meeting in the category of web-based
articles.
• Ended a two year old proposal for electronic voting and credentialing at the
House of Delegates by approving a recommendation that no changes be
made in the current system.
• Approved funding for further enhancement of the ASA web site.
• Approved the recommendation of the
committee on Residents and Medical
Students that a button be put on the
home page of the ASA web site for
information pertaining to them.
• Approved the recommendation of the
Committee on Electronic Media and
Information Technology that ASA join
a consortium of physician societies
formed to collaborate on web technologies.
continued on page 10
9
ISATODAY
ASA District 14
10
• Approved the concept of and outline for
a web-based educational module for
surgeons (and other physicians) to
acquire education and CME credits
needed to supervise anesthesia nurses
in administering anesthesia services for
office based surgery.While this was a
controversial subject, the ASA officers
convinced the Board that the American
College of Surgeons and others have
asked for assistance with educating its
members. It comes down again to a
patient safety issue.
• Approved the recommendation from
the Committee on Practice Parameters
that Practice Advisories undergo the
same approval mechanism in the
House, as do Practice Parameters. That
is, they are voted in or out and are not
amended in the House.
• Approved the request of the Committee
on Transfusion Medicine that $20,000
be allocated for a survey on current
transfusion practices.
• Referred a resolution regarding peer
review of expert witness testimony to a
committee or task force of the
President’s choice to address issues of
mechanisms of peer review, should officers and committee members testify
and allow their positions in ASA to be
exploited by lawyers, are our current
guidelines adequate, and can we make
ASA membership contingent on adherence to ASA standards, guidelines and
statements? The neurosurgeons just
threw out a member because of his testimony; can we do that?
• Referred a recommendation that ASA
form a task force to investigate the need
for lengthening resident training to provide further expertise in preoperative
evaluation and postoperative care.
• Disapproved a recommendation that
ASA go on record as opposing capital
punishment and substituted one that
expresses ASA support for the AMA
position opposing physician involvement in executions.
• Approved the report of the Task Force
on Graduate Medical Education recommending a study of forgiving $25,000
per year of education loans for a resident entering academic practice for a
maximum of 4 years if that resident
spent 2 years in a research fellowship.
Re-referred the issue of academic
departments providing summer externships in anesthesiology for medical students.
• Strongly commended the President, Neil
Swissman, MD, for all that he has done
this year.
• Disapproved the recommendation of
the Committee on the Anesthesia Care
Team saying the involvement of an
anesthesiologist in the care of every
patient undergoing anesthesia is “optimally desirable” instead of “essential” in
the Statement on the Anesthesia Care
Team. The word “essential” remains.
Approved the recommendation of the
Committee on Ethics regarding care for
patients with DNR orders. This included
plans for postoperative care that would
clarify that our interventions would be
anesthesia related. The Committee
declined to provide a recommendation
on expert witness testimony by ASA
officers. The Board also approved the
Committee’s recommendation that we
sign on to the revisions in the AMA’s
revised “Principles of Medical Ethics.”
• Approved the recommendations of the
Ad Hoc Committee on Rural Access to
Anesthesia Care, including that ASA
provide a forum where rural anesthesiologists can meet annually to discuss
their practices and that ASA create a
standing committee to continue to discuss this problem. (The Terrance Study
performed in 2000 showed that only
2.5% of anesthethics are performed in
small rural hospitals and only half those
(1.25%) without an anesthesiologist
directing
• Accepted kudos from the AMA for our
scope of practice initiatives, participation in AMA activities, and support of
AMA as a whole.We continue to have
one of the largest delegations to AMA.
• Accepted the report from the
Committee on Practice Management
detailing the incredible success of their
Certificate in Business Administration
Program in its first year, and approving
a recommendation that non-ASA members pay a fee for the course that reflects
the increment of ASA dues. This program made at least $100,000 for ASA in
its first year and is projected to do even
better next year.
• Approved that the First Vice President
be awarded a salary of $50,000 per year
for services provided to ASA. There may
not be a first Vice President after the
restructuring, but this would start next
year.
• Amended and approved the recommendation of the Section on Fiscal Affairs
that at least 150% of annual operating
funds be placed in a restricted reserves
account that could only be accessed by
approval of the Board in extraordinary
circumstances, and the rest of the
investment funds be in an unrestricted
reserve fund that could be spent by
emergency approval of the Board during short term budget deficits.
• Approved revisions to the 2001 budget
resulting in a shortfall of $2,103,000,
and to the 2002 budget resulting in
income of $19,541,500 and expenditure
of $19,241,100.
This is the last Board meeting I attended as your representative. Dr. Osborn will
be your District Director after the House of
Delegates meeting in October, and Dr.
Kenneth Tuman will serve as your
Alternate Director. It has been a privilege
and an honor to represent Illinois at the
ASA. Illinois is well respected, consulted
often and blessed by the whole society.You
have provided me with the highlight of my
career and I thank you. ◆
ISATODAY
A HIPAA is
Coming to
Your Hospital
Hugh C. Gilbert, MD
C
ongress, recognizing the need for
national patient record privacy
standards, enacted in 1996 the
Health Insurance Portability and
Accountability Act (HIPAA). The Act
establishes new privacy and security
requirements for payors, institutions, and
health care professionals and providers,
from the largest health networks to solo
practice professionals. In addition, provisions have been included that encourage
electronic transactions, designed to save
the health care industry money.
HIPAA applies to only those who
engage in “standardized electronic transactions,” as defined by the federal government. If you submit claims or perform eligibility checks electronically, either directly or though a third party, e.g., a billing
service, then you are subject to the HIPAA
privacy and security requirements. For
planning purposes you should assume
that HIPAA requirements apply to electronic and paper records. Everyone
involved in the health care delivery system
should start now to prepare for HIPAA.
Preparing for HIPAA will vary for
anesthesiologists, dependent on your
practice type. More than likely, anesthesiologists who are employed by their hospitals will experience the effects of HIPAA
as the hospital implements new privacy
procedures. For example, those changes
may include: designated areas for conversations between staff members, passwords to access computers, and a secured
location for paper medical records.
Anesthesiologists who are members of
group practices will be affected by the
new procedures the hospital implements
and are responsible for developing procedures to ensure patient confidentiality
when transferring medical records within
their office and by off-site contractors
such as billing and accounting services.
One must have a formal disaster plan in
place to protect patient information,
ensure that paper and electronic records
are stored with appropriate safeguards,
and secure Internet communications of
medical records by encryption.
HIPAA does have good points:
• Patients will be able to see and get
copies of the records and request
amendments to their health history.
• A history of any non-routine disclosures must be made accessible to
patients.
• Health care providers who see patients
will be required to obtain patient consent before sharing their information
for treatment, payment, and health
care operations.
• Patient authorization must be obtained
for non-routine disclosures and for
most non-health care
purposes.
• Patients will have the right to
request restrictions on the
uses and disclosures of their
information.
• The final rule establishes the
privacy safeguard standard
that covered entities must
meet, but it gives covered
entities the flexibility to
design their own policies
and procedures to meet
those standards.
However, HIPAA has a
troublesome side:
• People will have the
right to file a formal complaint with a covered
provider, health plan, or
HHS for violating provisions
of this rule or the policies
and procedures of the covered entity.
• Covered entities will have
to adopt written privacy
procedures, ensure their business associates protect the privacy of health
information, train employees on new
privacy procedures, and appoint an
individual responsible for ensuring
new procedures are followed.
• Congress provides penalties for covered entities that misuse personal
health information.
• Health plans, providers and clearinghouses that violate these privacy standards will be subject to civil liability.
Civil money penalties are $100 per violation and up to $25,00 per person per
year for each requirement or prohibition violated.
• Federal criminal penalties for knowingly violating patient privacy are up
to $50,000 and one year in prison for
obtaining or disclosing protected
health information, and up to $100,000
and up to five years in prison for
obtaining protected health information
under “false pretenses,” and
$250,000 and up to ten years
in prison for disclosing protected health information
with the intent to sell,
transfer, use it for commercial advantage, personal gain, or malicious
harm.
•
Implementation of the
HIPAA rules is estimated to cost $17.6 billion
over ten years. HHS
believes that the cost of
implementation will be
more than offset by the
$29.9 billion in projected
savings based on the savings expected by electronic transactions regulation issued in August
2000.
continued on page 12
11
ISATODAY
HIPAA is Coming
12
As required by the HIPAA law itself,
stronger state laws, like those covering
mental health, HIV infection, and AIDS
information will continue to apply. These
confidentiality protections are cumulative. The final rule will set a national
“floor” of privacy standards that protect
all Americans, but in some states individuals may enjoy additional protection. In
circumstances where states have decided
through law to require certain disclosures
of health information, the final rule does
not necessarily preempt these mandates.
The final rule will be enforced by the
HHS Office for Civil Rights (OCR). Before
covered entities must comply with the
rule, OCR will provide assistance to
providers, plans and health clearinghouses in meeting the requirements of the
regulation.
It is important that anesthesiologists
take an active role in developing any hospital procedure. By assuming a leadership
position you take control over your professional lives. The time is now to remind
all other health care providers that your
mother did not name you “anesthesia.” ◆
Resources:
Web site on the new regulation is available
at http://www.hhs.gov/ocr/hipaa/.
Secretary Thompson’s statement on
HIPAA is available at http://www.hhs.gov/
newpress/2001pres/20010412.html.
To obtain a copy of the Standards for
Privacy of Individually Identifiable Health
Information visit http://aspe.hhs.gov/admn
simp/final/pvcguide1/htm.
ISA and ASA will provide updates as
the HIPAA rules are interrupted.
Illinois State Medical Society has audit
tools and publications available to determine the changes you need to make to
meet the HIPAA privacy requirements.
2001 End
of Session
Report
T
he following is a summary of legislative action on bills that ISA
tracked during this past legislative
session. If you have questions regarding
this report, please call Amy Young at the
ISA office (312) 580-2487 or
[email protected].
HB0241: INS BIRTH CONTROL
COVERAGE - NO POSITION
The Bill provides that if a policy provides coverage for prescription drugs
approved by the federal Food and Drug
Administration for the treatment of
impotency, then the policy must provide
coverage for prescription drugs for the
prevention of pregnancy. It also amends
the Hospital Licensing Act by providing
that no hospital may promulgate policies
or implement practices that determine
differing standards of obstetrical care
based on a patient’s source of payment
or ability to pay for medical services;
requires each hospital to develop a written policy reflecting this and to post written notices of this policy in the obstetrical admitting areas of the hospital by July
1, 2001. Amends the Illinois Public Aid
Code by providing that the Department of
Public Aid shall provide reimbursement
to medical providers of epidural anesthesia services when ordered by the attending practitioner at the time of delivery.
Since introduced, the proposed legislation has been amended to delete reference the Department of Public Aid and
remove provisions requiring coverage of
prescription contraceptives. Last action of
the Bill: referred it to the Senate Rules
Committee on April 25, 2001.
SB0447: DENTAL PRACTICE TEMPORARY LICENSE - NO
POSITION
Amends the Illinois Dental Practice
Act. Adds the definition of “nurse.” Adds
oral and maxillofacial radiology to the
definition of “branches of dentistry”.
Changes the restricted faculty license
requirements to require that persons
receiving the license be employed to teach
full time at a dentistry school or hospital
in this State. Provides that a holder of a
restricted faculty license may practice
dentistry in his or her area of specialty
only in a clinic or office affiliated with the
dental school. Provides that a restricted
faculty license is valid for 2 (instead of 5)
years and may be renewed or extended.
Provides that a nurse may be employed by
a dentist and may perform those duties
permitted by his or her license.
The Bill was amended to change the
phrase parenteral conscious sedation to
conscious sedation and redefines “nurse.”
Last action on the Bill: sent to the
Governor for signature on June 21, 2001.
HB0245: MEDICAID-PAY FOR
EPIDURALS - SUPPORT
Amends the Hospital Licensing Act.
Provides that no hospital may promulgate
policies or implement practices that
determine differing standards of obstetrical care based upon a patient’s source of
payment or ability to pay for medical services and requires each hospital to provide a copy of its written policy reflecting
this to the Department of Public Health
and to post written notices of this policy
in the obstetrical admitting areas of the
hospital by July 1, 2001. Amends the
Medical Practice Act of 1987. Provides
that the Department of Professional
Regulation may discipline a person
licensed under the Act for denying or
threatening to withhold pain management services from a woman in active
labor, based upon that patient’s source of
payment or ability to pay for medical services. Amends the Illinois Public Aid
Code. Provides that the Department of
ISATODAY
Public Aid shall provide reimbursement to
medical providers for epidural anesthesia
services in accordance with the guidelines
of the American College of Obstetricians
and Gynecologists.
FISCAL NOTE (Department of Public
Health) HB 245 creates no fiscal impact
on the Department of Public Health, but
would have an impact upon the
Department of Public Aid.
Last action on the Bill: re-referred to
the House Rules Committee on March 16,
2001
HB3533: HEALTH CARE
WORKER PROTECTION ACT OPPOSE IN CURRENT FORM
Creates the Health Care Worker Needle
Stick Injury Protection Act. Provides that
no later than 6 months after the effective
date of this Act, the Department of Public
Health must adopt a bloodborne
pathogen standard governing occupational exposure of public employees to infectious materials. Provides that these standards must meet or exceed the federal
standards. Provides that the standards
must include (i) a requirement that
needleless systems be implemented in
facilities employing public employees and
(ii) a requirement to log certain exposure
incidents. Provides that the Department of
Public Health must create a list of needleless systems. Amends the State Finance
Act to create the Health Care Worker
Injury Protection Fund, moneys in which
shall be used for research into needleless
systems.
the House Rules Committee on April 6,
2001.
HB0048: SURGICAL
ASSISTANTS LICENSING OPPOSE
Creates the Surgical Assistant Practice
Act. Regulates surgical assistants through
licensing requirements. Amends the
Regulatory Sunset Act to repeal the new
Act on January 1, 2012. Amends the
Perfusionist Practice Act. Retitles the
Board of Perfusion as the Board of
Perfusion and Surgical Assisting. Adds a
member to the Board who is actively
licensed as a surgical assistant.
FISCAL NOTE (Department of
Professional Regulation) Revenue over 4
years is expected to be $321,500 and
expenses over 4 year would be $231,895,
for a net deficit of $89,605.
Since introduced an amendment was
adopted that requires coverage for service
rendered by surgical assistants.
Last action on the Bill: assigned to
the Senate Committee on Insurance &
Pensions on May 31, 2001.
HB0205: NURSING ACT LICENSING - NO POSITION
As amended, provides that an applicant who has never been licensed previously in any jurisdiction that utilizes a
Department - approved examination and
who has taken and failed to pass the
examination within 3 years of filing the
application must submit proof of successful completion of a Department-authorized nursing education program or recompletion of an approved registered
nursing program or licensed practical
nursing program prior to reapplication.
Deletes the provision that no applicant
shall be issued a license as a registered
nurse or practical nurse unless he or she
has passed the examination authorized by
the Department within 3 years of completion and graduation from an approved
nursing education program, unless the
applicant submits proof of successful
completion of a Department-authorized
remedial nursing education program or
re-completion of an approved registered
nursing program or licensed practical
nursing program.
Last action on the Bill: amendment
adopted by the House on June 29, 2001.
HB0247: INS COVER
CAESARIAN SECTION - NO
OPPOSITION
Amends the Illinois Insurance Code.
Provides that the decision to deliver by
Cesarean section shall be made only by
the patient and her attending physician.
Last action on Bill: re-referred to the
House Rules Committee on March 16,
2001.
HB2115/SB1340: INS
PROVIDER CONTRACTS SUPPORT ISMS BILL
Creates the Fairness in Health Care
Services Contracting Law. Provides that
the Department of Insurance shall regulate contracts between health care professionals and providers and insurance companies that maintain panels or networks
of providers. Prohibits unfair or misleading contracts. Sets forth prohibited contract terms and required contract terms.
Authorizes recovery of attorney’s fees
when a company’s actions or delays in
settling claims are vexatious and unreasonable.
Last action on the Bill: Senate Rules
Committee on July 1, 2001.
HB2400: NURSING ACTLICENSURE COMPACT - NO
POSITION
Amends the Nursing and Advanced
Practice Nursing Act. Provides that the
definitions of “practical nurse”,“licensed
practical nurse”,“registered nurse”, and
“licensed registered nurse” include persons holding the privilege to practice
under this Act. Defines “privilege to practice”,“license” or “licensed”, and
“licensee”. Provides for reciprocity for
persons granted the privilege to practice
in a party state to the Nurse Licensure
Compact. Creates the Nurse Licensure
Compact. Effective January 1, 2002.
Rules Committee on May 12, 2001.
HB0030: WORKERS’
COMPENSATION - NO
COLLECT-EMPLOYEE - OPPOSE
Amends the Workers’ Compensation
Act. Provides that a provider of medical
services or related services or items to an
injured employee agrees to be bound by
charges or payment levels allowed by the
Industrial Commission. Provides that discontinued on page 14
13
ISATODAY
End of Session Report
putes regarding reasonableness of fees
or charges shall be resolved in accordance
with the Act or the Workers’ Occupational
Diseases Act. Prohibits a provider,
employer, or insurance carrier from seeking payment for services or items from an
employee.
the Senate Rules Committee on May 31,
2001.
14
HB2192: WORKERS’
COMPENSATION—HEALTH
CARE PROVIDERS - OPPOSE
IN CURRENT FORM
Amends the Workers’ Compensation
Act and the Workers’ Occupational
Diseases Act. Makes various changes and
additions regarding: determination of
charges for health care services provided
to injured workers; processing of payments to health care providers; resolution
of disputes concerning charges for health
care services; submission of reports by
the Industrial Commission concerning
health care services; attorney’s fees; reimbursement for expenses; non-disputed
health care payments; disputed health
care payments; reports; and other matters.
the House Rules Committee on May 18,
2001.
HB 246: MEDICAL PRACTICE—
PUBLIC DISCLOSURE OPPOSE
Amends the Medical Practice Act of
1987 to provide for the public release of
individual profiles on persons licensed
under the Act, including information
relating to criminal charges, administrative disciplinary actions, hospital privilege
revocations, and medical malpractice
awards. Provides that a physician may
elect to include certain information in his
or her profile. Provides that certain information collected for physician profiles is
not confidential. Provides that, when collecting information or compiling reports
intended to compare physicians, the
Disciplinary Board shall require that only
the most basic identifying information
from mandatory reports may be used, and
details about a patient or personal details
about a physician that are not already a
matter of public record through another
source must not be released.
FISCAL NOTE (Department of
Professional Regulation) The total initial
cost is estimated at $1,448,500 and annual
maintenance cost will be $375,800, as follows: Pre-Profiling $485,000 Phase IInitial Set-up $275,000 Phase IICommunication, Data Collection, Entry,
and Verification $613,510 Phase III-Toll
Free Call Center $ 75,000 Annual
Maintenance $375,800 STATE MANDATES NOTE (Dept. of Commerce and
Community Affairs) In the opinion of
DCCA, HB 246 does not create a State
mandate under the State Mandates Act.
JUDICIAL NOTE (Office of the Illinois
Courts) HB 246 would neither decrease
nor increase the number of judges needed
in the State.
the House Rules Committee on April 6,
2001.
HB 2158: MEDICAL
MALPRACTICE INSURANCEOPPOSE
1987. Provides that a physician must
maintain a minimum of $1,000,000 in liability coverage. Amends the Illinois
Insurance Code. Provides that insurers in
the business of providing Class 2(c) insurance must establish a premium scale for
coverage classification.
Last action on Bill: re-referred to the
House Rules Committee on March 16,
2001.
HB 3051: PHYSICIAN
PROFILING - OPPOSE
1987 to provide for the public release of
individual profiles on licensed physicians
on the Department of Professional
Regulation’s website. Provides that information for the profiles shall be provided
by insurers who provide medical malpractice insurance to licensed physicians.
Requires the Department to post a disclaimer on its website. Limits the liability
for the insurer, the Department, and any
employee or agent of the insurer or
Department.
FISCAL NOTE (Dept. of Professional
Regulation) The end product with a total
initial cost estimate of $818,000 and
annual collection and maintenance cost of
$150,000 will make physician profiles
based on insurer claims available to the
public over the Internet.
2001.
HB 3086: HEALTH CARE JOINT
DISCUSSIONS ACT - SUPPORT
Creates the Health Care Services
Contract Joint Discussions Act. Authorizes
competing health care providers within a
geographical area served by a health care
plan to enter joint discussions with the
health care plan concerning various practices and procedures, clinical criteria,
drug formularies, reimbursement
methodologies, and inclusion and alteration of terms and conditions. Authorizes
competing health care providers to jointly
discuss certain terms and conditions
under certain circumstances. Amends the
Illinois Antitrust Act to provide that the
Act shall not be construed to make illegal
the activities of a person pursuant to and
in compliance with the Health Care
Services Contract Joint Discussions Act.
2001. ◆
ISATODAY
IMAPAC
Contributors
September 1, 2000 to July 17, 2001
Jose Abreu
Howard Albert
Noel Alcantara
Daniel Alyea
Jeffrey Apfelbaum
Bryan Apple
George Arends
Shanthi Aribindi
Yuri Aronov
Solomon Aronson
Rebecca Aureus
Obinna Asonye
Shyamala Badrinath
N. Kurt Baker-Watson
Kornel Balon
Emmanuel Bansa
Marisa Baorto
David Barinholtz
Rise Barkhoff
Matthew Barton
Verna Baughman
John Becker
Andrew Belavic
Richard Berkowitz
Howard Berlin
Harold Berner
Eric Bessonny
Jerome Bettag
Angelina Bhandari
Wendy Binstock
Patrick Birmingham
Mary Kay Bissing
Steven Blum
Gregory Bogdonoff
Roger Bohn
Felipe Bondoc
Derek Booton
Ann Brennan
Eva Buch-Kiljanska
James Bucher
Wynndel Buenger
Chester Buziak
Clair Callan
Marino Camaioni
Kenneth Candido
Gonzalo Castillo
Bruce Chandler
Kevin Chen
Sampath Chennamaneni
Obayya Chennareddy
Julian Chestnut
Christina Chomka
Johanna Chookaszian
Tae Chung
David Ciochetty
Dennis Coalson
Maureen Coleman
Gregory Collins
James Colombo
Richard Cook
Eleonora Cordella-Miele
Charles Cote
Stephen Cotton
Steven Croy
Thomas Cutter
Zerin Dadabhoy
Vi Dang
Andre De Wolf
David Desertspring
Robert Doty
Sandra Drewes
Howard Duncan
Norbert Duttlinger
David Eberhardt
Theodore Ellis
Lowell Enser
John Erickson
David Evelti
Shane Fancher
Samy Farag
James Feldman
Alexander Feller
Rosalino Figueras
Samuel Figueroa
George Fikaris
Randall Firfer
Michael Fox
Frederick Gahl
Maribel Galiano-Goll
Craig Cardner
John Garino
Dalia Garunas
John Gashkoff
Alphonsa George
Ramisis Ghaly
Anuradha Ghogale
Anthony Giamberdino
John Girardot
Silas Glisson
Glenn Godsher
Ira Goodman
Daniel Gorski
Andre Granzotti
Linda Gregg
Robert Griesemer
Steven Gunderson
Helena Gunnerson
Vijay Gupta
Glen Gutzke
Virgilio Guzman
Susan Hann
Mark Hanna
Pankaja Hanumadass
Pankaj Haridas
Jonathan Hausman
Ronald Hayes
Carol Heidmann
Priscilla Hensel
Charles Hewell
Carla Hightower
Richard Hirschmann
Joseph Holtz
Stephen Houde
Michael Hruskocy
Ching-Chong Huang
James Hunter
Robert Husfield
Kwang-Ko Hwang
Jae Wang Hyun
Juan Ibarra
Lorna Im
Bruce Irwin
Jon Jacoby
Jeffrey Jagmin
Neeraj Jain
John Jaworowicz
Harold Jesser
Jihad Jiha
Steven Jiotis
Bradley Johnson
John Johnson
Chance Juenger
Asuncion Jurado
Jeejy Kalathiveetil
John Kallich
Ramesh Kancherla
Sung Soo Kang
Cheng Kao
Ajita Kasbekar
George Katele
Mohan Kavuri
John Keith
Hazami Khater
Humaira Khatoon
Jeffrey Kidd
Charles Kim
Jae Kim
Kyu-Chul Kim
Robert Kim
Woo Chan Kim
Maria Kimovec-Grutsch
Jonathan Kind
Delbert Klump
Stanley Knight
Todd Knox
Gary Koehn
Heidi Koenig
Nagabhusha Koneru
Howard Konowitz
Erik Kooba
John Kowalski
Kathryn Kozak
Jonathan Krohn
Karen Kruger
Timothy Kurt
Maria La Porta
David Lang
Oswaldo Lastres
Michael Less
Ji Li
Dixie Lim
Rebecca Lim
Henry Liu
Douglas Loughead
Rashida Loya
Pang-Hsung Lu
Timothy Lubenow
Jordan Lurie
E. Eileen MacDonald
Samuel Macagba
Ramakrishna Madala
Mario Magleo
Rogelio Mahor
Neelam Malhotra
Cezar Mallari
Balaji Malur
Satya Manam
Bosebabu Mandava
John Mansell
James Markey
Sammy Marogil
James Maronic
Steven Marquardt
Peter Martin
Stephen Martin
Maen Martini
Dionisio Marucut
Lawrence Mason
James Mathers
William McDade
James McGrath
John Paul McGee
Daniel McQuillan
Laura Megher
Mary Mennella
Joseph Meyer
Paul Mesnick
Ronald Meyer
Joanne Michaelson
Robert Michaelson
Kevin Miller
Paul Miller
W. Stephen Minore
Daniel Mitchell
Robert Molloy
Robert Molanr
Ruth Moncayo
Dean Monma
Lilly Moon
John Moore
Mark Morris
John Mulvehill
Vemuri Murthy
Philip Myers
Tun Myint
Robert Natonson
Janet Newman
Edith Newsome
Wendy Nunlee
Usharani Nimmagadda
Michael O’Connor
Blasco Oliveira
Vesselin Oreshkov
Deofil Orteza
Rodney Osborn
Dale Ostrander
Randall Ostroff
Steven Outly
Heh Paik
Syung Paik
John Palmieri
Kenneth Pang
Soon Park
Parwane Parsa
Myrna Parungao
Arti Patel
Todd Patterson
Branka Pavlovic
Ronald Peacock
Eric Pedicini
Michael Perconti
Patricia Perry
Janet Phelan
Danil Platt
Wayne Polek
Susan Polk
Zbigniew Pomykala
James Poole
Edward Post
George Powell
Christine Prekezes
Robert Prince
Tomasz Przezdziak
Maria Quartetti
Vincent Quinlan
Bronwyn Rae
Milian Rakic
Antonio Ramirez
Naraharisetty Rao
Albert Ray
Michael Reedy
Carmen Rocco
Thomas Rooke
Jeffrey Rooker
Alfred Rosche
David Rosen
Lawrence Rossi
Mark Ruttle
Roman Saldan
Ferdinand Salvacion
Hefex Sami
Madison Sample
John Samuels
James Sanders
Timothy Sanders
Nicholas Sarros
Danny Sartore
Sudershan Saxena
Brian Schander
John Scheub
Larry Schick
Kevin Schmidt
Bradley Schnack
Karen Schneider
Edward Schulte
Jeffrey Schultz
Louis Serpico
Suzanne Serpico
Kamlesh Shah
John Shiro
John Paul Sims
Jose Sison
Tanyalak Sivaboborn
Michael Skaredoff
Marc Sloan
William Soden
Derek Sonnenburg
Chidambaram
Srinivasan
Timothy Starck
Timothy Staudacher
Richard Stephenson
George Streicher
Brian Strumpf
Radha Sukhani
R. K. Prasad Sundara
Dale Sutherland
John Szewczyk
Ma Tacadena
Pankaj Tanna
Alberto Testoni
Zuhair Thalji
Curt Theo
Angela Thomas
Raghu Thunga
Louis Tisovec
Michael Tobin
Janet Torpy
Maria De Lordes Torres
William Towne
Long Tran
Hung-Shing Tsang
Kenneth Tuman
Mary Tuman
John Valadka
Martin Valente
Memo Verdan
Enrique Via-Reque
Edward Villaflor
Mirasol Villaflor
Robert Waldvogel
Cathleen Watt
Howard Weiss
David Wenzel
Eric Werner
Robert Whitcomb
Ewilina Worwag
Peter Wuertz
Jeffrey Wygodny
Theodore Wynnychenko
Edward Yaghmour
Emma Yee-Salazar
David Yound
Leonard Zalik
Noel Zweig
Michael Zygmunt
15
N OW R AT E D
A-
(EXCELLENT)
BY A.M.BEST!
W H E N
© 2001 ISMIE
I T
M A T T E R S
M O S T

Fall 2001 - the Illinois Society of Anesthesiologists

Transcription

Similar documents

Four Reasons to Partner with AYUSA

Sierra Gower, CRNA, MS

PVC Decking by WOLF Home Products

January 2015 - Kentucky Society of Anesthesiologists

American Woodhenge: Archaeoastronoraly at Cahokia

Program - NYSORA.com

The ASA-GHO Resident International Anesthesia Scholarship in

Chocolate Vine/Five Leaf Akebia - Illinois Natural History Survey

Tires Plus Total Car Care of North Dakota and CornerStone

ASA Group

Anestesi vid kejsarsnitt

CONTENTS FEATURES Critical Care Medicine: At the Crossroads The Opportunity of Critical