Winter-Spring 2008 - Lake

A Publication of the Lake-Sumter Medical Society
Volume 1, 2008
THE SESSION
BEGINS...2008
• Physicians - The Endangered
Species
• Risk Management Guidelines:
Stroke Prevention and Management
• Case Study: Inadequate Communications Leads to Stroke
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MEDICAL MONITOR
Physicians...The Endangered Species
Dr. Shelley C. Glover, President of Lake Sumter Medical Society
H
ow does it feel to be on the endangered species
list? Just ask any Florida doctor. We know because
that is what we are becoming. It seems more and
more frequently we hear about another physician who is
“hanging up the stethoscope”, leaving private practice,
leaving Florida, retiring, or decreasing the services they
offer.
All the while Florida’s population bursts at the seams,
baby boomers’ demands on the healthcare system increase, and the incidence of chronic health problems
among the younger generation is on the rise. If that were
not enough, we are literally fighting for our financial lives,
bombarded with decreasing reimbursement rates, forced
to herd patients through our offices like cattle, and
threatened at every turn with litigation as well as backhanded, unfair business practices perpetrated by managed
care companies and other like-minded healthcare payers.
It’s a bleak picture. Certainly not the one we envisioned
when we took our Hippocratic Oath. It’s enough to make
any physician second
BOARD OF DIRECTORS guess their decision to
enter the practice of
medicine. The fact
President Shelley C. Glover, M.D.
that so many of us reNicola Ally, M.D.
main committed is a
Jon E. Anderson, M.D.
testament to the value
Stacy J. Berckes, M.D.
we place on providing
Herman Flink, M.D.
quality healthcare to
Samuel Goss, D.O.
our patients.
Michael Levine, M.D.
Mayssa Toppino, M.D.
Lake-Sumter Medical Society
P.O. Box 1578
Mt. Dora, Florida 32756
Phone 352-483-4748
Fax 352-483-4740
Linda Nagle, Exe. Director
Email: [email protected]
The Medical Monitor is a publication of
the Lake-Sumter Medical Society. The
Medical Monitor, its editor, and the
LSMS are not responsible for the opinions and/or statements of its contributors
or advertisers, nor do they necessarily
reflect the official policy of the LakeSumter Medical Society.
For information about advertising in
Medical Monitor, contact Linda Nagle,
Executive Director.
MEDICAL MONITOR
How do we get back
to the dream of practicing real medicine?
First, we must realize
that we did not get
into
this
situation
overnight. Thus, we
will not be able to
change it overnight.
There are no quick
fixes to our concerns.
So, what are we to do?
Throughout history the
determined have succeeded. How? Because
they believe they can,
and they are willing to
sacrifice to make it
happen. They do not
give up. They ban
together
for
the
greater good,
plan & strategize,
practice,
pick
their battles
wisely,
and
celebrate
small gains,
adding them
to their arsenal
of
strength
to
move to the
next stage.
LET ME REPEAT:
they
ban together,
and they do
not give up.
For too long, doctors have spent their time competing with
one another. This is why insurance companies and trial
attorneys have been able to weaken our ranks. Now instead of physicians deciding on how to best care for our
patients, others are dictating how we practice medicine.
There are plenty of patients for everyone. It is time for
physicians to realize that fellow physicians and our physician organizations are not the enemy! Physicians must
stop being wary and suspicious of the very organizations
which are in place to help us while allowing outsiders, who
do not have our best interest at heart, into our practices
on a daily basis. It is time we truly realize that we, the
physician members, are what comprise and dictate the
workings of our professional organizations. We, as members, must battle in the arena of political persuasion with
as much endurance and unity as our adversaries. For too
long we have allowed others to keep us divided and conquered. It is time to change! It is time we work together.
“Change is Inevitable”
The question is: “Are we going to be sitting at
the table when it happens?”
There is no better time to prepare than now. Let us work
with the AMA as they struggle to fix the SGR. Let us work
with the AMA as it campaigns to reduce the number of uninsured in our country. During this election year in which
(Continued on page 5)
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3
Living in a State of Oxymoron
By Linda Nagle, Executive Director
T
he political season
is upon us and already many of us
are grinding our teeth,
hoping it will go away
sooner rather than later.
It seems we live in a state
of oxymoron. We are
proud to be living in a
participatory democracy.
But please, don't bother
us with participating. We
are proud that disagreements in our country are
solved by the ballot box,
not the bullet. But please don't bother us with being educated voters.
Rare is the bird that loves taking time away from everyday
demands to do something that probably will not be particularly enjoyable and rarely brings immediate results.
Doctors are not alone in feeling put-upon when asked to
participate in something outside their primary concern or
interests. One could argue until blue in the face that political involvement is a civic responsibility. It wouldn't matter much. We would still feel put-upon.
Grrrrr. You know the feeling. But thank goodness there are
those who step up to the plate to make a difference. It
may be on the political scene or in our professions; it may
be in our neighborhood or it may be on behalf of a complete stranger. My experience is that most people who
make a difference are not leaders. Rather, they are people
who are inspired or compelled to act. When these everyday people get involved, they put the wheels under the
car. They make the car roll. Without them, a leader could
sit all day behind the wheel, going nowhere.
Now don’t get me wrong. We need leaders. They define
the path, inspire us, prepare the vehicle, and steer it on
its course. We could not do without them. We are glad
they are willing to commit the time it takes to be a
leader. But most of us are more willing to follow, especially when we trust our leaders and when they make it
easy for us to be involved.
This legislative season we need some good followers who
are willing to give a few minutes here and there. We need
you to make a call to a legislator, to send a fax or email,
and yes, sometimes
to attend a meeting.
Let the leaders do
the homework to pro“Those few minutes of your
vide you with the
time multiplied a thousand-fold
timely information to
in the ears of the legislators
act. But you put the
power behind their
will have an impact…”
work by taking those
few minutes when
called upon to act.
Those few minutes of your time multiplied a thousand-fold
in the ears of the legislators will have an impact, maybe
not today or tomorrow, but sometime. They add up to a
powerful force with whom your “opponents” must reckon.
So…when you get the request to help, don’t shrug it off.
Be proud to be a follower who makes a difference when it
counts.
SOBERING FACTS YOU SHOULD KNOW
W
commercial payers collapsed in 2006, with payment
levels averaging 17% below that of 2002 and a staggering 36% below that of 2004.” (Source: Moore, PhD. P.
The 2006 Fee Schedule Survey: Power to the Payers,
Physician Practice, January 2007).
hile reimbursements to health care providers
have been steadily falling over the last few
years, insurance premiums have been climbing.
Consider these cold facts from the Verden Report: “Cost
Versus Profit in Managed Care Today”, November 1, 2007:
•
The average employee contribution to companyprovided health insurance has increased more than
143% since 2000. Average out-of-pocket costs for deductibles, co-payments for medication, and coinsurance for physician and hospital visits rose 115%
during the same period (Source: Hewitt Associates
LLC. Health Care Expectations: Future Strategy and
Direction 2005. 17 November 2004).
•
According to the Physicians Practices’ 2006 Fee Schedule Survey, “average physician reimbursement from
4
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•
At a time when we have the largest number of uninsured individuals, the decreasing percentage of premium money that is spent on reimbursement to providers for rendered health care services and increasing
premiums have combined for record profits for at least
four of the five largest publicly traded national managed care organizations. The profit margin comes
from not only increasing premiums, but lowering the
amount that the managed care organizations spend on
health care services for its members. (Source: Verden
Report: “Cost Versus Profit in Managed Care Today.”
November 1, 2007).
MEDICAL MONITOR
(Continued from page 3)
healthcare is one of the leading issues, let us work
with the AMA to make sure that physicians are at the
table as the new healthcare plans are contemplated,
and that our opinion & vote are sought out and valued
by the candidates.
Let us work with the FMA as we go into the 2008 legislative session. Let us send emails and faxes, and make
calls for our managed care reform bill. Let us keep the
pressure on our local representatives and senators and
let them know that we do care about what is happening to our healthcare system.
Let us be supportive when the local Lake-Sumter Medical Society is able to find & offer services to save our
practices money, provide needed benefits and help us
work more efficiently.
Please join me in uniting to make a difference! Remember, you cannot continue to do the same thing and
expect to obtain different results. Let’s be a community of physicians, not a competitive group of doctors who happen to live and work in the same community.
Shelley C. Glover, MD
A Concerned & Committed Physician of Lake County
MEDICAL MONITOR
JOIN TODAY
ACTIVE DUES $275
RETIRED $55
DON’T MISS OUT ON THESE MEMBER BENEFITS:
• Physician employer and staff group health plan
• Up to 24.8% workers compensation dividend
• 5% discount on professional liability insurance with First
Professionals Insurance Co.
• 50% discount on member meetings
• Discount on practice manager meetings
• Physician referral services to inquiring patients
• Representation of your interests at local, state and
national level
• And more!
LET YOUR MEMBER BENEFITS RETURN
YOUR MEMBERSHIP DUES AND MORE!
CALL 352-483-4748 for an application
www.lakesumter.org
5
EXPO: A Time to Let it Hang Out
Hey, how about that flowing stream of decadent chocolate? Or those tingling fingers pulsating down your spine?
Perhaps you were cashing in at the miniature golf or imbibing the fruits of the complimentary drink tickets? Maybe,
you were simply looking for that latest product or service to help you better serve your patients or run your business, and, unexpectedly heard your name called as the winner of the endless bounty of wonderful prize drawings? If
so, then you were among the 150 lucky attendees at EXPO 2007.
If not, then it’s time you quit depriving yourself of one of Lake Sumter’s most noteworthy events of the year,
organized and hosted by the Lake Sumter Medical Society for the exclusive pleasure of Lake and Sumter County physicians and their staffs. Start planning now to join the excitement and enthusiasm at EXPO 2008.
EXPO 2008
When: Wednesday, November 5, 5 - 8 PM
Where: Lake Receptions in Mount Dora
Thanks to all our exhibitors, sponsors, volunteers and local businesses for your support at EXPO 2007
Is your bank getting too big?
Maybe it’s time to check us out!
• We have a wide selection of products like a
regional bank, while delivering the services only a
community bank can provide.
David Bradshaw
Assistant Vice President/
Commercial Banking
Officer
Denise Remmers
Assistant Vice President/
Banking Officer Manager
CBANK
OMMUNITY
& TRUST
• All decisions are made locally. The people you
speak to are the same people who will be handling
your banking business.
• We are the only locally owned bank with trust
powers and a complete line of trust portfolio
management services.
in a word…
www.cbtfl.com
352-259-3070
QUALITY
OF FLORIDA
6
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MEDICAL MONITOR
2007 EXPO EXHIBITOR LINE UP
Adams Property Consultants
Advanced Bionics
Advanced MRI & Imaging Centers
Barrett, Liner & Company*
Builders Unlimited
Central Florida Health Alliance aka
LRMC/TVRH*
Citizens First Bank
Community Bank & Trust of FL*
Comp Options Insurance
Diagnostic Pathology Associates*
Diagnostic Outpatient Centers*
eClinical Works
Eidson Insurance
EMRgence
Florida Hospital Waterman
First Professionals Insurance Co.
Home Instead Senior Care
Hospice of Lake & Sumter
Intercommunity Cancer Centers
Interim HealthCare
Lake Centre for Rehabilitation
Lake Medical Imaging*
Lakeside Open MRI
Lassiter-Ware Insurance
Liberty Medical Supply
Medical Disposal Systems
MD News
NCG Medical*
Physicians Imaging
Physio Med, Inc and Compass
Primoris Medical Revenue*
Principal Financial Group
Pulse Systems
Resource Providers, Inc
Riverside Bank
Senior Home Care, Inc*
South Lake Hospital
Sundrop Systems, Inc*
Total Family Weight Loss Center
Vintage Pharmacy & Specialty Compounding
Waterman Village
We Care of Lake County
HEARTFELT THANKS
TO OUR VOLUNTEERS: Melisa
Logan, Dennis Nagle & Dan Reale
TO OUR BABYSITTERS: Teresa Parrish & Laverne Bradley
*TO ALL OUR DRINK SPONSORS
TO OUR FOOD SPONSOR: Barrett,
Liner & Co.
Special Thanks to Lake Receptions
for an outstanding facility and services.
LOOK AT THE PRIZES AWARDED!!
You didn’t win anything? This year could by your lucky one. BE THERE -- EXPO 2008!
Advanced Bionics: Starbucks Gift Basket
Advanced MRI & Imaging Centers: Certificate to J. Scott’s Skin Care & Day
Spa
Builders Unlimited: Amex Gift Card
Citizens First Bank: Cooler of Goodies
Community Bank & Trust of FL: Staff
Lunch, Cash for Golfing
DOCs II Open MRI: Gift Basket
eClinical Works: Visa Gift Card
Hospice of Lake & Sumter: Gift Baskets & Teddy Bear
Intercommunity Cancer Center: Gift
Basket
Interim HealthCare:Thanksgiving
Decorations
Lake Centre for Rehabilitation: Gift
Basket
Lake Medical Imaging: Exquisite Fall
Centerpiece
Lakeside Open MRI: Gift Certificates
to Applebees
Central FL Health Alliance:Digital
Camera, Flat Screen TV
Medical Disposal Systems: Visa or
Mastercard Gift Certificates
Physio Med: Body Massage Gift Certificate
Riverside Bank: Gift Basket
South Lake Medical Arts Center: Nintendo Wii Gaming System
Senior Home Care: Certificate to Outback Steakhouse
Sundrop Systems: Certificates for
Free Advertising
Waterman Village: Lounge Chairs
We Care: Hand Embroidered Pillows
LSMS: Flight on a Stearman PT 17,
Staff Lunch
Plus a multitude of free memorabilia and treats at vendor booths
LOCAL AREA BUSINESSES SUPPORT EXPO
Thanks to these local area businesses who, recognizing the every day contributions of the medical community
to the quality of the lives of our residents, graciously contributed prizes for EXPO 2007. Be sure to say thanks
by utilizing their products and services.
CLERMONT CRISPERS
6 “Get It Free” Certificates
Mission Inn Resort
Champagne Brunch for 2
RIDGEBACK WINERY
Gift Certificate
EYE SPECIALISTS
Bottle of Champagne
Orlando Science Center
4 Admission Tickets
Plantation Residence Golf Club
2 Certificates for 2 Players Each
MEDICAL MONITOR
www.lakesumter.org
7
2008
Florida Legislative
ISSUES
“When the conduct of men is designed to be influenced,
persuasion, kind unassuming persuasion, should ever be
adopted.”
Abraham Lincoln, 16th President
Make yourself heard on the following issues coming before the Florida Legislature.
PRIORITY ISSUES TO PASS:
• MEDICAID TO MEDICARE
Increase the reimbursement rate for Medicaid to that of Medicare.
• MANAGED CARE
Pass legislation that would require managed care companies to
accept a valid assignment of benefits, legislation that would prohibit silent PPOs, and change certain provisions of the prompt payment law.
• PROFESSIONALS RESOURCE NETWORK
Obtain sovereign immunity for the two state programs (PRN and
IPN) that provide impairment services to health care licensees.
Require occupational listing on death certificates.
• ER SOVEREIGN IMMUNITY
Pass legislation that would provide sovereign immunity to physicians who provide mandated treatment to patients in emergency
rooms.
• HOSPITAL DEPARTMENT CLOSURE
Give the Agency for Health Care Administration the power to investigate decisions by a hospital to close a particular department
and to take action to ensure patients are not left without needed
medical care.
• EXPERT WITNESS CERTIFICATE
Pass legislation that requires expert witnesses to become licensed
in Florida and clarifies that giving expert testimony is the practice
of medicine.
• ALLIANCE FOR A HEALTHY FLORIDA
Seek a one dollar increase in Florida’s cigarette excise tax with the
revenues to be used to increase Medicaid reimbursement rates to
Medicare levels, to provide additional funding for the Kidcare program, and to provide additional Medicaid services.
ISSUES TO SUPPORT:
• PRIMARY SEAT BELT LAW
Enact legislation that would make seat belt violations a primary
offense in Florida.
• OFF-SITE EMERGENCY ROOMS
Support legislation that would impose a moratorium on the con8
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FLORIDA STATE CAPITOL
struction of any additional off-site emergency departments in the
State of Florida.
• FLORIDA KIDCARE
Support the efforts of the Florida Pediatric Society to legislatively
fix the Florida Kidcare Statute.
• PROSTATE CANCER SCREENING
Support legislation that would require health insurers to cover an
annual screening for
prostate cancer for men over 40.
PRIORITY ISSUES TO OPPOSE:
• SCOPE OF PRACTICE EXPANSIONS
Continue to oppose all scope of practice expansions including naturopaths, ARNPs, pharmacists, optometrists, psychologists, podiatrists, direct access to physical therapists, audiologists and speech
language pathologists.
• PROTECT ABILITY TO SELF INSURE
Oppose legislation that will take away a physician’s ability to self
insure or that will make it more difficult for a physician to meet the
financial responsibility requirements for licensure.
• FOREIGN PHYSICIAN LICENSURE
Oppose any legislation that allows a physician to practice in Florida without meeting the same requirements as all other applicants.
• PHYSICIAN PROFILE ISSUES
Oppose any legislation that makes the laws relating to profiles
more onerous.
• HEARING INTERPRETERS
Oppose any legislation that increases the cost of hearing interpreters.
• FABRE CHANGES
Oppose any legislation changing current law relating to the Fabre
doctrine.
• PHYSICIAN SUPERVISION ISSUES
Protect advances we have made relating to physician supervision
of nurses and PAs.
MEDICAL MONITOR
MEDICAL MONITOR
www.lakesumter.org
9
LAKE SUMTER MEDICAL SOCIETY
Community Begins at Home
Dr. Beaver accompanied by
his fiancé (center) and
Alachua County EVP Sally
Lawrence (right).
New LSMS member Dr.
Carlos Castellon (right)
leads the way through
the dinner buffet with
Dr. Cara Jacobs (left).
At its Fall meeting in 2007, LSMS hosted Dr.
Thomas Beaver, who spoke to members about
his medical tours in Iraq and Afghanistan. Afterwards the Society honored Dr. Beaver by
presenting a donation to District 20 Veterans
of Foreign Wars represented by Commander
Michael Fox. L to R: Com. Fox, LSMS Pres. Dr.
Shelley Glover, Dr. Beaver.
FMA Annual Meeting August 2007
A mixture of work and celebration for Lake-Sumter delegates.
Sometimes you just
have to let it loose!
Former Governor and Presidential want-tobe Mitt Romney, speaks to delegates at
the Good Government Luncheon about the
Massachusetts's health insurance plan.
10
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Being a delegate
means long hours in
the House of Delegates preceded by
committee work.
Taking it all in stride
are LSMS delegates (L
to R) Drs. Jon Anderson, Stacy Berckes,
and Shelley Glover.
MEDICAL MONITOR
MEDICAL MONITOR
www.lakesumter.org
11
Risk Management Guidelines: Stroke Prevention and Management
By the Risk Management Experts at First Professionals Insurance Company
Stroke remains a leading cause of death and malpractice claims against physicians. Few medical specialties are immune. Often, these malpractice claims
have little to do with the competency of the physician
but rather faulty monitoring and system failures. Frequently, the physician’s indefensibility is attributed
directly to inadequate management of anticoagulation
therapy. There are loss prevention measures shown to
reduce errors, deter lawsuits before they are pursued,
and preserve defenses necessary to defeat the unavoidable claim. They include:
♥ Identify patients at risk for stroke according to established clinical standards.
♥ Document why a patient at risk of stroke was or
was not placed on anticoagulation therapy.
♥ Educate patients about the implications of anticoagulation therapy.
♥ Document patient education.
♥ Establish written procedures for monitoring patients or anticoagulation therapy and follow them.
♥ Provide thorough patient education.
♥ Obtain informed consent.
♥ Document patient refusal or noncompliance.
♥ Keep AF patients consistently in INR 2.0 – 3.0 range.
♥ Commit to appropriate monitoring system.
♥ Utilize a Warfarin monitoring regimen system.
♥ Seek legal or risk management advice when uncertainty arises.
Information in this article does not establish a standard
of care, nor is it a substitute for legal advice. The information and suggestions contained here are generalized
and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide
only.
First Professionals Insurance Company is Florida’s Physicians Insurance Company and the endorsed carrier for
professional liability insurance.
♥ Identify patients at risk for stroke according to established clinical standards.
American College of Cardiology
AMI Treatment Guidelines
♥ Document why a patient at risk of stroke was or
was not placed on anticoagulation therapy.
♥ Educate patients about the implications of anticoagulation therapy.
♥
Early administration of aspirin
♥ Document patient education.
♥ Aspirin at discharge
♥ Establish written procedures for monitoring pa-
♥ Early administration of beta-blocker
tients or anticoagulation therapy and follow them.
♥ Identify all patients for whom anticoagulation
(Warfarin) is indicated.
♥ Document a specific reason or contraindication
whenever a high-risk patient is not on Warfarin.
♥ Create written policies and guidelines pertaining to
patient identification and documentation.
♥ Beta-blocker at discharge
♥ ACE-inhibitor or angiotensin receptor blockers
(ARB) at discharge for patients with systolic
dysfunction
♥ Timely initiation of reperfusion (thrombolysis or
percutaneous intervention)
♥ Smoking cessation counseling
♥ Discuss potential risks and benefits of therapy with
the patient and/or caregiver.
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MEDICAL MONITOR
MEDICAL MONITOR
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13
Case Study: Inadequate Communications Leads to Stroke
By the Risk Management experts at First Professionals Insurance Company
Editor’s Note: This case study analysis reflects an
actual First Professionals’ case.
Case Analysis:
The patient, a 65 year-old male, underwent prosthetic cardiac valve placement and was placed on
Coumadin under management by his internist. The
patient returned monthly to the internist’s office
and/or clinic lab for coagulation panels and dose
regulation. Several years later, the patient missed
several lab visits, which went unnoticed by the internist until 6 months later when the patient was
treated for a urinary tract infection and his chart
was reviewed. A coagulation panel was then done
and a dosage adjustment was necessary. The internist instructed the nurse to reduce Coumadin by
one milligram daily and call patient with new regimen. The nurse phoned the patient’s home and
relayed the instructions to patient’s wife. Two
weeks later patient admitted via ER with a diagnosis of ischemic stroke, sustaining significant neurological and cognitive deficits. Wife wrote “reduce
Coumadin to one milligram daily.” The nurse did
not document the phone conversation wherein the
patient was instructed to reduce the dose by one
milligram daily.
anticoagulation therapy. Loss prevention measures
shown to reduce errors, deter lawsuits before they
are pursued, and preserve defenses necessary to
defeat the unavoidable claim include:
♥ Identify patients at risk for stroke according to established clinical standards.
♥ Identify all patients for whom anticoagulation
(Warfarin) is indicated.
♥ Document a specific reason or contraindication
whenever a high-risk patient is not on Warfarin.
♥ Educate patients about the implications of anticoagulation therapy. Document these efforts
♥ Create written policies and guidelines pertaining to
patient identification and documentation.
♥ Establish written procedures for monitoring patients or anticoagulation therapy and follow them.
♥ Discuss potential risks and benefits of therapy with
the patient and/or caregiver.
♥ Obtain informed consent.
♥ Document patient refusal or noncompliance.
♥ Keep AF patients consistently in INR 2.0 – 3.0 range.
Risk Management Discussion:
Stroke remains a leading cause of death and malpractice claims against physicians. Few medical
specialties are immune. Often, these malpractice
claims have little to do with the competency of the
physician but rather faulty monitoring and system
failures. Frequently, the physician’s indefensibility
is attributed directly to inadequate management of
♥ Commit to appropriate monitoring system.
♥ Utilize a Warfarin monitoring regimen system.
♥ Seek legal or risk management advice when uncertainty arises.
FEBRUARY IS
AMERICAN HEART MONTH
14
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MEDICAL MONITOR
Preliminary Highlights of Governor Crist’s
Health and Human Services Budget Proposal
Florida legislators will be looking at this Health and Human Services budget proposal during the 2008 legislative session.
•
•
$60.6 million to pay for an additional 46,000 kids to enroll in KidCare
$64 million for indigent health care pilot in 14 counties (Escambia, Santa Rosa, Okaloosa, Gadsden, Duvall,
Alachua, Orange, Osceola, Hillsborough, Sarasota, Palm Beach, Broward, Miami-Dade, and Monroe). The funding
for this pilot comes from a combination of $28.5 million from Tobacco Settlement Trust Fund and $35.4 million
from the Medical Care Trust Fund.
DID YOU KNOW THAT
This 3-year pilot project is modeled after the current initiative in Broward
County. The areas selected represent high concentrations of the uninsured and
● ONE IN FIVE OF FLORIDA’S
high use of emergency rooms for primary care.
RESIDENTS ARE UNINSURED.
● FLORIDA RANKS THIRD IN THE
NATION IN THE NUMBER OF
UNINSURED.
•
•
Elimination of the CON process for the construction of new hospitals
$21.8 million to increase Medicaid reimbursements fees for dentists (20%
increase overall)
•
•
$600,000 for a community dental services program that will serve Medicaid
eligibles in rural counties
$68.1 million increase for Medicaid, which includes
•
•
•
$15.9 million for an increase in reimbursements for specialty physicians
$11.9 million for home health services
$1.8 million for a statewide County Public Health Department Pharmacy System
“GET FIT LAKE”
The Lake County Comprehensive Health Care Committee met on January 23 and debated ways in which the
committee could help coordinate and propel initiatives
currently underway or planned to help fight childhood
obesity in Lake County. The committee is made up of
various healthcare professionals and representatives
from various healthcare and government organizations
including Lake Sumter Medical Society. The committee
adopted the tag line “Get Fit Lake” as the overarching
banner under which it will promote various activities and
initiatives throughout the year.
If you or your practice would like to become involved
in “Get Fit Lake”, or if you would like to share your
knowledge and expertise during this campaign, please
contact LSMS. If you already have a planned program to
fight obesity among your young patients and would like
to get on the calendar of events, please also contact us.
You will be hearing more about “Get Fit Lake” in the
months ahead.
MEDICAL MONITOR
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15
Tamper Resistant Prescription Pads Mandated for Medicaid
By Leslie Witkin, President
Physicians First, Inc.
A
little noticed provision was tucked into a
piece of congressional legislation in May
2007,
mandating
tamper
proof
prescription pads for Medicaid prescribed drugs as of
October 1, 2007 and full compliance with all aspects
of the rule as of October 1, 2008. On Saturday,
September 29, 2007, President Bush signed a bill
delaying the implementation date until April 1, 2008
for the first phase for compliance. The date of
October 1, 2008 for full compliance still remains.
The Centers for Medicare and Medicaid Services
(CMS) outlined three baseline characteristics of
tamper-resistant prescription pads, but each state
will define which features it will require to meet
Tamper-Resistant Requirements
1. Prevent unauthorized copying of a
completed or blank prescription form.
2. Prevent the erasure or modification of
information written on the prescription
by the prescriber.
3. Prevent the use of counterfeit
prescriptions forms.
those characteristics in order to be considered
tamper-resistant. The baseline characteristics must:
By April 4, 2008 states must require at least one of
these baseline requirements. By October 1, 2008
states must require all three characteristics on
prescription pads in order to be considered tamperresistant. The requirement does not apply:
A. When the prescription is communicated by the
prescriber to the pharmacy electronically,
verbally, or by fax.
B. A managed care entity pays for the prescription.
C. In most situations when drugs are provided in
institutional settings such as nursing homes.
16
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E m e r g e n c y
prescriptions may be
filled as long as the
prescriber provides a
verbal,
faxed,
electronic, or compliant
written
prescription
within 72 hours. For
more information and
for a CMS FAQ section, go to this web address:
http://www.cms.hhs.gov/center/
intergovernmental.asp
The state of Florida has required tamper proof
prescriptions for Medicaid in compliance with the
CMS requirements since 2001 although enforcement
has not been strict. The Florida requirement became
effective on July 1, 2001 with full compliance
expected by October 1, 2001.
Florida requires providers to obtain their tamper
proof prescriptions from an approved vendor. The
Agency for Health Care Administration (AHCA)
approves vendors to manufacture and distribute the
counterfeit-proof prescription blanks. These vendors
are required to produce, as specified, a quality
product, maintain the security of the supplies they
are storing, and follow certain safeguards to ensure
timely delivery of the blanks to authorized
practitioners. To obtain a list of approved vendors go
to
the
AHCA
website:
http://
floridamedicaid.consultec-inc.com/index.jsp and
click on Provider Support.
“Computer
generated fax
exemption
eliminated as of
January 1,
2009.”
IF you are a practice that is using
software
to
generate
prescriptions that you then fax to
the pharmacy, or your computer
generates and sends a fax to the
pharmacy, you will no longer be
able to do so as a result of the
computer generated fax
(Continued on page 19)
MEDICAL MONITOR
LAKE SUMTER MEDICAL SOCIETY APPAULDS ITS VOLUNTEER PHYSICIANS
Thank you to our specialty physician members who are donating their time and talents to treat individuals in our community that do not have the means to pay for the care that they need. Not only is your service appreciated by the recipients, but your service is a contribution to all the tax payers of our community. In 2007 healthcare valued at nearly
$812,000 was generously donated by individuals, organizations, and medical professionals.
James K. Allen, M.D.
Kenneth Essig, M.D.
Ruth Meneses-Taylor, M.D.
Z. Nicola Ally, M.D.
Herman Flink, M.D.
William H. Middleton, M.D.
Jon Anderson, M.D.
D. Scot Ghivizzani, M.D.
Carl Ollivierre, M.D.
Jeffrey Baumann, M.D.
Shelley C. Glover, M.D.
Stacy Berckes, M.D.
Joseph Gurinsky, M.D.
Manoj Bhatia, M.D.
Richard Held II, M.D.
Ethiraj Ramchander, M.D.
David Bjerken, M.D.
C Steven Houston, M.D.
Thomas Sanders, M.D.
Richard Bosshardt, M.D.
H. Andrew Huntt, M.D.
Marc Scwartzberg, M.D.
Clifton Bridges, M.D.
Orlando Icaza, M.D.
Andrew Sher, M.D.
David Brunetti, M.D.
Hal Jacobson, M.D.
Charles Cartwright, M.D.
Mark Jacobson, M.D.
Matthew Casavant, D.O.
Christopher Johnson, D.O.
Daniel Sullivan, D.O.
Pairoj Chang, M.D.
George Kainz, M.D.
Mayssa Toppino, M.D.
William Charles, D.O.
Catherine Keller, M.D.
Rambabu Tummala, M.D.
Michael Levine, M.D.
Mark Vocci, M.D., PhD.
Raveendra Limaye, M.D.
Scott Wehrly, M.D.
Yi Liu, M.D., Ph.D.
Rosendo Diaz, M.D.
Maurice Yoskin, M.D.
Peter Marzek, M.D.
Carole Early, M.D.
Borys Mascarenhas, M.D.
Ernesto Zavaleta, M.D. - Volunteer
Medical Director for We Care
John Cowin, M.D.
Phillip Dascher, M.D.
Gregory Panzo, M.D.
Mahrad Paymani, M.D.
Steven Pillow, M.D.
Michel Snyder, M.D.
Christopher Soprenuk, M.D.
Kenneth Stark, M.D.
LAKE COUNTY COMMISSIONERS RECOGNIZE WE CARE PHYSICIANS
November 6, 2007: The Lake
County Board of County Commissioners recognized the valuable service so
graciously donated by specialty physicians through the We Care program.
At a ceremony held in county chambers, Commission Chairman Welton
Cadwell noted that since the program’s inception, volunteering physicians have contributed almost $6 million worth of service to community
residents.
(L to R) Andrea Payne, We Care Director; Chris Thorpe representing Lake Medical Imaging; Dr. chad Watkins, Dr. Gottfried Jean-Louis; Dr. Hal Jacobson; Dr. Philip Dasher,
and Dr. Shelley Glover.
MEDICAL MONITOR
www.lakesumter.org
17
W
e Care of Lake
County
An Initiative of the
Lake Sumter Medical Society
T
he start of the New Year has
always been a time of reflec- By Andrea Payne
tion on the past and projec- Executive Director
tion of hope into the future.
As we look back on our successes, we also must look
forward to our challenges.
We have 126 specialty physicians who volunteer their
services to treat We Care clients. These generous
healthcare professionals provide services to the growing
population of working poor in Lake County. Hundreds of
people have had their health restored through the care
and commitment of our providers. Unfortunately, the
needs of Lake County’s medically indigent are greater
than our resources at We Care.
We have over 60 people waiting for a volunteer physician. Some have been waiting for months. Our critical
needs change from time to time but we urgently need
specialists in all areas. You are probably seeing uncompensated patients anyway. We Care of Lake County can
provide you with:
•
•
•
Sovereign Immunity from litigation
5 hours CME credit
An efficient system to provide healthcare for your
charity patients
Please consider joining our group of dedicated professionals who are working together to make Lake County a
better place to live. Call me at 352-742-6595.
LAKE SUMTER MEDICAL SOCIETY
It takes a team effort to have your voice heard on behalf of
your profession and your patients.
Isn’t it time you joined the team?
With team effort and belief even the underdog can achieve
the unbelievable.
Together we become a Giant voice.
Join Today - Call LSMS at 483-4748 or download your
application at www.lakesumter.org
18
www.lakesumter.org
MEDICAL MONITOR
(Continued from page 16)
exemption being eliminated under the
e-prescribing standards as of January 1,
2009.
True e-prescribing under the eprescribing rules requires the use of the
NCPDP SCRIPT standard in the software
program. Two versions of this standard
are acceptable: NCPDP SCRIPT 5.0 or
8.1.
Many practices using software with
the computer generated fax function
have not implemented the actual eprescribing function that may also be a
part of the software, or they may be
required to upgrade their programs.
Because computer generated faxes
still end up requiring data entry on the
part of the pharmacy, the potential for
error is still felt to be great, and the
administrative burden is not truly
decreased.
10.1% Conversion Factor
Decrease Averted BUT
On 12/19/07 the House approved a
Senate amendment to temporarily stave
off the 10.1% decrease to the dollar
Conversion Factor and instead increase
the CF by 0.5%. However, this (and
other measures passed) will expire as of
6/30/08 unless Congress takes further
action.
Note, however, that your
reimbursements will still, in the majority, be less than last year. Why? The bill does not alter (just like last year) the
11.94% reduction in the work relative values for ALL codes in order to maintain budget neutrality.
Other items in the bill that are extended through 6/30/08:
1. Continue the therapy cap exception process.
2. Continue the 5% bonus payment to physician shortage areas.
3. Continue the geographic practice cost indice floor of 1.0.
4. Continue to allow independent laboratories to bill Medicare directly for the technical component of
certain pathology services.
If Congress does not act by 7/1/08, reimbursements would plummet as the 10.1% decrease to the CF would then
be back.
MEDICAL MONITOR
www.lakesumter.org
19