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FLORIDA SOCIETY OF PHYSICAL MEDICINE AND REHABILITATION
MEETING MINUTES
May 18, 2003
Hilton Clearwater Beach Resort

PO Box 330298
Atlantic Beach FL  32233-0298
Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net
www.fspmr.org 

Presiding:  Enrique Monasterio, MD, Vice President

 Present:  Drs Enrique Monasterio, Oregon Hunter, Venerando Batas, John Muenz, Robert Dehgan, Colleen Zittel, Victoria Rabe-Tagala, Amy Clunn, Justine L Vaughen, Dorothea Glass, Craig Lichtblau, Anthony Dorto, and Jesse Lipnick.  Guests:  Drs Joan Watkins and Richard Fry, Mayelin Gomez ARNP, Atty Dorothy Sims, and AAPMR Deputy Executive Director, Lynda Leedy JD.  Executive Director Lorry S Davis, MEd.

 AAPMR and Foundation for PM&R Report:  Lynda Leedy gave a presentation on the current and future activities of the Academy, and the FFPMR.  In 2004, AAPMR will conduct another comprehensive survey to determine the needs of Academy members.  FFPMR’s mission is “To enhance health and function through education and research in the field of physical medicine and rehabilitation.”  Contributions are appreciated.

 Old Business: 

1. A motion was made and carried to accept the minutes of the Aug 20, 2002, Orlando meeting.

2.  Dr Vaughen gave the membership report:  We currently have 123 members, 8 of whom are retired.  We have l inactive member.  There are 114 dues-paying members.

Over this past year, we lost 10 members to nonpayment of dues.  We sent a certified letter in January to members who had not paid in 2002.   Of those , we retrieved 3.

The remainder are Drs George Bonis, Carolyn Geis, Eric Kerstman, Stuart Krost, Eric Kurtz, Thomas Murray, Alan Novick, Daniel Picard, Krystyna Pisarska, and Paul Schwartz.  Dr Dorto will contact Drs Novick and Krost.  Dr Lipnick will contact Dr Kerstman, and Lorry will contact Dr Kurtz.  If members know any of the others, please call them and encourage them to “return to the fold.”  Lorry will follow-up with them if you let her know you have spoken with them and they’d like to reinstate their membership (ph 904 270 8886, fax 904 246 9233,  Lorry4@earthlink.net).

 We employed AAPMR to send FSPMR member apps, along with AAPMR dues notices,  to those AAPMR members in FL who are not FSPMR members.  From this, we netted 6 new member applications.  The cost was $85.27, a reasonably small amount for the benefit of 6 new member applications.  We will engage in this process annually.

 Today we consider 7 candidates for membership:

 Amy E Clunn MD                     Ocala                           Oregon Hunter MD

Mohan S Gulati MD                 W Palm Beach             needs recommendation

Paul Kornberg MD                   Tampa                          Jairo Parada MD

Donna M Lanthier MD Ft Myers                      James P Weiner MD

Shahriar A Nabizadeh MD       Jacksonville                  John Muenz MD

Witiza Perez MD                      Lake City                     Justine Vaughen MD

Andrew L Sherman MD           Miami                           needs recommendation

Dr Monasterio to contact

Robert W Sury MD                  Jacksonville                  John Muenz MD

 A motion was made and carried to accept all with recommendations.  Dr Gulati needs a recommendation.  No one present at the meeting knew him to do this.  Any member out there know Dr Gulati?

 The following inquired about membership, were sent applications and have not yet completed them:

 Emmanule G Acosta MD

Lance Cassell MD

Raul Cardenas MD

Jon Erich MD (Collen Zittel MD)

David Ernstoff MD (Rodolfo Eichberg MD)

 Members who know these applicants are asked to contact these potential members and encourage them to complete the application process.

 3.  Dr Zittel gave the Treasurer’s Report:  *

*Details of the Treasury Reports can be obtained by members from Lorry S. Davis, M.Ed., Executive Director, at Lorry4@earthlink.net.

 Hospitality Suite Discussion:  A motion was made and carried to release the hospitality suite at the work comp conference.  The FL Assoc of Oc/Env Medicine has done same.  Traffic in the last few years has not merited the expense, and sponsors are increasingly difficult to commit for this purpose.  Last year, we could find no sponsors and the suite cost us close to $2000, even with FAOEM paying 2/3 of the cost. 

4. Dr Zittel, Carrier Advisory Council Representative for FSPMR, gave the following Medicare Report:  There was a policy on Speech Therapy which we reviewed and this was fine, no comments on it; it was presented at the 12/7/02 CAC which I attended.  Those interested should look it up on the website.  Dr Conlan reviewed the policy on "Greater Occipital Nerve Block" which was presented at the CAC on March 1 2003.  His one paragraph synopsis of it is in your FSPMR March 20 broadcast fax, but basically, we all thought the policy was fair and no changes were submitted by PM & R.

5. Lorry Davis reported that PMR Jax had a meeting on Feb 19 at Brooks Rehab Hospital which Dr Muenz, Member-at-Large, organized, and Davis attended.

6. Dr Hunter gave the Legislative/FMA Report:  As a participant in the FMA’s Advisory Committee to the Three Member Panel, Dr Hunter stated there was concensus on that Committee re hating attorneys and increasing work comp fee schedules, but little else among the various physician specialties as to what the new work comp law should look like.  Davis also participated in these phone conferences.   

Various expansion of Scope of Practice bills were killed.

Re PIP legislation, the FMA was successful in helping to prevent the new PIP law from including a fee schedule, similar or tied to the work comp fee schedule.

Re tort reform, Dr Muenz cited that in Jacksonville, the NE FL Surgeons were quitting practice if there was no reform.  This includes general surgeons, orthopaedics, neurosurgeons, and obstetricians (this also means no mammography).  The Mayo Clinic in Jax is not politically involved.  Dr Muenz stated that non-economic caps are not necessarily the cure. There should be a pool of doctors with no claims with one set of malpractice premiums, and a pool of doctors with claims with another (higher) set of malpractice premiums.  This is similar to auto insurance – good drivers and bad drivers are not in the same pool.

Dr Zittel cited that in Orlando, neurosurgeons agreed to continue to take call until September.  Without them, there will be no Level 1 Trauma Center.

7. All members will be sent updated FSPMR Member Certificates.   

New Business:

1. Our next meeting will be in conjunction with the FL Work Comp Conference, with FAOEM, Tuesday, Aug 19, 12 – 3 pm, in Crystal Ballrooms E and F of the Orlando World Marriott Center.  Luncheon will be served.  Please RSVP to Lorry Davis (904 270 8886, 904 246 9233, Lorry4@earthlink.net) if you plan to attend.

We are looking for a sponsor or sponsors for this event.  Sponsorship is $2500 for 15 min, or $5000 for an entire half hour of physician audience.

2. Shall we meet again with the FL Academy of Pain Medicine?  We will address this question at the August meeting.

Respectfully submitted, 

Lorry S. Davis, M.Ed.
Executive Director

FSPMR BROADCAST August 2, 2006 

Next Meeting:  Although we are not meeting with the oc med docs at the work comp conference this year, we are again invited to attend their luncheon and business meeting on Tuesday, August 15, 12 pm, Anaheim Room (Orlando World Center Marriott).  Some of you attended last year.  RSVP to me, contact info below, if you will be at this luncheon. 

Talk has begun about possibly meeting in Tampa in February with some CME.  Venerando Batas MD, FSPMR President, is working on this.  Stay tuned for details…. 

Save these dates!  FSPMR is scheduled to meet in conjunction with SSPMR, May 11 – 13, 2007, at the JW Marriott Buckhead Atlanta.  Room rate $179, call 800 228 9290, tell them you’re with the Southern Society of Physical Medicine and Rehabilitation.  Cut off date is April 16, 2007.  10 hours of continuing ed. 

Minutes of the FSPMR April Miami Meeting

AAPMR:  November 9 – 12, 2006, Hawaii! 

Mark Rubenstein MD, FSPMR Member-at-Large, met with others in Vancouver, and reports they have been “really working to vitalize the Board Exam for PM&R.  It has become a very fair, highly psychometrically researched, referenced, exam written by those who care.  It will likely be a model for other boards to follow.”  Thank you, Dr Rubenstein. 

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net, http://fspmr.org

FSPMR BROADCAST June 15, 2006 

April Meeting in Miami, PIP, FMA and the 2006 Florida Legislative Session, Seeking Job Op, Editor 

April Meeting in Miami:  The minutes of that meeting will be forthcoming shortly under separate cover.  CONGRATULATIONS! to our new officers elected at that time:  President – Venerando Batas MD, VP – Robert Dehgan MD, Secretary – John Muenz MD, Treasurer – Duby Avila MD, Members at Large – Rigoberto Puente MD, Mark Rubenstein MD, Mitchell Freed MD.  And thank you for a job-well-done by Enrique Monasterio MD, now our Immediate Past President. 

PIP:  Thank you to Nnamdi Nwaoqwuqwu MD, who was active in supporting efforts to stop PIP from being put on a fee schedule.  He later asked for clarification from the FMA about the sunsetting of the current fee-for-service statute being delayed for 18 months.  The expiration date is now pushed to January 1, 2009.   

However, as you may be aware from a recent communication that Mark Rubenstein MD sent us, the Governor will not sign the PIP bill which passed.  Dr Nwaoqwuqwu encourages us to remain active with this issue.   

Dr Rubenstein lobbied in Tallahassee in April with a Palm Beach Co contingent.  The FMA first presented the bills and issues, and then they went on to keep appointments they had made with Senators and Representatives (including but not limited to Ken Pruitt, Adam Hasner, Ron Klein, David Aronberg, Anne Gannon, Susan Bucher, Joe Negron, Mary Brandenburg, Jeff Atwater, Carl Domino).  The issues they discussed in addition to PIP are listed below in the FMA Legislative Summary.   

Dr Rubenstein writes, “Overall, the experience was productive.  We were successful at explaining some of the nuances of these issues from the physician perspective to the legislators who were willing to listen.  For those of you who haven’t partaken in this activity before, I do recommend it.  Of course it is a significant difficulty in terms of canceling a day of patients, traveling to Tallahassee, etc.  The future of our specialty and the practice of medicine must be preserved.” 

FMA and the 2006 Florida Legislative Session:  Here are some of the outcomes of the FMA’s efforts:  *stopped effort to allow repeal of Amendment 3 from the Constitution to statute, maintaining limited attorney contingency fees in medical liability cases – the result of which has been a significant stabilization of the medical liability insurance market

*stopped naturopathic licensure

*stopped ARNPs from prescribing controlled substances

*stopped pharmacists from administering flu shots

*stopped allowing of foreign trained physicians to practice as physicians without completion of an ACGME residency

*stopped making it more difficult for a physician to self-insure and stopped draconian penalties for minor offenses related to physician profiles.

*stopped physician offices from having to be licensed and regulated as clinics.

*stopped requiring licensure for hearing interpreters, decreasing their availability, increasing costs to physicians, making it more difficult to comply with ADA

*did away with joint and several liability

*now only have to take the HIV/AIDS CME course one time

*now only have to take the Domestic Violence CME course every 6 yrs instead of every 2

*created more difficulty for ARNPs and PAs to set up practices independent of physician supervision

*passed requirement for all healthcare practitioners to wear nametags identifying their licensure or orally inform patient of same

*increased funding for the Professionals Resource Network, providing substance abuse assistance to physicians and other health care licensees.

*PIP fee schedule defeated, sunsetting of current fee for service delayed for 18 months

*allow unused cancer drugs to be collected and prescribed to patients in need 

SEEKING JOB OP:  Currently completing residency at Baylor College of Medicine/University of Texas PM&R Alliance; interested in inpatient and outpatient settings, especially musculoskeletal issues, pain management, electrodiagnostic studies, trigger point/peripheral joint/botox/phenol injections; currently applying for FL license.  Please call Rita S Mezzatesta MD, 713 797 1993 (home) 832 443 4961 (cell).

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net, http://fspmr.org

FSPMR BROADCAST April 24, 2006

 NEXT MEETING:                 Hey Everyone!  LAST CALL!

 It’s getting close to meeting time,  April 28 – 30 (Friday – Sunday), Miami.  If we don’t have your registration yet, please consider coming.  It’s a good scientific program (10 hours), a beautiful location, and there’s a complimentary dinner cruise around Miami. 

Here are the topics: 

Acute Stroke Imaging

Drugs, Documentation, and the DEA:  A Proactive Approach to Using Controlled Substances to Treat Pain (this is a real workshop where you are asked to bring your forms, difficult cases, etc)

Current Concepts in Botulinum Toxin Type A

The Neuromusculare Examination

Mild TBI and Post-Concussive Disorders:  Fact or Fabrication?

Current Update on Hepatitis C Virus

Integrative Medicine and Pain Management

Life Expectancy for Cerebral Palsy Patients 

Come on and join the fun!  Please go to http://fspmr.org for all program, hotel, and registration details.  If you have any questions, please call Lorry Davis, contact info below.  For those of you who have taken the time to let us know that you can’t be there this year, please excuse this note.  It’s a blast email/fax and it goes to all members. 

For hotel reservations, call 800 445 8667, tell them you are with Conference Code SSM, for the rate of $139.  This conference rate is now available upon the hotel’s availability.  You do not need to attend the conference in order to attend the FSPMR business meeting/luncheon.   

PROPOSED SLATE OF CANDIDATES, FSPMR 2006 – 2008: 

President:  Venerando Batas MD

VP:  Robert Dehgan MD

Secretary:  John Muenz MD

Treasurer:  Duby Avila MD

Members-at-Large:

Rigoberto Puente MD

Mark Rubenstein MD

Mitchell Freed MD

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR BROADCAST April 4, 2006 

Next Meeting and Legislative Action 

NEXT MEETING:                 Hey Everyone! 

It’s getting close to meeting time,  April 28 – 30 (Friday – Sunday), Miami.  If we don’t have your registration yet, please consider coming.  It’s a good scientific program (10 hours), a beautiful location, and there’s a complimentary dinner cruise around Miami. 

Here are the topics: 

Acute Stroke Imaging

Drugs, Documentation, and the DEA:  A Proactive Approach to Using Controlled Substances to Treat Pain (this is a real workshop where you are asked to bring  your forms, difficult cases, etc)

Current Concepts in Botulinum Toxin Type A

The Neuromusculare Examination

Mild TBI and Post-Concussive Disorders:  Fact or Fabrication?

Current Update on Hepatitis C Virus

Integrative Medicine and Pain Management

Life Expectancy for Cerebral Palsy Patients 

Come on and join the fun!  Please go to http://fspmr.org for all program, hotel, and registration details.  If you have any questions, please call Lorry Davis, contact info below.  For those of you who have taken the time to let us know that you can’t be there this year, please excuse this note.  It’s a blast email/fax and it goes to all members. 

For hotel reservations, call 800 445 8667, tell them you are with Conference Code SSM, for the rate of $139.  This conference rate is now available upon the hotel’s availability.  You do not need to attend the conference in order to attend the FSPMR business meeting/luncheon.  PLEASE RSVP to Lorry Davis (contact info below) for attendance at the FSPMR Business Luncheon, Sunday, April 30, 12:30 0- 2 pm. 

FMA and the 2006 FLORIDA LEGISLATIVE SESSION:   The FMA is providing online video of select committee meetings and physician testimony relating to priority bills.  These videos will be posted to the FMA website, www.fmaonine.org/legis.  You will need a compatible media player such as QuickTime, RealPlayer, etc. 

For all the bills below, PLEASE CONTINUE TO EMAIL/WRITE/CALL your legislators.  Go to http://www.leg.state.fl.us/Welcome/index.cfm?CFID=1011011&CFTOKEN=25419402, click on House or Senate, then enter the bill # you want to track.  When you find out what committee it’s in, you can click on Committees to see who is on what committee.  Then you can click on Senators or Representatives to get full contact info on that member. 

PIP – SB 2114 will be heard in the Senate Health Care Committee this afternoon.  We’ll keep you posted – we are against this bill!  It proposes a medical fee schedule for PIP benefits. 

HB 881 allowing foreign trained physicians to become licensed without completing a residency was stopped.  The sponsor, Rep Flores, was the only yes vote.  Voting no:  Reps Brandenburg, Cretul, Homan, Hukill, Rice. 

But this one was close! – ARNP prescribing HB 485 by Rep Farkas was stopped by a 5-5 vote.  Voting no, to stop the bill:  Reps Cretul, Homan, Sobel, Poppell, Henriquez.  Voting yes:  Reps Proctor, Roberson, Bendross-Midingall, Bowen, Garcia. 

Cutting back the scope of practice for podiatrists HB 575 by Rep Garcia, passed by an 8-2 vote in the House Health and Regulation Committee. 

Allowing pharmacists to administer flu shots, SB 570 by Sen Bennett, unfortunately passed out of the Banking and Insurance Committee, unanimously, and is now on the Senate floor. 

Increasing the supervision of ARNPs/PAs, HB 699/SB 1216, is favorably passing through Senate Committees, and is out of House Committees, onto the House floor. 

Joint & Several Liability, SB 2006 by Sen Webster,  allows for physicians to adequately defend themselves in medical liability cases, is headed to the Governor for signature. 

Expert Witness Bill, SB 2686 by Sen Webster requires out-of-state physicians to obtain an expert witness certificate prior to testifying in FL.  As of March 30, last posting online, this bill is now in the Senate Judiciary Committee.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR BROADCAST March 7, 2006 

NEXT MEETING:  April 28-30, 2006, Fri – Sun, with the So Soc of PM&R Annual Meeting at the Doubletree Grand Hotel Biscayne Bay, Miami.  The entire program and registration materials can be found at http://fspmr.org.  There will be 10 hours of scientific program on Sat and Sun.  On Sat evening, there will be a Water Fantaseas dinner cruise on the Miami Magic, hosted by this year’s SSPMR President, Dr Craig Lichtblau, also an FSPMR member.  The conference will end at noon on Sunday at which time FSPMR will have a business luncheon until 2 pm.  For hotel reservations, call 800 445 8667, tell them you are with Conference Code SSM, for the rate of $139.  That conference rate expires March 28 so call now!  Registration brochures have been mailed out and you have received yours by now.  You do not need to attend the conference in order to attend the FSPMR business meeting/luncheon.   

FMA and the 2006 FLORIDA LEGISLATIVE SESSION:  The 2006 Legislative Session begins today, and adjourns Friday, May 5.  PA/ARNP Supervision Bill (HB 699 by Rep Joe Negron) is being heard tomorrow, March 8, in the House Health Care Regulation Committee.  Encourage these committee members to vote YES.  By having these standards addressed in a rulemaking setting, the Board of Medicine will have time to hear testimony from all interested parties and consider the many factors involved in this issue.  The specialty of the physician, the type of health care practitioner under supervision, and the practice setting will all be considered.  Here are the committee members that need to hear from you:  rene.garcia@myfloridahouse.gov, eleanor.sobel@myfloridahouse.gov, dorothy.bendrossmindingall@myfloridahouse.gov, gus.bilirakis@myfloridahouse.gov, marty.bowen@myfloridahouse.gov, larry.cretul@myfloridahouse.gov, bob.henriquez@myfloridahouse.gov, ed.homan@myflorida.gov, ralph.poppell@myfloridahouse.gov,

bill.proctor@myfloridahouse.gov, yolly.roberson@myfloridahouse.gov.

More info:  FMA Legislative Affairs, 850 762 0233

MEDICAL MALPRACTICE REFORM BILL INTRODUCED IN U.S. CONGRESS:  This from FMA President, Dr Troy Tippett:  At the FMA's request, a great friend of medicine, Congressman Clay Shaw, filed a bill in the U.S. House of Representatives on March 2 that includes all the provisions of California MICRA type reform just as HR 5 did last session.  HR 5 was passed last year by the House of Representatives but as you know, if passed into law this bill would unduly punish Florida and 18 other states by making them retain any cap on non-economic damages that they currently had whether it was more than or less than $250,000.  As you may recall, without a fix we could be stuck with our $500,000 cap on non-economic damages forever.  Congressman Shaw’s bill fixes the so-called flexicap provision of HR 5 and would allow us to have the same benefits the rest of the world receives once we pass this in the House and Senate. Please take the time to email him at http://shaw.house.gov/Contact/ to thank him. While you are at it please also call or email your own member of Congress and ask them to sign on as cosponsors of this new bill.  Now it is up to all of us to get this bill passed in the House and Senate.  With your help we will accomplish this goal as well.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

2004 Continuing Education Schedule-at-a-Glance

2004 Sponsors/Exhibitors

 WORK COMP and the DWC-25:   Thank you to Dr Robert Dehgan who represented FSPMR at the October 28, Tallahassee meeting.  He met with other physicians, State reps, and carrier reps.  He reports, “The meeting was productive.  There were representatives from orthopaedics, family practice, plastic surgery, pain management, and occupational medicine.  Dr Michael Webb represented Liberty Mutual.  The form was revised and somewhat simplified.  Hopefully it should be out soon.”

FSPMR Broadcast October 26, 2004

Contents:  Yes on Amendment 3! No on Amendments 7 & 8!,

FSPMR Members Nominated for Florida Choice Awards, Medicare Patients to Save on Gleevec, Humira, and Others; Medicare Annual Fee Schedule and 2005 Participation Package on CD-ROM, FSPMR Members in Leadership Positions, Editor

YES ON AMENDMENT 3!  No on Amendments 7 & 8!  A victory is likely on Amendments 7 & 8.  Although Amendment 3 is nonpartisan, it's still nip and tuck between us and the trial bar.  They've outspent us and we've all seen the misleading TV ads.  A new ad from our side (Citizens for a Fair Share) will be aired this last week.

There is one week left until elections.  We have participated in the last couple of FMA teleconferences, and here are actions you can take during this last week to increase the number of voters we can touch between now and then:

1.      Answer your telephones, "Vote YES on Amendment 3!"
2.      Have your staff call patients (especially the ones you've really helped) to tell them you'd appreciate their support by voting YES on Amendment 3.
3.      Call and ask your hospital administrator to encourage their staff to vote YES on 3.  Even if they've said no in the past to requests for contributions - some will say yes to speaking to their staff.
4.      You in your white coat, your staff in scrubs, your family, your friends - get them all to the polls to have a PRESENCE there.  There are verified reports that the trial bar has hired people to be at the polls, IN WHITE COATS!, to tell people to vote no on amendment 3.
5.      Write letters to the editor of your local paper - email/hand deliver them.
6.      VOTE!

If any of you would like to know who the FLAMPAC endorsed candidates are in your district, please call (contact info at end) or go to http://www.flampac.org/election.asp.

FSPMR Members Nominated for Florida Choice Awards:  Nominees were Drs Juliana Garcia, Jay Olsson, and Antonio Rivera.   Congratulations to all of you!

Medicare Patients to Save on Gleevec, Humira, and Others:  This is a demonstration project that pays for 95% of drug coverage after limited out-of-pocket costs, for certain diseases, including rheumatoid arthritis.
FSPMR Broadcast Oct 26 '04, page 2

Medicare patients have to be on both Part A and Part B (as primary) without other drug coverage (Medigap or Medicare managed care OK) and have a covered diagnosis:  RA for Humira, Kineret, Enbrel; osteoporosis and homebound for Calcitonin or Miacalcin, and others.  No monthly premiums.  Projects now through December 2005.  Your patients can call 800 Medicare for more or 866 563 5386 to Trailblazer, the contractor who will assist in filling out the form.  More info is at http://www.medicare.gov, click on :  Medicare Replacement Drug Demonstration.  Physicians, for more info contact Sharon Fisher, 404 562 7377, sfisher@cms.hhs.gov.

Medicare Annual Fee Schedule and 2005 Participation Package on CD-ROM:  To be distributed early November.  Providers must qualify and register to receive the Fee Schedule and Participation Package in Hardcopy format.  For more info, contact Thomas Hughes, Sr Provider Relations Rep, Thomas.Hughes@fcso.com, 904 791 6778.

FSPMR Members in Leadership Positions:  Dr Mark Rubenstein is VP of the Palm Beach County Medical Society and next month, will be President-Elect.  In 2005 - 2006, he will assume the presidency. 

Dr Robert Dehgan is President of the Putnam County Medical Society.

Dr Craig Lichtblau is VP of the Southern Society of Physical Medicine and Rehabilitation (SSPMR) and will assume the presidency in April of 2005.

Dr Anthony Dorto is Secretary-Treasurer of SSPMR.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

August 16,2004

Inside:  FSPMR's Next Meeting, RSVP'd So Far, Sponsorship Presentation of 4Physicians.net/Practice Management and Recruiting, August 24 Meeting Agenda:  Report on 2004 Work Comp Legislation, DWC 25 Forum, Editor

FSPMR's Next Meeting:  Will be with the FL Workers' Compensation Educational Conference, Tuesday, August 24, 2004, 12 - 3 pm, The Orlando World Marriott, in the Crystal Ballroom, Rooms E & F.  Please RSVP to Lorry Davis, Lorry4@earthlink.net, or 904 270 8886, so we'll have a lunch for you!

RSVP'd so far:  Doctors Jairo Parada, Mark Rubenstein, Enrique Monasterio, Duby Avila, Venerando Batas, John Muenz, Mitchell Freed, Matthew Imfeld, David Haddock, Colleen Zittel, Robert Christopher, and Robert Dehgan.  Let us hear from the rest of you who are attending the comp conference, so we can have a lunch for you!

While you enjoy lunch, you will benefit from the Sponsorship Presentation of 4Physicians.net/Practice Management and Recruiting.  This outfit has coding, billing, and collection products that will be of interest to many of you.  They also offer expertise in financial and human resources management, operations, and compliance.

Part of the Business Meeting Agenda:

1.       2004 Florida Work Comp Legislation - Report from Dr Michael Webb, Chair of the FMA's Workers' Compensation Advisory Committee, and Fred Whitson, Attorney and FMA Director of Medical Economics (where work comp lies within the FMA)

2.  DWC 25 Forum - Making short presentations and fielding questions/comments:

a.      Dr Michael Webb

b.  Mr Whitson

c.  Sissy Kemmer of Nogar & Associates (formerly Sissy Nogar - with the Div of Work Comp for many years, now out on her own consulting)

d.  Sandra Seay (invited) - representing a TPA, Choice Medical Network.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR Broadcast June 29, 2004

FSPMR's Next Meeting:  Will be with the FL Workers' Compensation Educational Conference, Tuesday, August 24, 2004, 12 - 3 pm, The Orlando World Marriott, in the Crystal Ballroom, Rooms E & F.  Please RSVP to Lorry Davis, Lorry4@earthlink.net, or 904 270 8886, so we'll have a lunch for you!

There are a lot of questions about the new fee schedule and the DWC 25 Form.  This is an excellent forum to learn more!  The FMA's Work Comp Advisory Committee (and Dr Jesse Lipnick) will be working on this Form for the 2005 FL Legislature.  One of the Advisory Committee/FMA goals is:  Continue to make DWC-25 more user friendly and also collect only meaningful data.  Stop requirement to complete the DWC form every 30 days whether they see the patient or not.  Adding a reimbursement code specific for completing the form may be sufficient to stop the carriers from requiring this form every 30 days.  Get OIR to set a target date for capability to file DWC-25 (and all WC claims) electronically.  

FMA Work Comp Advisory Committee,  Fred Whitson, FMA Atty, and Director of Medical Economics (where work comp falls within the FMA) reports that although Governor Bush signed HB 1251 (revamping the FWCJUA's coverage and financial structure) into law, he vetoed a $10 million appropriation to cover a deficit in the Florida Workers' Compensation Joint Underwriting Assoc.  This pretty much guarantees that workers' compensation will be an issue again picked up by the 2005 Florida Legislature. 

Congratulations to FSPMR's 2004 - 2006 Officers:
President:  Enrique Monasterio MD, Miami
Vice President:  Venerando Batas MD, Tampa
Secretary:  Duby Avila MD, Kissimmee
Treasurer:  John Muenz MD, Jacksonville
Members-at-Large:
Walter Conlan MD, Altamonte Springs
Rigoberto Puente MD, Gainesville
Mark Rubenstein MD, West Palm Beach
Immediate Past President:  Jairo Parada MD, Tampa
CAC Representative:  Colleen Zittel MD, Winter Park

Minutes of the June 13, 2004, Coconut Grove Meeting will be forthcoming within the next couple of weeks.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net
 

FSPMR’s Next Meeting: Fri – Sun, June 11 – 13, in conjunction again with the FL Academy of Pain Medicine, The Ritz Carlton Coconut Grove. FSPMR’s business meeting will be on Sun, June 13, 12:30 – 3 pm. Hotel reservations: 305 365 4500 or 888 564 8660, tell them you’re with the FL Academy of Pain Medicine to get the excellent rate of $155/night. Go to http://fspmr.org or http://fapm.med.new.net to get all the details! Registration flyers were mailed out a couple of weeks ago – some of you have already registered. A great program! You can print out the registration form from the website addresses above, also. See you in Coconut Grove! Questions? Ph 904 270 8886.

AAPMR: FSPMR will meet with AAPMR, Oct 7 – 10, 2004, Phoenix, AZ. FSPMR’s meeting will be Thurs, Oct 7, 7 pm. Room assignment is not yet made. FSPMR will meet, chat, and then those who choose to go to dinner together will do so!

FMA Work Comp Lobbyist for 2004 Legislative Session: FSPMR contributed $1000.00 toward this effort. Hopefully, other specialty societies contributed sufficiently so that Hayden Dempsey can again be hired by the FMA to lobby in physicians’/patients’ favor. It is important that pro-physician/pro-patient forces be monitoring things closely while the “Glitch Bill” (SB 2268) goes through the legislative process. The bill is supposed to be limited to technical changes. Senator Posey, the Senate Banking and Insurance Committee Chair, has warned that any attempts to reverse substantive changes to SB 50A (last year’s work comp reform bill) will end action on the bill. But we know how politics work, and it is critical to keep a close eye on this one.

The FMA’s Work Comp Advisory Committee continues to stay abreast of the political scene. Dr Jesse Lipnick participates on this committee. The DWC Form-25 was a topic of a late January phone conference. All objections regarding this form were collected and presented to the DWC by Fred Whitson, FMA Atty. The Division (Dan Sumner, Deputy Division Chief chaired the meeting) said because of their regulatory requirements established in 440 FS, they needed this information, so there will be a Form DWC-25. The Chair of the FMA committee responds, “Please rest assured that the FMA unequivocally opposed the form. We were told…if we wanted some concessions that we should provide some recommended changes - which we did (asking for deletion of the most objectionable sections and paring it down to 2 pages - and asking for the flexibility of allowing surgeons and consultants to defer to the primary treating physician).”

DWC e-Alert Notification System: Go to the division's homepage at www.fldfs.com/wc/ and click on the DWC e-Alert icon that is in the top right hand corner. You will be asked to input your e-mail address and some other general information. Once you have signed up, the Division will automatically send e-mails to you that provide information about our activities such as rule hearings, informational memorandum, bulletins, press releases, legislation, publications, etc.

Work Comp Fee Schedule Injection Codes: Again, thanks to Dr Erick Grana, we have this clarification: Injection codes are listed among the surgery codes in PART B – which starts on p 118 of the 2004 Reimbursement Manual. Further, the DWC has a “Specialist on Call” everyday (850 922 6481) to answer questions about the RM.

Dr Grana also brought to our attention that Pharmed is promoting a new device called NeuroStat, for NCSs. Per Dr Grana, the marketing pitch is that any office staff member can perform the studies on this machine, with minimal training. After Dr Grana alerted us to this, we informed the FMA and its lobby staff in charge of scope of practice issues, and the AAEM was notified as well.

Rally at the Capitol: Our Executive Director, Lorry Davis, will represent us at the FMA’s Rally, Thursday, March 25. The focus will be the medical liability insurance crisis.

Other Action During this Florida Legislative Session: Session began March 2. As usual, there are the scope of practice issues. ARNP prescribing (controlled substances) is a big one (SB 2072). This past Tuesday, in Senate Health Care, the nurses did not have enough votes to pass the bill. The FMA asks that you let Senator Saunders, Chair, (saunders.burt.web@flsenate.gov) know that you are disappointed he did not support physicians and ask him to NOT agenda this bill again. Also not supporting physicians: Sen Dockery (dockery.paula.web@flsenate.gov) and Sen Wasserman-Schulz (schulz.Debbie.web@flsenate.gov). Thank the following for supporting physicians: Sen Carlton (carlton.lisa.web@flsenate.gov), Sen Fasano (fasano.mike.web@flsenate.gov), Sen Peaden (peaden.durell.web@flsenate.gov), Sen Villalobos (villalobos.alex.web@flsenate.gov), Sen Aronberg (aronberg.dave.web@flsenate.gov), Sen Dawson (dawson.mandy.web@flsentae.gov), Sen Wilson (Wilson.Frederica.web@flsenate.gov).

Controlled Substance Database: The FMA supports these House and Senate bills, while working hard to ensure that the new law does not negatively affect physicians who are practicing appropriately.

Naturopaths: Sen Diaz de la Portilla, SB 2604, Rep Bowen, HB 1375. The FMA is strongly opposed to naturopaths once again being licensed by the State of Florida as health care providers. Under these bills, a person who attends a school of naturopathy would be allowed to diagnose, treat, operate and prescribe for disease, pain, injury or other physical or mental condition. This is the definition of the practice of medicine.

JOB OP – Paid Ad: Excellent opportunity for a Board Certified/Board Eligible physiatrist to join a progressive practice in North Central Florida. This position is comprised of outpatient as well as inpatient responsibilities. Competitive salary and benefits with production bonus offered. Please reply to: Shari Bergquist, Human Resources Director, Southeastern Integrated Medical, P.A., Tel: 352-373-4321x122 Fax: (352) 373-9870, 4881 NW 8th Ave Suite 2 Gainesville, Fl 32605

Editor: Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL 32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR Broadcast January 10, 2004: 

FSPMR's Next Meeting; Workers' Compensation New Fee Schedule; Divison of Workers' Compensation Asks for Physician Input; JOB OP; Editor
FSPMR's Next Meeting:   Friday - Sunday, June 11 - 13, 2004, in conjunction, like last year, with the FL Academy of Pain Medicine, The Ritz Carlton Coconut Grove, Miami.  FSPMR's business meeting will be on Sunday, June 13, 12:30 - 3 pm. Reservations:  305 365 4500 or 888 564 8660, tell them you're with the FL Academy of Pain Medicine to get the excellent rate of $155/night.  Go to http://fspmr.org to get all the details!  Registration flyers will go out via regular mail in late February.

Workers' Compensation New Fee Schedule:  Thanks to Dr Erick Grana, we have the following clarification from the Work Comp Medical Unit of AHCA:  The 2003 Reimbursement Manual went into effect on 12/04/03, the 2004 RM went into effect on 01/01/04.  Under the 2004 schedule (according to the law, effective 01/01/04), you are to be paid the greater of either the 2003 WC MRA or the Medicare allowances increased to either 110% or 140%.   That is the reason that we had to publish both the 2003 MRAs and the Medicare percentage increases in the 2004 manual.  If your concern is how the Medicare increases were calculated for the 2004 RM - you would be paid from one of the locality columns depending on where you performed the service.  AHCA's Work Comp Medical Services Unit rounded all of increases of 110% and 140% for each of the localities according to whether the procedure was performed (in or out of facility).  The 2nd edition of the 2004 RM is being prepared and will incorporate the 2004 M'care payments.  Further, spinal injections are listed among the surgery codes in PART B - which starts on p. 118 of the 2004 RM.

Division of Workers' Compensation Asks for Physician Input:  On the appropriateness of continuing to use a "workers' compensation unique code" 97752 (Muscle testing, manual or by automated equipment with written report) in addition to the valid CPT code series of 95831 - 95834 (muscle testing, manual, with report [with specified body area corresponding to each code]).  In particular, the Division would like to hear from a PMR.physician.  The Division has also made this inquiry to the AMA (about the rationale for the CPT change in 1995 in which they deleted a specific code for "muscle testing, electrical").  Please send your responses to Anna L Ohlson, RN Consultant, AHCA WC Medical Services Unit, ohlsona@fdhc.state.fl.us, ph 850 410 1093, fax 850 414 6912.

JOB OP - Paid Ad:  Position available for a Board qualified/certified physiatrist in rapid expanding central FL practice.  Well-rounded general physiatry w/ extensive inpatient (acute and subacute settings) and outpatient (orthopaedic/musculoskeletal, pain management, NCS/EMG) ops - including medical directorships in surrounding facilities.  Good opportunity to grow and develop a practice BASED ON YOUR OWN INTEREST.  Compensation includes base salary, bonus, insurance benefits, 401K, etc.  Please fax current CV to 352 589 6410, to Margaret Herr, and include phone # where you can be reached evenings.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR Broadcast November 24, 2003

1.  FSPMR's Next Meeting, 2.  Organized Medicine, Workers' Compensation, 3.  FAST!  FL Alliance for Rapid Stroke Treatment, 4. Job Opportunity Paid Advertisements, 5.  Position Wanted Paid Advertisement, 6. Editor

FSPMR's Next Meeting:  Again in conjunction with the FL Academy of Pain Medicine, June 11 - 13, 2004, The Ritz Carlton, Coconut Grove, Miami.  Watch for your copy of PainInfo in the mail, which will have details, and/or go to FSPMR's website, http://fsprm.org for details.  Registration brochures are targeted to be mailed out in early March.

Organized Medicine:  Are You Collecting Signatures?.for the constitutional amendment to limit attorneys' contingency fees?  Have you contributed to Citizens for a Fair Share, the group that is organizing this effort?  If not, call 800 762 0233 (FMA).  FSPMR has contributed $500.00, and thank our President, Jairo Parada, MD, and his group which has contributed $2,000.00. 

Workers' Compensation:  Jesse Lipnick, MD, has replaced Oregon Hunter, MD, on the FMA's Advisory Committee to the Three Member Panel.  Per Fred Whitson, Atty, the FMA Director of Medical Economics, and the FMA staff person assigned to the Advisory Committee, "The majority of the 2003 legislative changes to Florida Workers' Compensation Law, Chapter 440, Florida Statutes, went into effect Oct. 1, 2003. Since significant revisions were made last session, with some not effective until Jan. 1, 2004, the legislature will probably only address "glitches or problems" in the workers' comp law during the 2004 Session. As physicians using this law, we need your assistance in identifying the specific areas that either are incorrect or are creating more problems than they resolve. Please email any comments to Fred Whitson, at fwhitson@medone.org."  Please cc Dr Lipnick (docrehab@aol.com) and Lorry Davis (lorry4@earthlink.net) with any communications to Whitson re work comp.

Also per Whitson, "legal advised that the 2003 Health Care Provider Reimbursement Manual will be official adopted 12/4/03."  The manual is now on the Division of Work Comp's website at this address: http://www.fldfs.com/WC/pdf/2003HCPRM.pdf.  It is 135 pages long.

Congratulations to Steven Tucci MD, FSPMR Member, and one of five physicians awarded at the First Annual Florida Choice Awards for Workers' Compensation, during the annual work comp conference in Orlando.

FAST!  Florida Alliance for Rapid Stroke Treatment:  FAST is a broad based group of organizations and individuals focused on improving the prevention and treatment of stroke throughout Florida.  Currently, the focus of the group is to work to advance the Florida Stroke Act, which will help promote systems and processes that can help improve stroke treatment statewide.  Specifically, the FL Stroke Act proposes to require that all EMTs and paramedics be trained to recognize the symptoms of a stroke and to utilize a stroke triage protocol approved by the FL Dept of Health; also requires EMS systems to transport stroke victims to a hospital that has been designated or certified as a "stroke treatment hospital" by the FL Dept of Health.  For more information, 727 570 8809, Lisa.Pelamati@heart.org.

Job Opportunity Paid Advertisements:

1.      Excellent opportunity for a Board Certified/Board Qualified physiatrist to join a progressive practice in North Central Florida. This position offers a nice blend of outpatient as well as inpatient responsibilities.  Please reply to:  Jim Smith, Rehabilitation Medicine Associates, 4881 NW 8th Ave, Suite 2, Gainesville, Fl  32605.

2.      IMMEDIATE position available for a board qualified/board certified physiatrist in Central Florida. This is a well-rounded general physiatry practice with extensive inpatient and outpatient opportunities. Inpatient patient programs include acute and subacute settings. The outpatient programs have extensive orthopedic/musculoskeletal patient populations, pain management, and numerous NCS/EMG cases. The practice is rapidly expanding. There is a fabulous opportunity to grow and develop a practice BASED ON YOUR OWN INTERESTS. Inpatient and outpatient medical directorships are available in surrounding facilities. Compensation including base salary and bonus, insurance benefits, 401K, etc. Please fax current CV (352) 589-6410 Attention: Margaret Herr, Practice Manager. Please include phone number where you can be reached in the evenings. Thank you.

Position Wanted Paid Advertisement:

Interventional Physical Medicine and Pain Management Specialist completing ACGME approved fellowship program is seeking position in South FL starting 7/04.  Please send correspondence to PMandRpain@aol.com or call (804) 285-4084.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net

FSPMR Broadcast August 6, 2003

Contents:
1. FSPMR's Next Meeting
2.  New FSPMR Contact Info!
3. Colleen Zittel Addendum

FSPMR'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center, Crystal Ballrooms E and F.  We will again meet with the FL Association of Occupational and Environmental Medicine.  Many thanks to Allergan who is sponsoring this meeting.  Dr Venerando Batas, FSPMR Secretary, will make a short presentation on Botox. 
Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above.   So far, we've heard from Drs Venerando Batas, Jairo Parada, Amy Bailey, Mike Inglehart, Robert Dehgan, Colleen Zittel, Gary Newcomer, Jim McCluskey, Jock Sneddon, Richard Dolsey, Bud Ferguson, Michael Band, Thomas Dukowitz, Michael Hankins, Bhupendra Gupta, Stan Haimes, Seth Feldman, Gary Clonts, Jeanne McGregor, and Homi Cooper.  Fred Whitson from the FMA will be joining us as will Diane McCluskey, MPH, Director of USFs ERC Center, and Bob Griffin, Director of PrimeComp Network out of Jacksonville.  Let's hear from the rest of you!
Minutes from our May meeting are attached.

NEW FSPMR CONTACT INFO!  FSPMR, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net

I attended the May 19 2003 Medicare Carrier Advisory Committee Meeting in Orlando. The following is my summary:

Many policies were discussed, from Reduction Mammoplasty to Diagnostic Larygoscopy, to Epoetin and many others irrelevant to PM&R; any interested parties should see the website www.floridamedicare.com to see the whole list we covered. The only policy pertinent to PM&R was "Biofeedback Revision", # 90901.

This policy on Biofeedback was designed to further define the indications and limitations of coverage for biofeedback training (90901) by any modality, including that for re-educating paralyzed muscle, as well as for urinary incontinence. I reviewed the policy, and overall it is good, but had some errors in the definition of autonomic vs. non-autonomic function. The allowed list of ICD-9 codes was incomplete (lacked upper limb monoplegia, as well as other spasm codes). I recommended these changes, which are now under consideration by Florida Medicare. I would greatly appreciate anyone's help in also reviewing this policy, especially any physiatrist who treats stroke and/ or spinal cord injury. Pull up the policy (or contact me for a copy) on www.floridamedicare.com, click on part B, under medical policies- "draft". This will be finalized (no further modifications allowed) on Aug 25th, so I need input as soon as possible. Thank you!

Lastly, Chris Hay from Medical Policy and Review gave a brief seminar on "Performing Provider Comparison Billing Report (CBR)". This has been available to all Medicare providers for years, but most of us don't know about it and therefore do not use it. You can get an individualized, confidential, detailed analysis for any 6 month period of all your Medicare claims, codes, compares you w/ your peers in your specialty, your county, your state, lists total allowed dollars per procedure code, lists all paid and denied procedure codes, and more. You may request this CBR by contacting Pam Barlow at pam.barlow@fcso.com. Include your name,provider # w/ suffixes for the CBR's you want, and address to send the CBR to. This may help us analyze and improve our own practices, and get a better perspective on how we compare to our peers. Contact me if you need further explanation.

That's all. See you all at the Aug FSPMR meeting.

Colleen Zittel MD

(407-643-1328)

cgzittel@aol.com

FSPMR Broadcast July 21 2003

Contents:
1.  New FSPMR Contact Info!
2.  FSPMR's Next Meeting
3.  News from Organized Medicine - Tort Reform, Work Comp
4.  Editor

NEW FSPMR CONTACT INFO!  FSPMR, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net

FSPMR'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center.  We will again meet with the FL Assoc of Occupational and Environmental Medicine.  Many thanks to Allergan who is sponsoring this meeting.  Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above.   So let's hear from the rest of you!  FSPMR members who will be presenters at the comp conference:  Dr Venerando Batas, FSPMR Secretary, will make a Botox presentation during our luncheon; Dr Oregon Hunter will moderate a panel on FCEs, Mon, Aug 18, 1:30 - 3 pm, and he will speak on "A Little Medical Knowledge is NOT a Dangerous Thing!" Wed, Aug 20, 8:45 - 9:45 am; Dr Matthew Imfeld will be a panel member for "Understanding Addiction:  Medication and Litigation," on Tues, Aug 19, 1 - 2 pm.   Are there more of you?

We will not have an exhibit booth at the conference.  After discussing this at May's meeting, and putting it out in the last broadcast that individuals could contribute $100 each and if sufficient, we could have a booth, there were only 3 contributors:  Drs Anthony Dorto, Oregon Hunter, and Victoria Rabe-Tagala. 

NEWS from ORGANIZED MEDICINE:  As most of you are aware, there is yet another special session scheduled to address tort reform, and you are urged to communicate with your legislators re same.
On July 15, Gov Bush signed Senate Bill 50A enacting major workers compensation reform.  Per Fred Whitson of the FMA, Dan Sumner, Deputy Division of Workers Compensation Director, stated that a new FL Work Comp Health Provider Reimbursement Manual must be developed.  Sumner assured Whitson that by Jan 1, 2004, the changes required by SB 50A will be incorporated into the Manual.  In response to a physician's concern about portions of the new law, particularly the "threat of fines" for not adhering to practice parameters, Atty Whitson provided this information:
Two of the difficult issues that will be addressed over the next several months, by the Division of WC and AHCA, will be, (1) development of a reimbursement fee schedule that includes SB 50A (referenced above) and (2) the use of practice parameters.   

New section 440.13(15) says:    PRACTICE PARAMETERS.-The practice parameters and protocols mandated under this chapter shall be the practice parameters and protocols adopted by the United States Agency for Healthcare Research and Quality in effect on January 1, 2003.

The fact is that the USAHR&Q does not adopt practice parameters, they screen guidelines, etc.  and if they pass scrutiny, make them available on a web site.  The language in the statute was a last minute compromise of three different inputs and ended up being incorrect.  Both the Division of WC and AHCA are aware of the problem and are having internal discussions on the issue.  I guarantee you that many meetings will occur before final decisions are made. Until then, there are no practice parameters to follow. 

Re the "threat of fines"  for not adhering to practice parameters.  The language in section 440.13(8) is (new language in bold): 

(8)     PATTERN OR PRACTICE OF OVERUTILIZATION.-
(a)     Carriers must report to the agency all instances of overutilization including, but not limited to, all instances in which the carrier disallows or adjusts payment or a determination has been made that the provided or recommended treatment is in excess of the practice parameters and protocols of treatment established in this chapter. The agency shall determine whether a pattern or practice of overutilization exists.
(b)     If the agency determines that a health care provider has engaged in a pattern or practice of overutilization or a violation of this chapter or rules adopted by the agency, including a pattern or practice of providing treatment in excess of the practice parameters or protocols of treatment, it may impose one or more of the following penalties:
1.      An order of the agency barring the provider from payment under this chapter;
2.      Deauthorization of care under review;
3.      Denial of payment for care rendered in the future;
4.      Decertification of a health care provider certified as an expert medical advisor under subsection (9) or of a rehabilitation provider certified under s. 440.49;
5.      An administrative fine assessed by the agency in an amount not to exceed $5,000 per instance of overutilization or violation; and
6.      Notification of and review by the appropriate licensing authority pursuant to s. 440.106(3).

As you can see, the agency (AHCA) has always had the ability to impose a fine for overutilization, what is new is that practice parameters can now be used to assist in that proof.  Also note that the agency must prove a "pattern of practice" before any penalty can be assessed.  A pattern of practice proof requires a significant, reliable sample size.

Re justification needed to contractually go above the fee schedule.  This issue is addressed in four different paragraphs, sections 440.12(a) and (d), and  440.14(a) and (b) [underlining by me]:  

(12)    CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM REIMBURSEMENT ALLOWANCES.-
(a)     .. Annually, the three-member panel shall adopt schedules of maximum reimbursement allowances for physicians, hospital inpatient care, hospital outpatient care, ambulatory surgical centers, work-hardening programs, and pain programs. An individual physician, hospital, ambulatory surgical center, pain program, or work-hardening program shall be reimbursed either the agreed-upon contract price or the maximum reimbursement allowance in the appropriate schedule.
       ..

 (d)    Reimbursement for all fees and other charges for such treatment, care, and attendance, including treatment, care, and attendance provided by any hospital or other health care provider, ambulatory surgical center, work-hardening program, or pain program, must not exceed the amounts provided by the uniform schedule of maximum reimbursement allowances as determined by the panel or as otherwise provided in this section. This subsection also applies to independent medical examinations performed by health care providers under this chapter.                  ..

(14)    PAYMENT OF MEDICAL FEES.-
(a)     .. Payment to health care providers or physicians shall be subject to the medical fee schedule and applicable practice parameters and protocols, regardless of whether the health care provider or claimant is asserting that the payment should be made.
(b)     Fees charged for remedial treatment, care, and attendance, except for independent medical examinations and consensus independent medical examinations, may not exceed the applicable fee schedules adopted under this chapter and department rule. Notwithstanding any other provision in this chapter, if a physician or health care provider specifically agrees in writing to follow identified procedures aimed at providing quality medical care to injured workers at reasonable costs, deviations from established fee schedules shall be permitted. Written agreements warranting deviations may include, but are not limited to, the timely scheduling of appointments for injured workers, participating in return-to-work programs with injured workers' employers, expediting the reporting of treatments provided to injured workers, and agreeing to continuing education, utilization review, quality assurance, precertification, and case management systems that are designed to provide needed treatment for injured workers.

This incomplete list gives you some idea of language you can put in your contracts/agreements to justify getting more than the reimbursement fee schedule amounts.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Email:  Lorry4@earthlink.net

FSPMR Broadcast August 6, 2003

Contents:
1. FSPMR's Next Meeting
2.  New FSPMR Contact Info!
3. Colleen Zittel Addendum

FSPMR'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center, Crystal Ballrooms E and F.  We will again meet with the FL Association of Occupational and Environmental Medicine.  Many thanks to Allergan who is sponsoring this meeting.  Dr Venerando Batas, FSPMR Secretary, will make a short presentation on Botox. 
Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above.   So far, we've heard from Drs Venerando Batas, Jairo Parada, Amy Bailey, Mike Inglehart, Robert Dehgan, Colleen Zittel, Gary Newcomer, Jim McCluskey, Jock Sneddon, Richard Dolsey, Bud Ferguson, Michael Band, Thomas Dukowitz, Michael Hankins, Bhupendra Gupta, Stan Haimes, Seth Feldman, Gary Clonts, Jeanne McGregor, and Homi Cooper.  Fred Whitson from the FMA will be joining us as will Diane McCluskey, MPH, Director of USFs ERC Center, and Bob Griffin, Director of PrimeComp Network out of Jacksonville.  Let's hear from the rest of you!
Minutes from our May meeting are attached.

NEW FSPMR CONTACT INFO!  FSPMR, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net

I attended the May 19 2003 Medicare Carrier Advisory Committee Meeting in Orlando. The following is my summary:

Many policies were discussed, from Reduction Mammoplasty to Diagnostic Larygoscopy, to Epoetin and many others irrelevant to PM&R; any interested parties should see the website www.floridamedicare.com to see the whole list we covered. The only policy pertinent to PM&R was "Biofeedback Revision", # 90901.

This policy on Biofeedback was designed to further define the indications and limitations of coverage for biofeedback training (90901) by any modality, including that for re-educating paralyzed muscle, as well as for urinary incontinence. I reviewed the policy, and overall it is good, but had some errors in the definition of autonomic vs. non-autonomic function. The allowed list of ICD-9 codes was incomplete (lacked upper limb monoplegia, as well as other spasm codes). I recommended these changes, which are now under consideration by Florida Medicare. I would greatly appreciate anyone's help in also reviewing this policy, especially any physiatrist who treats stroke and/ or spinal cord injury. Pull up the policy (or contact me for a copy) on www.floridamedicare.com, click on part B, under medical policies- "draft". This will be finalized (no further modifications allowed) on Aug 25th, so I need input as soon as possible. Thank you!

Lastly, Chris Hay from Medical Policy and Review gave a brief seminar on "Performing Provider Comparison Billing Report (CBR)". This has been available to all Medicare providers for years, but most of us don't know about it and therefore do not use it. You can get an individualized, confidential, detailed analysis for any 6 month period of all your Medicare claims, codes, compares you w/ your peers in your specialty, your county, your state, lists total allowed dollars per procedure code, lists all paid and denied procedure codes, and more. You may request this CBR by contacting Pam Barlow at pam.barlow@fcso.com. Include your name,provider # w/ suffixes for the CBR's you want, and address to send the CBR to. This may help us analyze and improve our own practices, and get a better perspective on how we compare to our peers. Contact me if you need further explanation.

That's all. See you all at the Aug FSPMR meeting.

Colleen Zittel MD

(407-643-1328)

cgzittel@aol.com

FSPMR Broadcast April 9 2003

Contents:

1.  FSPMR's Next Meeting
2.  Organized Medicine:  Work Comp Reform Legislative Update
3.  Opposition to Scope of Practice Bills
4.  Editor

 FSPMR Broadcast, April 9, 2003 

FSPMR'S NEXT MEETING: Friday - Sunday, May 16 - 18, 2003, Hilton Clearwater Beach Resort, in conjunction with the Annual Meeting of the Florida Academy of Pain Medicine.  FSPMR's business meeting and luncheon will be Sunday, May 18, 12:30 - 3 pm.  Please RSVP to Lorry Davis for the Sunday luncheon meeting.  Contact information below.  RSVPs so far from Drs Jairo Parada, Robert Dehgan, Enrique Monasterio, Dorothea Glass, Colleen Zittel, Oregon Hunter, Anthony Dorto, John Muenz.  Let's hear from you so we'll know how many lunches to provide!

Three FSPMR members, Drs Anthony Dorto, Oregon Hunter, and John Muenz are involved as speakers.  Dr Dorto's topic is "Malingering, Symptom Magnification, and Fraud," Dr Hunter's is (co-presented with Dorothy Sims, JD) "Is There an Impairment Rating for Pain?" and Dr Muenz' is "Botulinum Toxin in the Treatment of Cervicothoracic Pain."   17 hours of CME.  Plan to be there!

If you haven't already registered at the Hilton Clearwater Beach Resort, please do so now!  When you call, say you are with the FL Academy of Pain Medicine to get the negotiated rate of $140/night.  This rate will be honored ONLY THROUGH April 15, 5 pm, so call now!  800 753 3954.

You were mailed brochures, but if you haven't seen one, go to http://fapm.med or fapm.med.new.net, and nose around the website until you find the program and the registration piece, or simply CALL ME! 352 372 9360 - Lorry Davis

ORGANIZED MEDICINE:  WORK COMP REFORM:  On April 7, Dr Oregon Hunter, and Lorry Davis participated in a phone conference with the FMA's Advisory Committee to the Three Member Panel and Rep Dennis Ross, Chair of the House Select Committee on Workers' Comp.  Ross is a defense attorney well-schooled in comp.  He states FL has the highest medical expenses and the lowest paid doctors, and he is committed to raising physician reimbursements while still trying to bring overall costs down.  The Governor and Speaker of the House want to reduce work comp rates for employers.  Per Ross' report we are currently at 83% of Medicare for nonsurgical and 120% for surgical.  To get us to 125% nonsurgical, 150-200% surgical, Ross offers these incremental steps:  17%/yr increase nonsurgical, 5%/yr increase surgical, for 5 years.  He says the shift has to be revenue neutral. 

Ross supports maintaining physicians' ability to negotiate (above the fee schedule, in and out of managed care arrangements) as the "ultimate safety net."  Dr Michael Webb, Chair of the FMA Committee, responded that even though quality physicians can negotiate, they are still not participating in the work comp system in Florida.

Dr Webb stated that testimony given during the Gov's Work Comp Commission revealed that FL's hospital profits in comp were 3 - 4 times the national average.  Ross acknowledged this by stating that although litigation was also a significant cost driver, hospitals accounted for over 60% of comp costs.  Ross stated that his tactic has been to continue negotiations with hospitals to "wean 'em off," as opposed to having them go "cold turkey" with diminishing profits.

Dr Troy Tippett, a neurosurgeon from the panhandle, inquired about proposed legislation to have a state run insurance program.  Ross said that the Governor does not want the state competing with private entities.

Dr Webb reminded us that the Gov's Work Comp Commission, to which Ross was present, determined that FL's comp system is broken.  Dr Webb asked if the budget neutral requirement could be bendable because the time to treat the system with bandaids is over, major reform is required.  Ross agreed that some movement needed to be made to see that employer rates go down.

Ross ended with stating that there will be an increase in physician reimbursement, although not the increase physicians want.  It won't be what will bring quality providers "back in droves."  The improvement will be piecemeal.  FL's work comp system is "very frustrating" for Ross.  It is an ongoing battle for him.  And he states he has an ongoing commitment, as long as he's in the legislature, to eventually completely fix the system, but it won't be this year.

On June 4, in Orlando, a one day seminar sponsored by the FL Work Comp Institute will be held to unveil and explain whatever work comp reform has been legislated.  You will be receiving a registration flyer in the mail.

Scope of Practice:  The FMA is working diligently in OPPOSITION to:

ARNP's, HB 341 Rep Carole Green, SB 1736 Sen Gwen Margolia

PA's, HB 1311 Rep Dennis Baxley, SB 2022 Sen Charlie Clary

Optometrists, HB 699 Rep Joe Pickens, SB 1714 Sen Dennis

Pharmacy/Immunizations, HB 1519 Rep Phillip Brutus

Naturopaths, HB 1615 Rep Carole Green, SB 2014 Sen Skip Campbell

Psychologists, HB 1583 Rep Phillip Brutus, SB 1820 Sen Gwen

Alternative Health Care, HB 1301 Rep Rene Garcia

SB 2738, Dept of Health Bill, provides in Section 34 that Chiropractors and Podiatrists shall be paid the same as a physician for any given procedure.  Please contact your Senators in opposition to this Bill.

Editor:  Lorry S. Davis, M.Ed., Executive Director, P.O. Box 330298
Atlantic Beach, FL 32233-0298, Tel: 904-270-8886, Fax: 904-246-9233Email:  Lorry4@earthlink.net

FSPMR Broadcast, March 20, 2003
Contents:  1.  FSPMR's Next Meeting, 2.  Tort Reform, 3.  Work Comp Reform, 4.  PIP Reform, 5. Scope of Practice Bills, 6. MEDICARE, 7.  Editor

FSPMR'S NEXT MEETING: Friday - Sunday, May 16 - 18, 2003, Hilton Clearwater Beach Resort, in conjunction with the Annual Meeting of the Florida Academy of Pain Medicine.  FSPMR's business meeting and luncheon will be Sunday, May 18, 12:30 - 3 pm.  Please RSVP to Lorry Davis for the Sunday luncheon meeting.  Contact information below.  RSVPs so far from Drs Jairo Parada, Robert Dehgan, Enrique Monasterio.  Let's hear from you so we'll know how many lunches to provide!

Three FSPMR members, Drs Anthony Dorto, Oregon Hunter, and John Muenz are involved as speakers.  Dr Dorto's topic is "Malingering, Symptom Magnification, and Fraud," Dr Hunter's is (co-presented with Dorothy Sims, JD) "Is There an Impairment Rating for Pain?" and Dr Muenz' is "Botulinum Toxin in the Treatment of Cervicothoracic Pain."   17 hours of CME.  Plan to be there!

Go to fapm.med.new.net to get more information about the hotel, rates, registration, and the rest of the program.  FSPMR members will be given registration discounts.  You will be receiving a registration brochure via regular mail, with all details, within a couple of weeks.  Look for it!  You will also receive another issue of PainInfo newsletter, FAPM's publication, probably in April.  This newsletter will also contain info about the meeting.

ORGANIZED MEDICINE:
Tort Reform:  On Wed, Mar 12, the House Health Care Committee heard PCB 03-03.  The Committee voted 15-6 in favor of the bill that contains a cap of $250,000.  (Thank Reps Benson, Bilirakis, Farkas, Rene Garcia, Green, Harrell, Homan, Mayfield, Murzin, Negron, Poppell, Prieguez, Robaina, Sansom and Sobel.)The bill as capped is $250,000 per defendant, but the amendment by Rep Homan changed it to $250,000 per incident, which is what the FMA has been seeking.  The FMA is drafting amendments and lobbying further changes.  Please contact your State Rep and ask them to support the amendment deleting the wrongful death language, support the amendment adding subsequent treater/expert witness to the bill, support the amendment deleting the language which changes the makeup of the Board of Medicine, vote no on any amendment changing the cap, vote no on any amendment on mandatory insurance

Frank Farkas, St Petersburg:  farkas.frank@myfloridahouse.com, 850 488 5719
Edward Homan, Tampa:  homan.ed@myfloridahouse.com, 850 488 3087
Anna Benson, Pensacola:  benson.holly@myfloridahouse.com, 850 488 0895
Gus Bilirakis, Palm Harbor:  bilirakis.gus@myfloridahouse.com, 850 488 5580
Rene Garcia, Hialeah:  garcia.rene@myfloridahouse.com, 850 487 2197
Carole Green, Ft Myers:  green.carole@myfloridahouse.com, 850 488 2047
Gayle Harrell, Pt St Lucie:  harrell.gayle@myfloridahouse.com, 850 488 8749
Stan Mayfield, Vero Beach:  mayfield.stan@myfloridahouse.com, 850 488 0952
Dave Murzin, Pensacola:  murzin.dave@myfloridahouse.com, 850 488 8278
Joe Negron, Stuart:  Negron.joe@myfloridahouse.com, 850 488 8832
Ralph Poppell, Titusville:  poppell.ralph@myfloridahouse.com, 850 488 3006
Manuel Prieguez, Miami:  prieguez.manuel@myfloridahouse.com, 850 488 4202
Julio Robaina, Miami:  robaina.julio@myfloridahouse.com, 850 488 6506
Ray Sansom, Ft Walton Beach:  sansom.ray@myfloridahouse.com, 850 488 1170
Eleanor Sobel, Hollywood:  sobel.eleanor@myfloridahouse.com, 850 488 0465

Work Comp: Dr Oregon Hunter, and Lorry Davis continue to participate in phone conferences with the FMA's Advisory Committee to the Three Member Panel.  There are numerous work comp bills being filed.  The FMA's work comp lobbyist, which FAOEM helped fund, Hayden Dempsey, was formerly on staff with the Governor's Office and then served on the Governor's Work Comp Reform Committee.  He states the Governor wants reform. 

Dennis Ross, R-Lakeland, Chair of the House Select Committee on Workers' Comp says that this Committee will issue a report with recommendations, not a bill.  Rep Ross is drafting a bill that he will sponsor that will go to the House Insurance Committee as a PCB and is expected to pass through that Committee as early as next week. Ross' bill is expected to call for the establishment of practice parameters, overutilization measures, and is expected to contain some of FairCare's principles.  Sen Clary, the Senate's designated work comp person, has filed SB 1946 and this is expected to be the companion bill to Rep Ross'. 

The FMA's Committee is working ardently with lobbyists Dempsey and FMA's Fred Whitson to monitor all the work comp bills filed and respond immediately with amendments where needed.  It is felt that 150% - 200% of Medicare for the fee schedule is not likely to fly because at this point, NCCI states that this would increase total expenditure by 12%.  NCCI will be asked to run the numbers for 150% across the board, or perhaps 130% - 180%.  The Governor wants the reform to be budget neutral. The FMA's committee agreed that the absolute bottom line would be to retain the right to negotiate.

On June 4, in Orlando, a one day seminar sponsored by the FL Work Comp Institute will be held to unveil and explain whatever work comp reform has been legislated.  You will be receiving a registration flyer in the mail.

PIP:  Please contact members of the House insurance Committee and tell them to defeat the amendment pertaining to the fee schedule, tying it to Medicare, PCB 03-HIN-01.  Regarding the one way attorney fee, Jeff Scott of the FMA said this is "what guarantees that you will get paid, and not suffer the same nickel and dime antics that HMOs engage in.  If a PIP insurer does not pay your bill, you can sue and if you win, recover all of your attorney fees.  If you lose, you simply pay costs (not including attorney fees).  Thus if you submit a bill for $100 that the insurer cuts to $80, you can sue to recover the $20 because you will get all of your expenses back.  In the HMO context, if they cut your bill by $20, you are stuck because if you sue and win, the attorneys' fees you will pay will exceed the $20 you obtain.  For names and email addresses of this Committee, contact Lorry Davis. 

Scope of Practice:  The FMA is working diligently to prevent passage of:

ARNP's, HB 342 Rep Carole Green, SB 1736 Sen Gwen Margolia
PA's, HB 1311 Rep Dennis Baxley, SB 2022 Sen Charlie Clary
Optometrists, HB 699 Rep Joe Pickens, SB 1714 Sen Dennis Jones
Pharmacy/Immunizations, HB 1519 Rep Phillip Brutus, no Senate Bill yet
Naturopaths, HB 1615 Rep Carole Green, SB 2014 Sen Skip Campbell
Psychologists, HB 1583 Rep Phillip Brutus, SB 1820 Sen Gwen Margolis
Alternative Health Care, HB 1301 Rep Rene Garcia, no Senate Bill yet

MEDICARE:  Thank you to Dr Walter Conlan who represented PM&R at Medicare's Carrier Advisory Council meeting, March 1.   His report:  Discussion concerning greater occipital nerve block:  comments made by neurology, anesthesia, rehabilitation medicine.  General indications for this block are acute and chronic occipital neuralgia, chronic tension headache, tx of vascular headaches, as well as to confirm dx of suspected occipital neuralgia.  Injection therapy for tx is for those who have failed symptomatic management.  If only temporary relief of symptoms is obtained, or failure to respond to blockage, neurolysis of the greater occipital nerve may be indicated.  ICD 9 codes that support medical necessity include: tension headache, occipital neuralgia, other syndromes affecting the cervical region, headache.   Utilization guidelines:  not expected  that the occipital block would be frequently repeated.  More than 3 injections in a 3 month period would suggest use of other therapies including C2 nerve block, C2 facet blocks, and/or neurolysis.  All committee members felt that the local medical review policy was fair and allowed physicians and patients access to this treatment.  If you have any concerns over this review policy please contact me at conlanfamily@earthlink.net.

Discussion concerning financial limitation for outpatient rehabilitation services:  Effective July 1, 2003, outpatient physical therapy will increase to $1590 yearly.  Outpatient payments are limited to a combination of physical and speech therapy at $1590, and an occupation therapy limit of $1590.

Discussion re HCPCS codes would take a great deal of time to discuss and likely would not help to clarify the situation. 

Finally some good news: as you all may well know, instead of the 4.4% decrease in Medicare reimbursement as of March 1, 2003, Medicare will increase reimbursement by 1.6%.  Any claims that are filed after March 1 for services provided prior to that date will be reimbursed at the new increased 2003 reimbursement schedule.  For claims which sent after March 1 for services performed prior to that date, there is a good chance that Medicare will be asking for a small refund in July 2003. 

If you have further questions please go to the web site:  www.cms.gov. 

Editor:  Lorry S. Davis, M.Ed., Executive Director, P.O. Box 330298
Atlantic Beach, FL 32233-0298, Tel: 904-270-8886, Fax: 904-246-9233, Email:  Lorry4@earthlink.net

Table of Contents: FSPMR's Next Meeting, Organized Medicine: Work Comp Reform, Tort Reform & Rally, Days at the Capitol, Doctor of the Day, Nurses Should Not Be Authorized to Prescribe Controlled Substances, Medicare: A 1.6% Increase, Not a 4.4% Decrease, 2003 Florida Medicare Fee Schedule, CAC Policy - Nerve Blocks, NCV Policy, Editor

FSPMR'S NEXT MEETING: Friday - Sunday, May 16 - 18, 2003, Hilton Clearwater Beach Resort, in conjunction with the Annual Meeting of the Florida Academy of Pain Medicine. FSPMR's business meeting and luncheon will be Sunday, May 18, 12:30 - 3 pm.

Three FSPMR members, Drs Anthony Dorto, Oregon Hunter, and John Muenz are involved as speakers. Dr Dorto's topic is "Malingering, Symptom Magnification, and Fraud," Dr Hunter's is (co-presented with Dorothy Sims, JD) "Is There an Impairment Rating for Pain?" and Dr Muenz' is "Botulinum Toxin in the Treatment of Cervicothoracic Pain." 17 hours of CME. Plan to be there!

Go to fapm.med.new.net to get more information about the hotel, rates, registration, and the rest of the program. FSPMR members will be given registration discounts. You will be receiving a registration brochure via regular mail, with all details, within a couple of weeks. Look for it! You will also receive another issue of PainInfo newsletter, FAPM's publication, probably in April. This newsletter will also contain info about the meeting.

ORGANIZED MEDICINE:

Work Comp Reform: FSPMR contributed $1000.00 to the FMA for its work comp reform lobbyist effort. Dr Oregon Hunter represents FSPMR on the FMA's Advisory Committee to the Three Member Panel, and he and FSPMR Executive Director Davis have been participating in this committee's teleconferences. Dr Hunter continues to work intensively on this issue with the FMA.

Tort Reform: The FMA's Days at the Capitol March 27's Tort Reform Rally will be held at 2 pm, front steps of the Old Capitol Building in Tallahassee. FSPMR's President, Dr Jairo Parada and Executive Director Davis will participate. We urge as many PM&R docs as possible to give up a day in clinic, not only to march for tort reform for your own practice, but for the future of the next generation of physicians. If you are interested in participating, and have not been receiving information from the FMA about this, please contact Lorry Davis, information at the end of this broadcast.

To bolster the tort reform effort, thanks go to the following physicians who responded to Dr Parada's request (President of the FMA, Dr Robert Cline asked Dr Parada to communicate to FSPMR members, asking for contributions) for $100 contributions each to People For a Better Florida: Drs Patrick Gonzalez, Colleen Zittel, Mitchell Freed, Lauren Lerner, James Petrola, Jairo Parada, Venerando Batas, James Patterson, Rodolfo Eichberg, Roberto Dominiguez, and Paul Kornberg. Contributions can still be made to People for a Better Florida, mail them to Lorry Davis, 7008 SW 30th Way, Gainesville, FL 32608. To date, FSPMR has contributed $1050.00.

Days at the Capitol also consists of organized legislative visits. If anyone else wants to participate, let us know. You are urged to contact your Florida legislators now regarding tort reform. If you don't know who your legislator is, click on
http://capwiz.com/law/officials/state/&state=FL&lvl+L. The FMA needs to know when
you make these contacts, if you have a good relationship with a legislator, and what your legislators are saying to you. You can call Sarah Jennings at 800 762 0233, or email her at sjennings@medone.org.

The FMA is again calling for Doctors of the Day for the 2003 FL Legislative Session. If you are willing to spend a day in Tallahassee during the Session, March 4 - May 2, providing health care for members of the legislature and its employees, improving and strengthening physician-legislator relations, contact Michell Jacquis at the FMA, mjacquis@medone.org, or call her at 800 762 0233.

Scope of Practice: Communicate with your legislators about HB 341, by Rep Green, and SB 548, by Sen Margolis, Nurses Should Not Be Authorized to Prescribe Controlled Substances.

MEDICARE: GOOD NEWS! The AMA along with component state medical societies have been successful in stopping the 4.4% Medicare Reimbursement cut, and instead physicians will be receiving a 1.6% increase in the 2003 Medicare fee schedule. The effective date for the fee schedule will be 3/1/03. CMS has stated that claims with dates of service before March 1 that are processed by carriers after March 1 will be paid at the 2003 rate, which means that practices will be overpaid 1.6% for every claim with a January or February date of service that is processed by carriers after March 1. Mass adjustments will be made in July and physicians will be asked to reimburse Medicare for the overpayments that were made to them for these January and February claims. CMS has suggested that providers either transmit as many claims as possible by the close of business March 28 to prevent these overpayments, or that they hold those claims until after July 1 when the claims processing systems will be able to differentiate between the 2002 and 2003 fee schedules. For further information, go to www.cms.gov.

Regarding the release of the Florida Medicare fee schedule for 2003: The information was posted today in the Federal Register. Now that First Coast Service Options, Inc. (FCSO), the Florida Medicare Carrier, has the information, they say that it will take a couple of days to get the conversion factor transferred to dollars. They hope to have it on their website by Monday or Tuesday of next week. They suggest that providers may wish to hold their Medicare claims for a few days until the fee schedule is completed. FCSO sends their apologies to providers for the inconvenience, but states that the few days delay is better for providers than the 4.4% decrease would have been. They ask for the patience of providers for just a few more days.

CAC Policy - Nerve Blocks: Many thanks to Dr Colleen Zittel, Treasurer, who has been doing an outstanding job representing PM&R on the Carrier Advisory Committee for Medicare. She is joined by Dr Walt Conlan. Drs Zittel and Conlan send the following urgent message: All PMR docs who do Greater Occipital Nerve Blocks need to review the current draft Medicare Local Medical Review Policy (LMRP) on this topic.(www.floridamedicare.com, click on Part B, then Local Medical Review Policies, then drafts); also, a link is provided near the bottom of the most recent Medicare e-news
you received. Dr Conlan will be attending the next CAC meeting (March 1) when this will be discussed, and any comments about the policy can be forwarded by Dr Conlan or Dr Zittel to Medicare, preferably before the meeting, but also for up to 45 days after this meeting (mid-April). After that, the policy is final, so action is needed soon. Neither Dr Conlan nor Dr Zittel perform these injections, so it is imperative that we get some input from physiatrists who do, so that the policy is critiqued appropriately and corrected if needed. Dr Zittel can be contacted at cgzittel @aol.com, Dr Conlan at conlanfamily@earthlink.net. Thank you!

NCV Policy: Dr Zittel's communications with Medicare on this topic, from June 10, 2002, through the present, can be viewed on FSPMR's website: fspmr.org, click on the Medicare category.

FSPMR Broadcast, January 30, 2003 

FSPMR'S NEXT MEETING:  

Friday - Sunday, May 16 - 18, 2003, Hilton Clearwater Beach Resort, in conjunction with the Annual Meeting of the Florida Academy of Pain Medicine.  FSPMR’s business meeting and luncheon will be Sunday, May 18, 12:30 – 3 pm. 

The program is being finalized and three FSPMR members, Drs Anthony Dorto, Oregon Hunter, and John Muenz are involved as speakers.  Dr Dorto’s topic is “Malingering, Symptom Magnification, and Fraud,” Dr Hunter’s is (co-presented with Dorothy Sims, JD) “Is There an Impairment Rating for Pain?” and Dr Muenz’ is “Botulinum Toxin in the Treatment of Cervicothoracic Pain.” 

In the meantime, go to fapm.med.new.net to get more information about the hotel, rates, and the rest of the program.  FSPMR members will be given the same registration discounts as FAPM members.  You have already been mailed a PainInfo newsletter, FAPM’s publication, and you will receive a couple more before the May meeting.  These newsletters will contain info about the meeting, and you will be mailed a separate registration.  Look for them! 

Work Comp Reform:  FSPMR pledged and gave $1000.00 to the FMA for its work comp reform lobbyist effort.   Dr Oregon Hunter represents FSPMR on the FMA’s Advisory Committee to the Three Member Panel, and he and FSPMR Executive Director Davis have been participating in this committee’s teleconferences.   

Tort Reform:  The FMA’s Days at the Capitol March 27’s Tort Reform Rally will be held at 2 pm, front steps of the Old Capitol Building in Tallahassee.  FSPMR’s President, Dr Jairo Parada and Executive Director Davis will participate.  We urge as many PM&R docs as possible to give up a day in clinic, not only to march for tort reform for your own practice, but for the future of the next generation of physicians.  Many of us who watched the State of the Union address know that President Bush put tort reform and medical liability malpractice issues in his speech.  The public and political climate for this reform has never been better.  If you are interested in participating, and have not been receiving information from the FMA about this, please contact Lorry Davis, information at the end of this broadcast. 

Days at the Capitol also consists of organized legislative visits.  If anyone else wants to participate, let us know.  You are urged to contact your Florida legislators now regarding tort reform.  If you don’t know who your legislator is, click on http://capwiz.com/law/officials/state/&state=FL&lvl+L.  The FMA needs to know when you make these contacts, if you have a good relationship with a legislator, and what your legislators are saying to you.  You can call Sarah Jennings at 800 762 0233, or email her at sjennings@medone.org.    

The FMA is again calling for Doctors of the Day for the 2003 FL Legislative Session.  If you are willing to spend a day in Tallahassee during the Session, March 4 – May 2, providing health care for members of the legislature and its employees, improving and strengthening physician-legislator relations, contact Michell Jacquis at the FMA, mjacquis@medone.org, or call her at 800 762 0233. 

FSPMR is a member of the Coalition to Heal Healthcare in Florida, an organization with a comprehensive plan to fix Florida’s broken medical liability system.  Log on to www.healFLhealthcare.org.

FSPMR Broadcast, December 20, 2002 

FSPMR'S NEXT MEETING:  

Sunday, May 18, 2003, 12:30 – 3 pm, Hilton Clearwater Beach Resort, in conjunction with the Annual Meeting of the Florida Academy of Pain Medicine.  You will be receiving more information about this as it becomes available.  The program is being finalized and two FSPMR members, Drs Anthony Dorto and Oregon Hunter are involved as speakers.  Dr Dorto’s topic is “Malingering, Symptom Magnification, and Fraud,” and Dr Hunter’s is (co-presented with Dorothy Sims, JD) “Is There an Impairment Rating for Pain?”  In the meantime, go to fapm.med.new.net to get more information about the hotel, rates, and the rest of the program. 

Work Comp Reform:  FSPMR is pledging $1000.00 to the FMA for its work comp reform lobbyist effort.  The FMA is using its resources this year to deal with tort reform, and it does seem likely that there will be some sort of reform this legislative session.  The Governor’s Commission on Work Comp Reform will next meet in January and reportedly will begin drafting language for a bill.  Dr Oregon Hunter, with input from President Dr Jairo Parada and the rest of FSPMR’s Executive Committee, has been representing FSPMR on the FMA’s Advisory Committee to the Three Member Panel.  FSPMR Exec Dir Lorry Davis attended the 3MP meeting Oct 28 in Tallahassee, where the 3MP approved the FairCare Plan.  This is the Fogels/Revel plan that we heard about at our last meeting.  The FMA’s Advisory Committee’s position supports some of the FairCare plan, for example better medical reimbursements, but not all of it.  The FMA has been vocal at the Gov’s Commission meetings.  This Commission had a teleconference on Dec 18 with these pertinent outcomes  (information from Fred Whitson, FMA Atty):   

1. Re the medical delivery system:  Recommend that provider reimbursement fees be increased to be in line with other states, that authorization guarantees payment, standardization so fees paid are the same regardless of location/venue.  And the reduction in fees for hospital outpatient services and for free standing facilities. (The Commission voted unanimously to accept this position.)

2. Medical dispute resolution process:  Should expedite the dispute process and include the establishment of a claims operations unit tasked to triage the work comp disputes, with those determined to be medical and ripe being sent to an out-of-state peer review panel.  (The Commission voted 9 – 2 to accept this.)

3. Indemnity benefit:  Concept is to shift from an impairment model to a functional loss model.  Vote postponed until January meeting due to lack of data.

4. Attorney fees:  Discussion included attorneys must be part of the work comp system to aid aggrieved employees; hourly fees vs contingency model. (Discussion to continue at January meeting).

FSPMR and FMA Activities:  FSPMR President, Dr Jairo Parada, has been faithfully representing FSPMR at FMA functions:  He attended the Oct 18 Specialty Society meeting in Tampa with these comments:   

1. New membership opportunities:  We should encourage specialty society members to join the FMA directly without involvement in their county societies if they so choose.  Follow-up:  FSPMR sent their member database to the FMA, and the FMA is to send letters signed by both Drs Robert Cline, FMA President, and Dr Parada,  to FSPMR members who are not yet FMA members.

2. The Board of Medicine is looking for physicians in each specialty for their “Voluntary Medical Expert Witness Program.”  Experts typically review a few department investigations each year and submit a written report.  Often the case concerns allegations of substandard care.  There is compensation.  For more info, contact Amarilys Martinez, 850 414 8126.

3. The Specialty Society section authorized Francie Plendl, FMA Counsel, to meet w/ the FL Board of Medicine about its approval of the AAPS as a recognized board in this state.  Their standards for certification are much lower than the ABMS Boards.

Dr Parada attended the Board of Governors meeting, Nov 23 in Tampa where the above issue was acted upon:  Approved that the FMA policy be amended as follows:  That the FMA use any and all means to ensure that the FL Board of Medicine allow only those physicians certified by ABMS boards or other boards whose standards are identifcal to ABMS to advertise themselves as Board certified in that specialty.  Also at this meeting, the FMA Bd of Govs approved a compromise proposal to present to the Bd of Medicine that PA’s records be countersigned within 7 dys for the first 6 months of employment, countersigned within 30 dys after the 6 months of employment, and that this rule also apply to ARNPs. 

AAPMR:  We saw many of you at the Annual Assembly in Orlando last month.  Dr Parada and Lorry Davis attended the Council of State PM&R Society Presidents Meeting.  It was a good and interesting meeting and we were fairly comfortable that Florida has already dealt with issues other states are now getting into, example:  PTs gaining direct access. 

HAPPY HOLIDAYS!

FSPMR Broadcast, October 21, 2002

FSPMR'S NEXT MEETING:

Thursday, November 21, 2002, Orlando World Center Marriott, Crystal Ballroom D, 7:30 pm, in conjunction with the 63rd Annual American Academy of PM&R Assembly.  The Florida Hospital Neuroscience Institute is providing dinner and Frank Huang-Hellinger MD, PhD, Chief, Interventional Neuroradiology will present "Interventional Neuroradiology:  Latest Minimally Invasive Approaches to Cerebrovascular Disease and Compression Fractures."  1 hr of CME will be provided.

You will be receiving an invitation via fax and email for this.  Be sure to RSVP to the invitation as space is limited.

Governor Bush Creates Task Force to Address Healthcare Liability Insurance Crisis:  This press release, dated August 28, 2002, was sent out by the FMA in a message from the EVP, Sandra Mortham.  Sec of FL's Dept of Health, John Agwunobi MD MBA, whose dept will be responsible for providing logistical and staff support for the task force, applauded the Governor.  The task force will consist of Chair John Hitt PhD, President, University of Central FL; Marshall Criser Jr, President Emeritus, UF; Richard Beard, Trustee, University of So FL; Donna Shalala, President of the University of Miami,; Fred Gainous, President FL A&M.  According to statistics from the Dept of Health & Human Services, insurance rates increased an average of 30% in the past 2 yrs with further increases expected.  The task force will submit its recommendations and/or proposed legislation to the Gov, Pres of the Senate, and Speaker of the House by Jan 31, 2003; the task force shall continue in existence until its objectives are met, but no later than June 30, 2003.

Dr Marc Rubenstein, FSPMR member, gave a presentation on this subject at our meeting in August in Orlando.  When the minutes are out, which will be in the near future, there will be attachments that he provided about this crisis.

Also, Dr Dina Miller, FSPMR member, emailed:   "Just found out that renewal rates for my med-mal insurance (never had any claims made) will triple for this year.  Yikes!  Are any of the other members going bare?  (I know we don't pay a lot compared to surgeons.)"  Please email your responses to Dr Miller at dinamiller@the-beach.net, and please cc Lorry Davis, Lorry4@earthlink.net.  Thanks.

The "Revels/Fogel" Plan:  Work Comp Reform:  We heard Jerry Fogel talk about this plan at our meeting in August, and Claude Revels introduced himself to us.  According to the Sept issue of The Florida Workers' Comp Reporter, "the Revels/Fogel plan would allow doctors to make medical decisions while leaving employers the right to address return-to-work issues."  The plan is formally titled "A Principle-Based Integrated-System Model:  A Self-Executing System" and more about this will be included in the above-referenced August meeting minutes.  This plan is also mentioned in the October issue of The Florida Workers' Comp Reporter.  A story which appeared in the Ocala Star Banner, to which Dr Michael Webb, FAOEM, contributed can be found at http://www.starbanner.com/articles/business/796.shtml.

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FSPMR Broadcast, August 12, 2002
Last Chance to RSVP!

FSPMR'S NEXT MEETING: Tues, Aug 20, 2002, 12 - 3 pm, Aruba & Bahamas rooms, w/ the FL Workers' Compensation Educational Conference, Aug 18 - 21, Orlando World Center Marriott.  We will again meet with the FL Assoc of Occupational and Environmental Medicine, and after lunch, split into two groups. 

RSVP to Lorry Davis, Exec Dir, 352 372 9360, fax 352 373 8034, Lorry4@earthlink.net, to make sure there is a lunch for you. 

Thank you to Elan Pharmaceuticals for sponsoring this luncheon meeting. 

Signed up so far:  Drs Eve Hanna, Mike Webb, Homi Cooper, Jairo Parada, John Muenz, Rob Dehgan, Matt Imfeld, Dave Haddock, Alan Doyle, Michael McDonald, Stephen McDonald, Jim ZeBranek, Richard Dolsey, Nick Potochny, Gary Newcomer, Richard Johnson, Mitch Freed, Mark Rubenstein, Venerando Batas, Greg White, Mark Rubenstein, Gary Clonts, Steven Field, Seth Feldman, Colleen Zittel, Jock Sneddon, Mike Hankins, Pedro Oliveros, Michael Band, Bob Fleigelman, Craig Lichtblau, Michelle Eaton, Toni Belisle, Joan Watkins, Phyllis Gerber, and Kathy Jenkins.  We know more of you plan to attend, so be sure to RSVP to Lorry, so you'll have lunch!  RSVPs will be taken through noon on Thursday, Aug 15.  Final orders have to be given to the hotel at that point.

Our hospitality suite will be # 20968, same as last year.  Last year, Dr Michael Webb had a mail label (standard Avery 5160 or other brand, same size) placed on the back of his business cards.  Great idea!  Please have someone in your office do the same for you.  It's a great way to hand out your business card and invite someone to our suite at the same time.  The label should say "You and your associates are my guests at the FSPMR Hospitality Suite.  Beverages, snacks, relaxation.  East Tower.  Floor 9 Rm 20968.  Hours:  5 - 8, Sun - Tues (8/18 - 8/20)  See you there!"  Of course, the writing will need to be reduced so that it all fits on the mailing label.  Great idea!

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net


 

First Coast Service Options (FCSO), Inc.
A CMS (formerly known as HCFA) Contracted Carrier & Intermediary

FCSO Medicare Provider Web Site: www.FloridaMedicare.com
WEB SITE UPDATES: Detailed information on the following can be found on the Web site.

NEW ON-LINE REGISTRATION FOR EDUCATION AND TRAINING EVENTS

To simplify the registration process, providers now have the ability to use our online registration process from their office, home and other locations with Internet access. If you are interested in participating in a seminar, workshop, or teleconference, we encourage you to register for one of our educational forums by visiting the Education/Training page and selecting the "Calendar of Events" or "List of All Scheduled Events." Click on the selected event to complete your online registration. Don't delay -- register today!

Below is a complete list of upcoming events currently available:

PART A:

Medicare Building Blocks Seminar, Tallahassee (11/8/02)
Medicare Building Blocks Seminar, Jacksonville (11/14/02)
Outpatient Observation Seminar, Jacksonville (11/6/02)

PART B:

Basic Skills Workshop, Dania (12/4/02)
Beyond The Basics Workshop, Dania (12/5/02)
Medicare Building Blocks Seminar, Tallahassee (11/8/02)

First Coast Service Options (FCSO), Inc.
A CMS (formerly known as HCFA) Contracted Carrier & Intermediary

FCSO Medicare Provider Web Site: www.FloridaMedicare.com
WEB SITE UPDATES: Detailed information on the following can be found on the Web site.

Correct Procedure Code for Influenza Vaccine

The Centers for Medicare & Medicaid Services (CMS) has notified carriers the whole virus vaccine (CPT code 90659) has not been produced for the 2002 flu season. Therefore, Influenza vaccines should be billed using code 90658. In the event a provider does bill code 90659, it will be reimbursed at the same fee as code 90658.

First Quarter 2003 Medicare B Update! will be Available Soon -- The First Quarter 2003 Medicare B Update! will be posted to the provider education Web site next week. Items of interest include:

• New Format for Your Medicare B Update!
• Advance Beneficiary Notices (ABNs)
• Annual Updating of ICD-9-CM Codes Must Be Date of Service Driven
• Requirements for Reporting Dates—Paper Claims
• Claims Processing Requirements for Clinical Diagnostic Laboratory Services Based on the Negotiated Rulemaking

IMPORTANT – link to CMS Web site: http://cms.hhs.gov/manuals/pm_trans/AB02129.pdf

• Questions and Answers Related to Implementation of National Coverage Determinations (NCDs) for Clinical Diagnostic Laboratory Services
• Local Medical Review Policy Reconsideration Process
• Health Insurance Portability and Accountability Act–Administrative Simplification (HIPAA-AS) Update
• TriCenturion Selected as Program Safeguards Contractor
• Remittance Advice Coding and Health Insurance Portability and Accountability Act (HIPAA) Transaction 835v4010 Completion Update

Quarterly publication in hard copy format resumes with this issue. Watch for it!

---

MEDICARE PART B - CARRIER INFORMATION

SPECIAL RELEASE ARTICLES

10/25/02: Effective October 28, 2002 New Changes for Florida Medicare Part B Provider Customer Service Call Center

FCSO Medicare Provider Web Site: www.FloridaMedicare.com
WEB SITE UPDATES: Detailed information on the following can be found on the web site.

MARCH 8, 2002 CONVERSION TO MEDICARE'S MULTI-CARRIER SYSTEM (MCS)

• MCS Post Transition Issues <Revised 04-30-02>

> To assist providers who are experiencing issues related to MCS, First Coast Service Options, Inc. (FCSO) has developed this MCS Post Transition Issues communication, which will provide a status of the most commonly reported issues. This communication will be updated regularly as new information becomes available. Estimated completion dates (ECDs) are subject to change based on new issues and corresponding impacts. Please continue to check the web site for updates.

• MCS Post Transition FAQs <Revised 04-30-02>

• FCSO CONTINUES TO PERFORM MASS ADJUSTMENTS <Revised 04-30-02>

> FCSO continues to assess the volumes associated with issues inappropriately resulting in denials. As noted in the current MCS Post Conversion Issues Matrix, several mass adjustments have been completed and the next planned adjustments include the following:

PROCEDURE CODE(S): Procedure to diagnosis denials

Q0091 denied with diagnosis code V762
G0105 denied with diagnosis V160
76075 denied with diagnosis 7330 and 73301
84436 denied with diagnosis 24290
85013 denied with diagnosis 2859
93320 and 93325 when billed with diagnosis 78609

PROCEDURE CODE(S): Procedures denied in error as invalid procedure, denial message 160.

All 93XXX codes
G0121
36820

PROCEDURE CODE(S): 77333 and 77334 denied due to MAX SERVICES

PROCEDURE CODE(S): Services denied incorrectly by a specialty 48.

97001 and 97002
11001
93923 and 93925

PROCEDURE CODES(S): 65855 denied with message 839.

PROCEDURE CODE(S): 98940-98943 incorrectly denying for UPIN when billed by a Chiropractor.

PROCEDURE CODE(S): 68761 by specialty 41.

Note: Please see the MCS Post Transition Issues matrix for the specific dates. Mass adjustments may be subject to change. Please continue to check the web site for the most current information.

• FCSO TO PUBLISH SUMMARY OF MEETINGS WITH HEALTHCARE LEADERS

  > FCSO met with key healthcare leaders from throughout Florida on April 25th and 26th. In three separate sessions, FCSO met with the highest Medicare billers in Florida; members from various medical specialties, county medical societies, and consultants; physicians and other partners on the Carrier Advisory Committee (CAC). The purpose of the meetings was to provide information on FCSO’s performance after the conversion to the Multi-Carrier System (MCS), learn about issues not yet identified, and solicit input from healthcare leaders on how to improve service. FCSO plans to post a special summary of these sessions to the web site on Thursday, May 2, 2002.

CPT codes, descriptors and other data are copyright 2001 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

FACTS:  WORKERS’ COMPENSATION REIMBURSEMENT SCHEDULE

 Chair

Members William J. Bryant, DDS , Alan W. Christensen, MD , Michael Hankins, MD , David R. Johnson, MD , G. Grady McBride, MD , William Nevius, DC , Rigoberto Puente-Guzman, MD , Jerry A. Rubin, MD , Diane B. Tellier, DC , Brian D. Wolff, MD

  Division Representatives Reginald Watkins, Chief, BRMS , Cathyann Dufford, BRMS , Barbara M. Moody, BRMS , Nancy Rice, BRMS , Anna Ohlson, RN

Ø      Facts about Workers’ Compensation in Florida

• Litigation is the primary cost-driver of workers’ compensation costs in Florida, not medical treatment.
• The majority of litigated cases involve, directly or indirectly, issues related to access to patient or physician requested diagnostic evaluation, specialty consultation or treatment. 
• Physician reimbursement levels have not changed since 1997.
• Workers’ Compensation Managed Care Arrangements base most contracts on the reimbursement schedule but are not required to do so.
• It is the consensus of the Workers’ Compensation Oversight Board and the Physician Advisory Committee to the Division of Workers’ Compensation that Florida’s reimbursement schedule is inadequate and outdated.
• There is a distinct difference between workers’ compensation and non-workers’ compensation medical care.
• The National State Median Workers’ Compensation Fee Schedule is 150% of Medicare1
• The current Workers’ Compensation Fee Schedule is the lowest in the country.
• The average Workers’ Compensation premium rate is the 2^nd highest in the country

Ø      Concerns of Florida Physicians and the Florida Medical Association

• Patients have inadequate access to quality medical care due to low reimbursement levels and resulting inadequate physician participation.   
• Work injured patients have become a second-class citizen with regard to medical care.
• Physician groups have left and are leaving the workers’ compensation arena.
• There have been recent reports of occupational medicine clinics leaving the state due to the inadequate fee schedule.
• Specialists are unavailable to treat injured employees in many areas of the state.

Ø      Proposed Solutions:

• Physicians need a fair fee schedule reference to serve as a baseline for negotiations under Workers’ Compensation Managed Care Arrangement contracts and to serve as a fair reimbursement for treatment outside of WC managed care.
• Physicians recommend a Workers’ Compensation reimbursement schedule set at 150% of Medicare for non-surgical codes and 200% of Medicare for surgical codes.
• Legislation is needed to allow for:

1.         Adequate physician representation on the Three Member Panel.

2.         Mandatory meeting time frames to follow annual Medicare changes.

3.         An automatic increase to be applied reflecting the Consumer Price Index if Medicare changes are not implemented during a given calendar year. 

• This is simply the right thing to do.  Insurance carriers should expect, at least initially, an increase in total costs but anticipate long term savings through improved access to quality care and reduced litigation.

Ø      Facts about Workers’ Compensation in Florida

• Treatment provided outside a Workers’ Compensation Managed Care Arrangement must be reimbursed according to the Division’s schedule and guidelines.
• The Three Member Panel is authorized to establish reimbursement levels for Workers’ Compensation treatment, but they have not addressed this issue since 1996. 
• The 1996 Reimbursement Schedule decision, implemented in 1997, was based upon a budget-neutral approach; i.e., that total expenditures would not increase beyond what would be expected under the 1995 Fee Schedule.  The 1995 Fee Schedule had not reflected any increases since 1986 (which was based upon 1984 data).
• Workers’ Compensation Managed Care Arrangements base most contracts on the reimbursement schedule even though it is clear that the schedule is only required for non-managed care treatment.  (Because WCMCAs became optional in 1994 and mandatory 1/1/97, the vast majority of Workers’ Compensation care is provided through a Managed Care Arrangement)
• Contracts based on the reimbursement manual allow an additional level of appeal and review when a reimbursement request is denied by the WCMCA.  (Providing that the contract specifies that the reimbursement manual rules, in addition to the reimbursement manual fee schedule, will be adhered to).
• In 1996, the Three Member Panel approved an incremental implementation of reimbursements generally based on Medicare that would be completed in 2000.  However, the graduated steps required annual approval by the panel and have not been executed. 
• There is a distinct difference between workers’ compensation and non-workers’ compensation medical care.  Variables include physician and staff time, disability expertise and teamwork emphasizing return to work.  One occupational physician estimates that office visits by workers’ compensation patients results in an average loss of$17.00 per visit.  

Ø         Concerns of Florida Physicians and the Florida Medical Association

• Lack of treatment delays return to work and increases employee dissatisfaction.
• Carriers representing employers or large self-insured employers and physicians are the critical parties to contracts with WCMCA’s.  DWC, DOI and AHCA play supportive roles and should not be allowed veto power over or micromanagement of these relationships.

Ø         Proposed Solution

·         Physicians need a fair fee schedule reference to serve as a baseline for negotiations under WCMCA contracts and to serve as a fair reimbursement for treatment outside of WC managed care.  This will result in a “win-win-win” arrangement for injured workers, employer/carriers and physicians – with a reduction in litigation and total Workers’ Compensation costs.

·         Physicians throughout the State of Florida presented testimony to the Workers’ Compensation Oversight Board in June, 2000 as well as to the Three Member Panel October 18, 2000 regarding a Fair Reimbursement Schedule, referencing the different dimensions of Workers’ Compensation care, including medico-administrative activities and disability management and team efforts to return the patient to work.   Their recommendation was:  150% of Medicare for non-surgical codes and 200% of Medicare for surgical codes.  

• At the 11/29/00 meeting, the Three Member Panel should, at a minimum, implement the installment changes agreed upon in 1996, with the exception of eliminating any reduction in fees should result from that application of the formula.

Prepared by Linda Knopf, Consultant / former Assistant Director of Division of Workers’ Compensation and modified by Michael J. Webb, MD 11/20/00 

TASK FORCE ON WORKERS’ COMPENSATION ADMINISTRATION

Recommendations and Answers to Questions Presented in the Enabling Legislation 4

Funding the Administration of the Workers’Compensation System and Operations of the Division of Workers’ Compensation 6

Eliminate Interest On Medical Bills and Jurisdiction of JCC to Hear Medical Bill Payment Disputes 17

Partial Dismissal of a Petition for Benefits 20  

Eliminate Docketing Orders 20  

Setting Definite dates for Mediation, Pretrial and Final Hearings 21  

Workers’ Compensation Oversight Board Judges of Compensation Claims 21

ENABLING LEGISLATION:

5. What cost savings could be achieved in the administration of the workers’ compensation system, including the operations of the Division of Workers’ Compensation.  

6. What organizational changes affecting the administration of the workers’ compensation system, if any, should be made to make it more efficient. To assist the Task Force in its work, the Executive Office of the Governor contracted for the completion of a budgetary and operational analysis of the Division of Workers’ Compensation, detailing the staffing of the division, receipt and expenditure of revenues, reliability of financial records and reports, and the efficiency of internal controls and procedures.

PRELIMINARY STATEMENT:

WORKING PHILOSOPHY OF TASK FORCE:

Recommendation: Continue to fund the administration of the workers’ compensation system, including the judges of compensation claims and the operation of the Division through an assessment on the premiums that employers pay for their workers’ compensation insurance. No funds should be allocated from general revenue. Try to decrease the assessment rate for carriers that are doing an excellent job providing accurate benefits in a timely fashion.

Recommendations: A complete audit of the Division’s operating budget and cash reserves should be conducted, with a view toward using cash reserves to lower the assessment rate, while still maintaining the fiscal soundness of the Division. In addition, eliminate the mechanism that requires the Division to use the Treasury to invest the Division’s cash reserves.

Recommendations : Staff at the Division need to be adequately equipped to carry out the core functions. There should also be a determination of whether certain functions of the Division should be outsourced. Several suggestions for outsourcing include the educational functions of the Division and functions such as the early dispute resolution, if a version of this is determined to be within the core functions of the Division. Another area for outsourcing appears to be the mediation function of the state mediators. The testimony presented to the Task Force was that private mediators have been more effective in resolving cases.

Recommendation: Transfer the Division’s Bureaus to the Department of Insurance (DOI), with the exception of the judges of compensation claims, which should be transferred to the Division of Administrative Hearings under the Department of Management Services. Prior to a transfer, a determination should be made of whether certain functions of the division might better be outsourced. With regards to the self-insurance section, the non-regulatory functions should be transferred to Florida Self-Insurance Guaranty Association (FSIGA) and the regulatory functions to the Department of Revenue.

Recommendations : This bureau should develop and implement dynamic field and paper audits that are triggered by complaints or by prior untimely claim handling practices. When identified, the Division should aggressively impose appropriate penalties to discourage untimely claims handling. Stronger compliance and monitoring enforcement is essential.

BUREAU OF OPERATIONS SUPPORT:

Recommendation: The bureau would continue administer the PT supplemental benefits, the SDTF, and the WCATF. It may be most cost effective to limit the bureau’s involvement with solvency petitions of claimants, since these are basically never denied. It may be more cost effective to settle claims for PT supplemental benefits instead of continuing to administer this program. Leave the administration and reimbursement from the SDTF in its current form.

Recommendations : Eliminate all exemptions in the construction industry and require that all persons engaged in the construction industry be covered by Workers’ Compensation insurance. The proof of coverage (POC) function of this bureau should be outsourced to a private entity such as the National Council on Compensation Insurance (NCCI), while the enforcement power to correct coverage fraud should be retained. Experience has demonstrated that verifying certificates of insurance on sub-contractors is not practical. This transfer would create greater accuracy, faster response, be less burdensome to

BUREAU OF RESEARCH AND EDUCATION:

Recommendations: The educational material distributed should be coordinated for accuracy, and a determination of whether the production of these materials could be effectively outsourced is needed. Education of stakeholders, even prior to an injury, has been an effective component of reducing costs in other states. All written and educational material should be simplified and centralized under one roof. The Bureau of Research and Education has a Project Data Management Team section referred to as the Data Quality Audit Consulting Team (DQACT) with 5 FTE’s. The salaries and related benefits for operating the DQACT are approximately $360,000. The Division should assess the value added benefits that DQACT brings to the Division.

Recommendations : Eliminate the requirement to file an RFA, since all parties agree that it is not helping to timely resolve claims. Instead, only require the filing of a petition for benefits which must be served on the employer/carrier, the JCC having jurisdiction over the claim, and the Division. Require that documentation be submitted with the Petition for Benefits supporting each request for benefits. Once a petition for benefits has be filed, the employer/carrier should have thirty days to either pay or deny the requested benefits before attorneys’ fees apply. Repeal all portions of section 440.191, Florida Statutes, except subsection 440.191(1)(b). A determination of whether the new early intervention program is working should be made, but a more foundational question of whether the Division should be the one doing early intervention, or whether the carriers or employers need to do be incentivized to do a better job needs to be addressed. Any early intervention program should also be approached from the perspective of outsourcing.

Recommendation: Repealing the mandatory managed care provision contained in section 440, Florida Statutes. Employers may still have in place a managed care system, but only if they determine that is the most effective system for them. Need a specific statement in the legislation that the elimination of the mandatory managed care provisions would be procedural and therefore could be applied retroactively.

Recommendation: Limit independent medical exams to only one (1) per date of accident and allow insurance carriers to charge these expenses as medical benefits.

ELIMINATE INTEREST ON MEDICAL BILLS AND JURISDICTION OF THE JUDGE OF COMPENSATION CLAIMS TO HEAR MEDICAL BILL PAYMENT DISPUTES

Recommendation: Eliminate the judicially created payment of interest on unpaid medical bills. Eliminate the jurisdiction of the judges of compensation claims to resolve disputes regarding unpaid medical bills.

Recommendation: Similar to what other states have done, the amount an attorney may receive in fees should be limited to a contingency amount, as currently set out in the statute, with the claimant being responsible for paying 20% of any contingency amount awarded. One exception would be in a case in which three requirements were met. First, the claim was for medical benefits only. Second, said claim for medical benefits only must have been formally denied by the carrier. Finally, no request must have ever been made for indemnity benefits and no claim for indemnity benefits should be ripe. In such a case where those three requirements are met, the fee awarded may be a reasonable hourly rate, but may not exceed twice the value of the medical benefits obtained up to $5,000.00. Attendant care shall not be considered a medical benefit for purposes of this fee calculation.  The only other exception would be with regards to appellate attorney’s fees. It is recommended that the hourly rate for appellate attorney’s fees should be limited to $125 per hour up to a maximum of $5,000.00.

The statutes provide that attorneys’ fees do not attach until 30 days after the filing of a Request for Assistance and 14 days after a Petition for Benefits has been filed. The First District, however, created as exception to this provision in its ruling in Allen v. Tyrone Square 6 AMC Theaters. In this case, the appeals court held that the request for assistance and a petition for benefits need not be filed for attorneys’ fees to attach if the issue in question involves medical benefits only. In this case, what constitutes notice to the carrier is subjective. Case law also has not clarified what constitutes a reasonable time to respond to one of these subjective "requests" prior to incurring attorneys’ fees.

Recommendation: In the interest of the timely provision of benefits, and in light of the removal of the RFA process, provide that entitlement to an attorneys’ fee attaches when either a medical or indemnity benefit is not provided within 30 days after the Petition for Benefits has been filed.

Recommendation: Allow for partial dismissal of a petition for benefits, so that only claims that are ripe, due and owing can be addressed.

Recommendation: Eliminate the review and docketing process, which will reduce attorneys’ fees, unnecessary paperwork and administrative costs.

Currently, dates for mediation, pretrial and final hearings are tentatively scheduled and then often canceled and rescheduled. These delays drive up the costs for the administration of the system and delay the delivery of benefits to the injured workers.

Recommendation: Once the petition becomes final, mediation must be scheduled within 60 days; a pretrial conference must be scheduled within 90 days; and a final hearing must be scheduled within six months. If any of these dates need to be rescheduled, a new date should be set and put in the order continuing the event being reset.

Recommendation: Eliminate the Workers’ Compensation Oversight Board

Recommendation: Since the DLES will be eliminated this year, it is recommended that the JCCs should be moved to the Division of Administrative Hearings (DOAH), which can improve the existing capacity to control scheduling, case load, time off, and other administrative functions of the JCCs. The hearing process would be exempt from the Administrative Procedures Act (APA). Eliminate jurisdiction of JCCs to hear issues regarding medical and other provider bill payment disputes.