Minute Archives

Tuesday, August 24, 2004, 12 – 2 pm
Crystal Ballrooms E & F
Orlando World Center Marriott

MINUTES

Many thanks to 4Physicians.net/Practice Management and Recruiting Solutions, for sponsoring today’s luncheon.

Presiding:  Enrique Monasterio, MD, FSPMR President, and Jeanne McGregor, MD, FAOEM President

Present (in order of sign-in):
FAOEM:  Drs Jeanne McGregor, Ramon Ryan, Gary Clonts, Michael Hankins, Cynthia Lewis-Younger, Kathleen T Jenkins, Kenneth G Phillips, Karen Carlson, Gary Newcomer, Stephen H MacDonald, PM Glencross, Joe Mignogna, Mike Band, Stan Haimes, Richard Dolsey, Robert Fleigelman, Albert T Lojko, Homi S Cooper, Melissa Smith-Horn, Michael J Webb, Jock M Sneddon, Harold Haase, Monica Grinberg, Joan Watkins, and Toni Belisle. 

Barb Maxwell, RN, attended for Dr Norman Hoger.

GUESTS:  Drs Gary W Jay and Sanford Silverman (FL Academy of Pain Medicine), Dr Charles C Grant - Medero Medical Ocala, Dr Nanamdi C Nwaogwugwu – Physiatric Pain & Medical Rehab Orlando, Dr Robert M Chapa – Occupational Medicine Clinics Jacksonville, Bill Redden – Dr Chapa’s Administrator, Dan Sumner – Deputy Director, FL Division of Workers’ Compensation (DWC), Fred Whitson, Atty – FMA Director of Medical Economics, Sissy Kemmer – Nogar & Associates, Don Davis – DWC Bureau Chief, George Furlong – VP with Choice Medical Management, Nancy Maynard – Administrator, All in One Comp Care Ocala.

FSPMR:  Drs Robert Dehgan, Matt Imfeld, Colleen Zittel, David Haddock, Enrique Monasterio, Mitchell Freed, Venerando I Batas, Robert P Christopher, Israel Grinberg, Duby Avila, P Mark Glencross, and Craig Lichtblau.

FAOEM & FSPMR Executive Director, Lorry S Davis MEd.

Self-introductions all around.

DWC 25 Forum

FSPMR August 2004 Minutes, page 2

Fred Whitson, Atty, FMA Director of Medical Economics
Michael Webb, MD, Chair of the FMA’s Medical Economics Committee, and of                      the FMA’s Work Comp Advisory Committee
Sissy Kammer, President, Nogar & Associates
Dan Sumner, Deputy Director, FL Division of Workers’ Compensation
George Furlong, VP, Choice Medical Management

Each of the participants gave a short overview of their involvement with the DWC 25, and then there was a Q&A period.  All participants were aware of problems from the physician perspective such as the 30 day reporting requirement, post MMI reporting, the #10 question (per Dr Webb, objective findings can also be found on physical exam; if no objective findings, allows physician to bring the patient to closure; also acceptable to write “unknown at this time.”)  It was stressed that the DWC 25 is a communication tool between physicians and carriers, and the carriers are just as confused as the physicians.  Per Dan Sumner, the Division had “no dog in this fight.”  To give more input or to ask questions regarding the DWC 25, contact AHCA – Welby Cox-Myers RN, 850 410 1730, coxmyerw@fdhc.state.fl.us, or Dr Webb at drmjwebb@aol.com.  Dan Sumner stated the Division’s position is that the DWC 25 is a work in progress and that they are looking to work with physicians and carriers to continue to smooth out this required form.

FMA 2005 Work Comp Legislative Goals – Mr Whitson said that the #1 goal remains improved reimbursement, i.e., 150% of Medicare for nonsurgical and 200% for surgical.  The 2^nd goal is to continue to work to reduce the hassle factors.  Getting an electronic filing mandate target date is also on the list.

Vote YES on Amendment 3, Mr Whitson discussed the FMA’s continued progress on the contstitutional amendment to limit attorneys’ contingency fees (Yes on 3).  Go to http://www.brevardelections.org/04amend.htm#fla1 for exact wording.
Vote NO on Amendment 7:  “Current Florida law restricts information available to patients related to investigations of adverse medical incidents, such as medical malpractice. This amendment would give patients the right to review, upon request, records of health care facilities' or providers' adverse medical incidents, including those which could cause injury or death. Provides that patients' identities should not be disclosed.
The direct financial impact this amendment will have on state and local government revenues and expenditures cannot be determined, but is expected to be minimal. State agencies will incur some additional costs to comply with public records requirements of the amendment, but these costs will be generally offset by fees charged to the persons requesting the information.”

FSPMR August 2004 Minutes, page 3

Vote No on Amendment 8:  “Current law allows medical doctors who have committed repeated malpractice to be licensed to practice medicine in Florida. This amendment prohibits medical doctors who have been found to have committed three or more incidents of medical malpractice from being licensed to practice medicine in Florida.
The direct financial impact on state and local governments resulting from the proposed initiative would be minimal. There will likely be additional costs to the state of less than $1 million per year, but these costs will be offset by licensure fees.”
Citizens for a Fair Share – Mr Whitson and Lorry Davis appealed for continued contributions to Citizens for a Fair Share, especially to support television ads for the above amendments between now and the November elections.  For more information about Citizens for a Fair Share and how to contribute, go to http://www.citizensforafairshare.org/.

FSPMR and FAOEM broke into separate meetings.

Respectfully submitted,
Lorry S Davis MEd, Executive Director, FAOEM & FSPMR

FSPMR MEETING:

Old Business:

Dr Avila orchestrated a motion to be made and carried that the Minutes of the June 13, 2004, Coconut Grove Meeting were approved with this correction:  Dr Robert P Christopher was present.

2.  Dr Batas gave the following Membership Report:  We currently have 117 members, 9 of whom are retired.  A motion was made and carried to accept the following candidates for membership:  P Mark Glencross MD, Jacksonville; Alan K Novick MD, Hollywood, and Bao T Pham DO, Orange Park.             

3.  A motion was made and carried to accept the Treasury Report that Dr Monasterio presented:  Specific information on the Treasury Report can be obtained by members from Lorry S. Davis, Executive Director, PO Box 330298, Atlantic Beach FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net 

4.  Dr Zittel gave the following Medicare Report:  Dr Walt Conlan attended the June 5th CAC meeting, in which he reviewed the Debridement Services (11000), new policy, and the policy on Preparation and Application of Skin Substitute (Revision) (15000).  He forwarded details re: these policies to Lorry, and she in turn, published them in a broadcast to all members.
 
Botulinum Toxin Policy (L-5840)
This policy has been deleted fully and rewritten over the last year, to now include Botulinum Toxins A & B in one policy.  Please see the website www.medicare.com and click on Part B, medical policy, final, to review.  All our documentation for its use in treatment of muscle pain, myofascial pain, headaches & pain mgmt. were not incorporated or included in the policy, unfortunately; however, the usual neurological indications for torticollis, spasticity, dystonia, etc, are included, as they were in the previous policy. Muscle spasm (728.85) and hyperhydrosis are included, among the list of many ICD-9 codes.  After one year of revision, this is now final as of 7-6-04.
 
Inpatient Rehab Policy
My most recent contact with the Medicare nurse in charge of this issue (Tammy Padgett) suggests that there hasn't been a final decision as to whether there will be a LCD (Local Coverage Decision) policy for Inpatient Rehab (for Florida Medicare).  She is getting individual summary letters to the individual providers who were part of the widespread probe process.  She assured me that she would contact me for my (our) input once a decision has been made.  I will need help in reviewing this policy & providing input, so I will contact FSPM & R members once I am contacted again.
 
Please contact me for any questions on these matters (cgzittel@aol.com; Sylvia Yost, Secretary, 407 643 1328). 
FSPMR August 2004 Minutes, page 5

5.  Dr Zittel was awarded a plaque for her continued efforts as FSPMR’s Medicare CAC Representative.  Post this meeting, she wrote in, “…thank you to all the FSPMR membership and Exec Committee for my plaque of recognition for the CAC work I've done.  I appreciate it very much.”
 
Dr Freed discussed the 75% Rule.  In-patient rehabilitation continues to take hits.  Per the 75% Rule, there will be continued reduction (10 – 20%) in rehab beds.  The 75% Rule will be instituted over the next 4 years.  There is a moratorium on this until September.  Details about this and its concomitant Amendment can be found on AAPM&R’s website at http://www.aapmr.org/.  Most Florida legislators support the Lowey-Wamp 75% Rule Law.

New Business:

 Next Meeting:  In conjunction with the FL Academy of Pain Medicine –
Friday – Sunday, July 29 – 31, 2005, The Gaylord Palms Resort and Convention Center, Orlando (technically Kissimmee) – a mile from the Disney gates.  Room rate is $149 single/double, and reservations can be made by calling 407 586 0000, and tell them you're with the Florida Academy of Pain Medicine.

Lorry suggested that since FSPMR was meeting in July of 2005, we should not meet in August of 2005, in conjunction with the work comp conference.  There was agreement.  Dr Dehgan discussed the Jacksonville physiatric scene and suggested that FSPMR meet there in the spring.  He suggested that the meeting might be in conjunction with a Mayo Clinic EMG course.  Both Dr Dehgan and Dr Nwaogwugwu cited a relationship with the clinic and said they would work together to see if an FSPMR meeting could be held there.  Dr Christopher suggested that if a Jacksonville meeting could not be worked out, FSPMR should meet in April of 2005 with SSPMR in New Orleans.  There was agreement.

 There will be NO meeting in conjunction with the 2004 AAPM&R Annual Assembly, October, Phoenix, AZ.

Respectfully submitted,

Duby Avila, MD
FSPMR Secretary

 

FLORIDA SOCIETY OF PHYSICAL MEDICINE AND REHABILITATION
June 13, 2004
The Ritz Carlton Coconut Grove
12:30 – 3 pm 

MINUTES 

Thank you to Advanced Prosthetics and Orthotics of America who not only sponsored this meeting, but is also a partial sponsor of our website. 

Presiding:  Enrique Monasterio MD, Vice President

Present:  (in order of sign-in) Drs Cynthia S Crawford, Erick Grana, Enrique Monasterio, Ibiza Nevares, Dorothea D Glass, Lilla Shkolnikov, Craig Lichtblau, Ronald Tolchin, Tony Dorto, Israel Grinberg, Robert Dehgan, and Duby Avila, Executive Director Lorry Davis

Guests:  Drs Anjan K Ghosh, Alexandra Vadasz, Paul Kotturan, and Monica Grinberg. 

Old Business:

1. A motion was made and carried to accept the minutes of the August 19, 2003, Orlando Meeting.

2. The following Membership Report was presented by Robert Dehgan MD:

(note:  Dr Dehgan serves as President of the Putnam County Medical Society) 

We currently have 115 members, 8 of whom are retired.  We lost some members in the past year to nonpayment of dues (3 notices are sent), and Dr Lawrence Prokop has moved to Michigan.

 We again 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 2 new member applications.  The cost was $77.  We will engage in this process again for 2005.

 A motion was made and carried to accept the following as members:

Duby Avila MD                        Kissimmee                 sponsor:  Enrique Monasterio MD

Gary H DiBlasio MD                W Palm Bch                             Craig Lichtblau MD

Lance S Cassell MD                 Sarasota                                   Oregon Hunter MD

Israel Grinberg MD                  Pembroke Pines                       Dagoberto Garcia MD

Mohan S Gulati MD                 W Palm Beach                         Ronald Tolchin DO

Youssef Wassef MD                Gainesville FL                           Justine Vaughen MD

P Mark Glencross MD, Jacksonville     (member FAOEM/ACOEM) and Bao T Pham DO, Orange Park, need recommending members.

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

Michael Bertram MD               

Ariel Inocentes MD                  Jairo Parada MD

Terrence Peppard MD             Enrique Monasterio MD 

   3. Treasury Report:

Dr Colleen Zittel, Treasurer - Specific information on the Treasury Report can be obtained by members from Lorry S. Davis, Executive Director, PO Box 330298, Atlantic Beach FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net 

4. Legislative Report –
   1. Workers’ Compensation – Lorry Davis reported that Jesse Lipnick MD, is  FSPMR’s rep on the FMA’s Workers’ Compensation Advisory Board.  Dr Lipnick has been vocal about the difficulties with DWC Form 25.  The major legislative work comp activity during the 2004 sessin was restructuring the Workers’ Compensation Joint Underwriting Administration.  However, when Governor Bush signed the bill, he vetoed

the appropriation.  Therefore, it is thought that in 2005, work comp will again be a hot item in the Florida Legislature.

2. PIP – Ronald Tolchin DO, read the following report from Dr Mark Rubenstein:  (Note:  Dr Rubenstein is in line to become the President of the Palm Beach County Medical Society).

“This regards a new administrative rule which has been adopted as FL Statute 627.736(5).  In August of 2003, a notice of rule development was proposed at a statewide level.  Insurers from personal injury matters requested that the State adopt legislation that would limit diagnostic tests in patients who sustained personal injuries.  The list was

broad, and INCLUDED EMG/NCS.  The FSPMR and other organizations responded to the statewide request.   In Sept of 2003, a public workshop occurred in Tallahassee where input from various members of the health care and insurance communities provided data.

In Oct of 2003, I was personally contacted by the State Attorney via a third party.  I supplied literature and advice regarding appropriate and inappropriate items for inclusion of this ‘list’ of tests.  I was successful in block needle electromyography and never conduction studies from being included on this list (to the dismay of the insurance companies).  Somehow the State enlisted my services in reviewing and providing appropriate wording for the administrative rule.  The ‘rule’ was adopted into law on 1/7/04.

Since the law was adopted, a chiropractor has objected and filed suit.  The State Attorney has retained me as an expert on behalf of the State (and insurance companies) to review the allegations, etc.  This has entailed reviews of depositions, interrogatories, literature, etc.  The major objection to the rule is currently use of Surface EMG as a diagnostic tool.

On July 19 and 20, I will be in Tallahassee testifying (as an expert for the State).  Currently, we are reviewing the merit (or lack thereof) of the chiropractor’s objections.

I will keep you updated as to any other issues which may be relevant to the FSPMR.”

A copy of the “Notice of Proposed Rulemaking” and/or a copy of the statute as entered into law 1/7/04 can be requested from Lorry Davis. 

Dr Dorto commented on noncovered services other than surface EMG, such as spinal ultrasound. 

5. Dr Tolchin discussed the new PM&R residency program.

New Business:

1. Dr Dorto read the following Message from the Outgoing President, Jairo Parada, MD:   

“I am sorry I will miss the meeting on the 13, but I need to go to Colombia due to  family matters.  I want you all to know it has been a great honor to have been the president of our society for the  past 2 years .I want to thank all of you for  your help, especially Lorry, as I do not believe I could have done it without her tremendous help.  For this I will always be grateful.

I have seen first hand the great job done by the FMA on behalf of ALL physicians, and I encourage our members to join and remain members of our umbrella organization which is the only way to successfully tackle the many and rather perilous obstacles facing organized medicine and the practice of our specialty.  I also want to encourage you to

become politically active and support financially, political candidates that are friendly to our profession just as has been done for many years by insurance companies, businesses, attorneys, chiropractors, and other organizations.   I feel we have reached a point where these expenditures are part of the ‘cost of doing business.’

I am confident our incoming president will continue to lead us in our future endeavors and  I wish Dr Monasterio great success in his  presidency.”

2.  Dr Dorothea Glass presented the following Slate of Candidates for 2004 – 2006:

President – Enrique Monasterio MD
VP – Venerando Batas MD
Treasurer – John Muenz MD
Secretary – Duby Avila MD

Members-at-Large:
Rigoberto Puente-Guzman MD
Walter Conlan MD
Mark Rubenstein MD

Past President - Jairo Parada, MD

Medicare CAC Liaison – Colleen Zittel MD

3.  A motion was made and carried to accept the above slate of officers.

4. Comments from Incoming President – Dr Monasterio thanked the members for electing him President.  He plans to focus on increasing membership which in turn will give us a bigger bank account, which in turn will give us the means to give more politically and have more impact.

5. Dr Monasterio plans to attend the FMA July and September meetings to represent FSPMR.

Good and Welfare:

1. Next Meeting:  In conjunction with the FL Work Comp Conference, with FAOEM, Tuesday, August 24, 12 – 3 pm, Orlando World Center Marriott. 

We’re looking for sponsors, $2500.

2.  SSPMR 2003, May, Richmond, VA, went well.  SSPMR is trying to get other state societies to meet with them, hopefully first weekend in May, 2005, New Orleans. 

3. Meeting – Spring/Summer 2005:  After discussion about the merits of meeting with SSPMR in Spring of 2005 (delineation led by Dr Robert Christopher), and the merits of meeting again with the FL Academy of Pain Medicine in the spring/summer of 2005 (delineation led by Dr Glass), a motion was made and

carried to meet again with the FL Academy of Pain Medicine in spring/summer 2005. 

Respectfully submitted, 

Lorry S Davis MEd, FSPMR Executive Director                                  fspmr june

Tuesday, August 19, 2003, 12 – 2 pm
Crystal Ballrooms E & F
Orlando Marriott World Center

 MINUTES

Many thanks to Allergan, Inc, for sponsoring today’s luncheon, and to Venerando Batas, MD, FSPMR Secretary, for making today’s presentation on Botox.

 Presiding:  Jairo Parada, MD, FSPMR President, and Homi Cooper, MD, FAOEM President

 Present:  Drs Karen Carlson, Ken Phillips, Mark Rubenstein, Jodi Shields, Monica Grinberg, Jairo Parada, Enrique Monasterio, Colleen Zittel, Ramon Cagtellanos, Tony Dorto, Venerando Batas, Sunita Patel, Gary Newcomer, Gary Clonts, Michael Hankins, Mike Band, Stuart Brooks, Jim McCluskey, Phyllis Gerber, Seth Feldman, Tom Dukowitz, Stan Haimes, Howard Eskildsen, Michael Webb, Robert Dehgan, Robert Fleigelman, Stephen MacDonald, Jock Sneddon, Michael MacDonald, Joan Watkins, Richard Johnson, Richard Dolsey, Bob Chapa, Emmett Ferguson, Homi Cooper, Jeanne McGregor, Leon Behar, PM Glencross, Executive Director Lorry Davis.

Guests:  Fred Whitson JD/FMA, Jean Feldman RN/Choice Medical Mgmt, Bob Griffin – Dir PrimeComp Network, Billy Reddin – Mgr for Dr Chapa, Diana McCluskey MPH – Dir NIOSH Educational Resource Center, Nat Levine – Practice Mgr, Drs Ramon Castellanos, Ariel Inocentes, Rosa Bruce, and Indrek Melder.

 Self-introductions all around.

 Update on Florida’s New Work Comp Law – Fred Whitson, Atty, FMA; Michael Webb MD, FAOEM.  Atty Whitson outlined his article, “Practice Matters,” which is attached.  Dr Webb outlined “New Law Changes (SB 50A) 2003,” which is also attached.  Additionally, Whitson stated that there will be a 20% decrease in reimbursement for dispensing meds, Oct 1; the part of the new law dealing with practice parameters is problematic – is yet to be seen what’s going to be used here; causality has to be 51%; physicians can negotiate above the fee schedule.  4 or 5 reasons about why you should be getting reimbursed at a higher level need to be written into contracts with payors abFL has 3 Medicare regions with different reimbursements – these may or may not be used for work comp; there is no phase-in, it’s a go Jan 1, 2004.

 Respectfully submitted,   Lorry Davis, MEd, Executive Director

 FSPMR Minutes, Presiding:  Jairo O Parada MD, President

Old Business

1. Minutes of the May 18, 2003, Hilton Clearwater Beach Resort, were approved – Dr Venerando Batas, Secretary.
2. Membership Report:  Dr Enrique Monasterio, VP.  We currently have 125 members, 8 of whom are retired.  We have 1 inactive member.  There are 116 dues-paying members. 

Inducted into membership were:

Lewis J Herzbrun MD, Eustis, sponsored by Dr Monasterio

Anrdrew L Sherman MD, Miami, sponsored by Dr Monasterio

Jay N Wright MD, Ocoee, referred by Dr Marc Gerber

Mohan S Gulati, MD, W Palm Beach, needs a sponsor (anyone reading these minutes able to do that?)

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

Jon Erich MD (Colleen Zittel MD)

David Ernstoff MD (Rodolfo Eichberg MD)

We will again be working with AAPMR to target their Florida members who are not yet FSPMR members.

    3. Treasury Report:  Dr Colleen Zittel, Treasurer - Specific information on the Treasury Report can be obtained by members from Lorry S. Davis, Executive Director, PO Box 330298, Atlantic Beach FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net 

4.      Report on PIP- Dr.Parada discussed the Dept of Health approaching the FMA regarding which tests are appropriate for these types of patients. A list of approved tests has been proposed . Spinal Ultrasound, Dermatomal SSEPs are examples of excluded tests. On behalf of FSPMR, Dr Parada recommended that NCSs not be excluded, that they be performed in conjunction with EMGs, and in the method approved by the American Academy of Electrodiagnostic Medicine.  The results of various specialties’ input to the Dept of Health is not yet known.

5.      Medicare report- Dr. Zittel… She discussed the Medicare Biofeedback policy revision, which is for neuromuscular re-education, not pain management. With the help of Dr Freed and several Florida Hospital PT’s, multiple ICD-9 codes regarding spinal cord injury, stroke, etc. were added.  The final policy, hopefully incorporating our suggestions, will be out in the next several months.   Additionally, she mentioned about Greater Occipital Nerve Block Policy-defining indications and ICD-9. Furthermore, she mentioned about NCV-EMG policy should be patterned after the AAEM guidelines.  Watch your Medicare Provider B Update for new or revised policies when they come out.  All draft as well as final policies can be accessed on www.floridamedicare.com.

New Business

6.      New Business: OK to proceed with again joining the Florida Academy of Pain Medicine annual meeting in 2004.  It will be in Coconut Grove, June 11 – 13.

Good and Welfare

7.      Message from Robert Christopher MD:  “Unfortunately, I won’t be able to attend the luncheon in Orlando on August 19.  On that day, Doreen and I will be leaving Orlando to fly to Great Falls, MT, where we will be joining a tour of Glacier Park and the Canadian Rockies.  We will return on Aug. 28.  Best wishes for a successful meeting.”

8.      Central Florida Job Posting:  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 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.

iii. Survey carriers to determine the estimated impact on carrier costs and Workers’ Compensation premium rates by implementing changes to the carrier reimbursement schedule or implementing alternative reimbursement methods.

 iv. Submit recommendations on or before January 1, 2003, and biennially thereafter, to the President of the Senate and the Speaker of the House of Representatives on methods to improve the Workers’ Compensation health care delivery system.

 v.  The division shall provide data to the panel, including but not limited to utilization trends in the Workers’ Compensation health care delivery system. The division shall provide the panel with an annual report regarding the resolution of medical reimbursement disputes and any actions pursuant to s.440.13(8)

 c.   PAYMENT OF MEDICAL FEES. -

 Fees charged for remedial treatment, care, and attendance, except for independent medical examinations, may not exceed the applicable fee schedules adopted under this chapter.

 d.  For any self-insured employer or carrier who elects to deliver the medical benefits required by this chapter through a method other than a Workers’ Compensation Managed Care Arrangement, the discontinuance of the use of the Workers’ Compensation Managed Care Arrangement shall be without regard to the date of the accident, notwithstanding any other provision of law or rule.

 2.  New Medical Fee Schedule (effective July 8, 2002)

Health Care Provider Fee for Service Reimbursement Manual, 2002 Edition
In Adobe Acrobat format, 1.2 mb. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.
 

Presented by Michael J. Webb, MD
Medical Director, U.S. HealthWorks - Ocala
Florida Workers’ Compensation Institute Conference
Wednesday 8/21/02

The Expected Outcomes
In Adobe Acrobat format. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.

Florida Medical Association, Inc.
Summary of Major Actions
Board of Governors
July 20-21, 2002
Westin Diplomat Resort  
Hollywood, Florida  

• Council on Ethical and Judicial Affairs

• ·         Approved that a charter be issued establishing the Franklin County Medical Society.

• ·         Reaffirmed and sunsetted FMA policies under the ten-year old review policy.

• ·         Recommend to House of Delegates that Gonzolo Huaman, M.D. and Charles Mutter, M.D. be reelected to the Council and the seat being vacated by Dr. Charles Eytel be submitted at a later date.

 Council on Legislation 

• Approved that the FMA seek legislation that will provide for a cause of action in prompt pay cases, the disclosure of fee schedules by managed care companies; and legislation prohibiting hold harmless clauses in contracts.
• Support legislation prohibiting retaliatory action against a provider.
• Support legislation creating a licensure category for “Anesthesiology Assistants” under the supervision of a licensed physician.
• Approved that the FMA proceed with passing a tort reform bill with some or all of the following provisions: issues relating to expert witness; subsequent treater, collateral sources, periodic payment, offer of judgment, medical review panels, bifurcation of trials, standard of proof, jury pool composition, control over settlements, joint and several liability, no mandatory insurance, and sliding scale for attorney contingency fees.
• Approved workers’ compensation as a legislative priority for 2002-03.
• Approved continued opposition for the following:

Oppose legislation allowing bare bones health insurance policies, but look toward insuring more patients and use of medical savings accounts.

Oppose licensure of hospital administrators.
Oppose scope of practice expansion issues for non-M.D.s and non-D.O.s.

• Approved reaffirmation or sunsetting of ten-year old policies, except the PMATF policy not be sunsetted.

Council on Medical Economics

• Approved recommending to the House of Delegates that Resolution 01-48, Hospital Self-Designation for Specialty Care, not be adopted.
• Approved recommending to the House of Delegates that Resolution 01-61, Medicaid Hospital Services Physicians’ Certification, be adopted.
• Reaffirmed and sunsetted FMA policies under the ten-year old policy.

Council on Medical Education and Science

• Recognized the need to review and update the FMA courses on HIV and AIDS and direct staff to explore available sources for development and funding of this project including coordination with resources in Florida and assist the CME Committee with course development.
• Approved recommending to the House of Delegates reaffirmation of ten-year old FMA policies.

Council on Public Health

• Approved that the FMA and the CMSs have a defined role in state, regional and local disaster     training, planning and funding; and are an integral part of the planning process with the Department of Health and the Florida Department of Law Enforcement.
• Approved that the FMA create an FMA Environment and Health Section under the Council on Public Health that advises the Board on issues of the natural environment as these issues may affect the public health.

Approved recommending to the House of Delegates that Resolution 01-10, Global Warming Response Plan, be adopted as amended.

• Approved that the FMA write a letter to the Department of Health (DOH) voicing support for the Community Environmental Health Advisory Board and encouraging the DOH to resume regular meetings of this Board.
• Approved supporting the concept of a nationwide health tracking network that monitors chronic diseases and environmental factors that may be related to them and that the FMA be an advocate for this network.
• Approved the creation of a Minority Health Care Section under the Council on Public Health for the FMA to take a lead role in addressing minority health care issues and public health care disparities in Florida.
• Approved recommending to the House of Delegates FMA policies to be reaffirmed or sunsetted.

Committee on Managed Care 

• Approved recommending to the House of Delegates that FMA policies be reaffirmed or sunsetted in accordance with FMA sunset policies.

Specialty Society Section

• Approved that the FMA give the Florida Academy of HIV Medicine initial recognition as a recognized specialty society of the FMA.

Medical Student Section Governing Council

• Approved amending the FMA Bylaws to increase the number of medical students in the FMA House of Delegates from three to four delegates and alternate delegates.
• Approved that the Medical Student Section Bylaws be amended reflecting changes in duties of its officers, to increase MSS delegates in the FMA House of Delegates and make editorial changes updating the bylaws.
• Approved that a new award category of “Advocate for Medical Students” be created and that the first recipient be awarded to Madelyn E. Butler, M.D.

Task Force on Tort Reform

• The Board received a comprehensive report from the Task Force on Tort Reform, chaired by Dr. Dennis Agliano. 

Task Force on Membership

• Approved changing the FMA Charter and Bylaws to allow direct membership in the FMA and to allow county medical societies and other association memberships independent of the FMA; and that this provision be reviewed in two years and modified as necessary.
• Approved that the delegates to the FMA House of Delegates be allocated proportionately by representative groups; that each physician member of the FMA shall be allowed to designate not more than two of the following representative groups to represent him/her in the FMA House of Delegates:  County medical societies, FMA recognized specialty societies and FMA recognized societies organized by physicians sharing and wishing to advance a common interest; and that the provision for representation in the House of Delegates be reviewed in two years and modified as necessary.

Committee on Bylaws

• The Board approved bylaws changes implementing the membership changes and representation in the House of Delegates; approved changing the bylaws to allow a seat on the Board for the FLAMPAC President, Chair of the Specialty Society Section, and the Chair of the Conference of Medical Society Executives; approved other changes and revisions to bylaws for recommendation to the House of Delegates.

Report of the Executive Committee

• Approved the sale of the FMA building at 100 E. College Avenue, relocate to the Adams Street building, relocate some staff outside downtown area, pay off existing loan and invest proceeds.
• Approved nominations for FMA Awards to be presented at the Annual Meeting.
• Support continued fund for a public relations campaign next year focusing on physicians’ issues.
• Support a statewide demonstration to publicize the issue of professional liability insurance.

Other Actions

·         Approved that the President and Executive Committee be authorized to appoint task forces and advisors to hire consultants as necessary for tort reform.

·         Approved sending RFPs for a public relations firm to focus on constitutional amendment activities in 2004 and report back with recommendations at the November Board meeting.

·         Approved $800 to Tim Bullard, M.D. to continue efforts on expert witness database.

·         Approved in-kind contributions from the FMA to the Citizens for Tort Reform

Facts About the Medical Malpractice Claims Crisis in Florida
Matt Gracey, Malpractice Insurance Specialist

ü     We are now in an unfolding malpractice insurance crisis because claims against doctors have skyrocketed.  Malpractice insurers did not collect enough premiums in the last five years to cover these claims and have either left Florida’s market or are severely restricting their underwriting requirements.  Only a handful of companies are still offering coverage in South Florida, whereas almost forty companies vied for the doctors’ coverage only three years ago.     

 ü     Between 1980-1999 there was a 995% increase in indemnity and legal expenses in Florida for paid medical malpractice cases.  That is a huge increase per year on average and is the real cause of the malpractice claims crisis.

 ü     The average legal expense in these cases in 1980 was $5,208.  In 1999 it went up to $39,747.

 ü     Many plaintiff attorneys say that the malpractice insurance crisis is just another insurance company problem.  They blame the high rates on 9/11 and insurance companies’ lowered investment returns with the downturn in the financial markets.  Both of these situations certainly have caused rates to increase by some percentage points, but are not the real cause of the tremendous increases in rates that we have seen.   

 ü     Nuisance Cases:  The above claims numbers are for paid cases only, and do not take into account the incredible expense, aggravation, loss of time, and stress caused by the majority of claims filed against doctors that are groundless and are stopped without any indemnity payments.    Nationally malpractice insurers close 70% of cases against doctors without any payment made.  The dominant company in Florida closed 82% of their cases in 2000 without payment. 

ü     74% of the total indemnity payments made in Florida in 1999 were for non-economic damages.  Many states, including California, have reformed their tort laws to place a cap on these non-economic damage awards.  In virtually every state that has done so, malpractice insurance claims and rates have stabilized. 

ü     If the insurance companies were making exorbitant profits we would have many offering coverage today in Florida.  In fact we have gone from 40+ companies offering malpractice insurance coverage in Florida three years ago to less than six viable companies today.  The second largest malpractice insurer in the country, St. Paul Company, recently announced that they lost almost $1 billion last year and that they will no longer be renewing the policies for 42,000 doctors nationwide.   

ü     Often we are seeing in article headlines now associated with anti-tort reform efforts that medical errors account for 98,000 deaths each year.  While obviously successful in generating massive amounts of media attention, the study that produced this number was very flawed.  The data was from a State of New York 1984 study and then was repeated using 1992 data from Colorado and Utah.  The 98,000 deaths was a number the study authors extrapolated from the 1984 controversial analysis of 180 actual deaths out of 30,000 acutely ill, hospitalized patients. In the 1992 data analysis, again very flawed data was extrapolated and 44,000 deaths from medical errors were reported.  Even the incredibly high spread between 44,000 and 98,000 should be a warning that the results are flawed but the headlines and plaintiff attorneys, of course, always use the 98,000 number.     

Know the facts behind the current malpractice crisis that is threatening the practices of many Florida doctors.  Unless we get meaningful tort reform the claims against doctors will continue to increase, and the malpractice insurance prices will follow.   

For more information on facts, figures, tort reform efforts, and information on malpractice insurance, contact: 

Matt Gracey
Malpractice Insurance Specialist
Gracey - Danna, Inc.

(800) 966-2120 / (561) 276-3553

Medical Malpractice Insurance Evaluation Checklist

 You are encouraged to use this checklist every year to ask important questions about your current policy and company or one that you might be considering.

q       What is the company's A.M. Best rating?  You should not settle for any insurer rated less than an “A-“ unless there are mitigating factors that make good business sense.

q       How long has the company insured physicians in your state?

q       What is the history of their rate charges in your state and elsewhere? Ask about the number of rate increases or decreases the carrier has had in the past several years.

q       Is a large concentration of the company's policyholders in a higher risk territory or specialty? If the carrier has a larger insured exposure in higher rated territories like Dade, Broward, and Palm Beach counties or in higher risk medical specialties it could cause claims to soar and the carrier could incur a larger loss impact. As a result of this exposure, the carrier could impose severe rate changes or worse, leave the state. This creates many concerns including policyholder non-renewals, lost vesting of tails, and could jeopardize the quality of defense for open claims.

q       What is the company's policyholder surplus?

q       What is the company's overall medical professional liability premium volume in your state?

q       Are the exclusions outlined and clearly defined?

q       Are the policy definitions clear and straightforward?

q       Does the information on the application become part of the insurance agreement?

q       What are the "tail" provisions upon termination of the policy? Does the "tail" coverage offer unlimited duration or is it limited to a certain number of years? What are the retirement requirements for "tail" coverage? The policy should have provisions for vested tails upon retirement, disability and death.

q       Is defense coverage offered outside or inside the limits of liability?  (It should always be outside.)

q       What is the claims coverage "trigger?" A "demand trigger" is so unfavorable that you should always insist on a trigger that recognizes an “incident report.”

If you accept a demand trigger (and you often aren't asked) the company will not defend any incidents you might report until the incident turns into a written demand or claim against you. This can cause serious problems when changing carriers. The new company, and your previous company, will exclude the incident from coverage because you had prior knowledge of and reported the incident to your previous insurer.

q       How is your corporation, professional association or other entity covered? Can you endorse the policy to properly cover a corporation for free on a shared limits basis or can you purchase separate, affordable corporate coverage?  Is vicarious liability coverage included in the separate corporate policy? (It should be.)  Even if you are a solo practitioner and have formed a closely held professional association, it should be named on the policy.  

q       How are your employees covered?  What about coverage for any skilled ancillary personnel like physician assistants or surgical assistants who are often excluded from coverage under the standard policy forms? 

q       Who are the company’s defense lawyers? Are they local attorneys and do they have experience in defending medical professionals?  If you are sued, will your case be handled by a senior member of the legal firm or assigned to a less experienced associate?  

q       Is legal defense coverage offered for investigations by the Agency for Healthcare Administration (AHCA)?  Are there different policy limits for this coverage?

q       Is coverage offered for defense of regulatory investigations of Medicare / Medicaid usage and billing practices? Are there different policy limits for this coverage?

q       Is the "Retroactive Date," sometimes called a prior-acts date, the same as your previous policy? Your retroactive date is critical. You should personally check the date on your policy each year. Remember that when switching companies, it is usually better to keep the same retroactive date with your new company rather than purchasing a "tail" and going onto a first year claims-made policy.

q       Is your policy effective date the same as your previous policy? (It must be the same to avoid gaps in retroactive coverage.)

Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Gracey - Danna, Inc.  He has created successful and stable malpractice insurance programs for numerous south Florida and statewide medical organizations, including the Palm Beach County Medical Society.  He continues to lecture and author educational material to help doctors understand their insurance issues.

New Law Changes (SB 50A) 2003

Highpoints of Medical Features

Michael J. Webb, MD

Florida Workers’ Compensation Institute

August 18, 2003 

I.      Improvement of employer/employee access to quality care: increase in physician participation.  Many physicians had left the Workers’ Compensation system because of the low fee schedule (the lowest of the 50 states) and because of administrative demands which accompanied work injury treatment (“hassle factors”). 

New Fee Scheduled Effective January 1, 2004: 110% of Medicare for non-surgical CPT codes; 140% of Medicare for surgical CPT codes (or present fee schedule, whichever is higher).

 Negotiation of fees: Physicians and carriers can negotiate contracts which pay above the fee schedule (reason must be stated in the contract). 

II.      Reduction in hassle factors: The Division of Workers’ Compensation will standardize physician reports to employers and carriers, thereby reducing the number and variety of forms which challenge the physician.  Effective January 1, 2004, the Department of Financial Services shall require that all medical bills properly submitted by the provider be paid within 45 calendar days.

 III.      Enhancement of quality, reduction in variation of medical services and improvement in resource utilization: Requirement of clinical practice guidelines adopted by United States Agency for Healthcare Research and Quality (AHRQ).  Independent Medical Examinations. 

Intended results: put physicians and carriers on “same page” regarding acceptable guidelines for quality care; speed authorization of requested diagnostic studies and treatment; reduce the number of unnecessary tests and treatments.

 Reality:  AHRQ maintains a library of clinician guidelines but does not endorse or update specific state regulatory process to remedy this shortcoming is expected (e.g., establishment of a Clinical Care Guidelines Committee which will review AHRQ and offer resources and produce edited versions of existing guidelines).

 Independent Medical Examinations: In cases involving dispute, effective October, 2003, the employer and employee are entitled to only one IME per injury (rather than per specialty).  If the employee wins the dispute, the employer will reimburse the cost.

 If care is being provided under a managed care arrangement, the carrier will pay the costs of the IME if a network physician is used.  The parties may mutually agree to a “consensus IME”, when the conclusions shall be finding to both parties.

 Reasonable necessary medical care of injured workers shall in all situations: 

1. Utilize a high intensity, short duration treatment approach that focuses on early activation and restoration of function whenever possible.

2. Include reassessment of the treatment plans, regimes, therapies, prescriptions and functional limitations or restrictions presented by the provider every 30 days.

3. Be focused on treatment of the individual employee’s specific clinical dysfunction or status and shall not be based upon non-descript diagnostic labels.

IV.      Establishment of a compensable work injury condition: A greater focus on reasonable medical care benefits: Effective October 2003, the establishment of a bona fide work injury or medical disorder must be based on objective relevant medical findings.  Pain alone, or other physical complaints, in the absence of objective relevant medical findings, will not be compensable. 

Causation:  To be compensable, the work injury must be the major contributing cause (greater than 50%) for the condition which is under treatment (compare to “old law”: major contributing cause is defined as being greater than any other contributing cause).

Tuesday, August 20, 2002, 12 – 3 pm
Aruba and Bahamas Rooms
Orlando World Center Marriott 

MINUTES

 Many thanks to Elan Pharmaceuticals for sponsoring this luncheon and to Dr David Hocker for presenting “How to Prevent Lost Time for your Occupational Medicine Clients with Skelaxin and Sonata

 Present:  (in order of sign-in) Bob Chapa MD, Homi S Cooper MD, Jairo Parada MD, Michael Macdonald DO, Joan Watkins DO, Venerando Batas MD, Toni Belisle MD, Leon Behar MD, Seth Feldman DO, Stephen MacDonald DO, William J Bryant DDS, Michelle Eaton MD, Eve Hanna MD, Jolen Keller MD, Robert Dehgan MD, Guy N Crump MD, Mark Rubenstein MD, Tom Quinn DO, Rich Johnson MD, Nick Potochny DO, Alan Doyle DO, Colleen Zittel MD, Enrique Monasterio MD, Michael Hankins MD, Gary Clonts MD, Stan Haimes MD, Erick Grana MD, Robert Fleigelman MD, Richard Dolsey MD, Mitchell Freed MD, David Haddock MD, Jock Sneddon MD, Victoria Rabe-Tagala MD, Kathleen Jenkins MD, Jeanne McGregor MD, Mike Band DO, Matt Imfeld MD.

 Presiding:  Jairo Parada MD, FSPMR President  & Homi Cooper MD, FAOEM President

 Self-introductions all around. 

1. Update on What’s Happening with Work Comp Legislation –

1.  Michael Webb MD, FAOEM FMA Liaison, Co-Chair FMA Medical Economics Committee.  Please see the attached “Medical Service Features of 2002 Workers’ Compensation Legislation.”

2. Jerry Fogel, Study Director for mandated Three Member Panel Study (Health Care Provider Survey) – discussed comprehensive work comp reform for the 2003 legislative session that is supported by the Florida Medical Association.  Mr Fogel works on this project with Dr Webb and Claude Revels, an employer representative with JM Family Enterprises, who stepped into the meeting momentarily to introduce himself.  Dr Webb will keep us as informed as possible regarding this developing reform.  Please see the attached “The Expected Outcomes.”   

2.   Review of FMA’s Board of Governors Summary of Major Actions, July 20 – 21, including 2003 Legislative Agenda (note work comp is a priority) – Dr Cooper, Enrique Monasterio MD, FSPMR Treasurer – please see attached “FMA Summary of Major Actions.”

3. Tort Reform – Mark Rubenstein MD, FSPMR, Treasurer Palm Beach Co Medical Society, discussed “Facts About the Medical Malpractice Claims Crisis in Florida,” (attached) and gave us a “Medical Malpractice Insurance Evaluation Checklist.” (attached).  Dr Rubenstein suggests contacting Matthew Gracey, Malpractice Insurance Specialist, for guidance (Gracey-Danna Inc, 62 SE 6^th Ave, Delray Beach FL  33483, ph 561 276 3553, fax 276 6545, gracey@graceydanna.com).  Dr Rubenstein is well aware of the crisis, especially since he is from So FL and they have been the hardest hit.  He serves on the Tort Reform Committee for the Palm Beach Co Medical Society and several months ago flew with a contingent of over 100 to Tallahassee for a march on the capitol, and more recently participated with 400 other physicians and health care professionals who marched on the courthouse in West Palm Beach.

 FSPMR and FAOEM then broke into separate groups.

 Respectfully submitted, Lorry S Davis, MEd, FSPMR Executive Director

 Old Business: 

 1. Minutes of the May 25, 2002 meeting at the JW Marriott Lenox, Atlanta were reviewed and approved.

 2.  Dr Monasterio’s Membership Report:  Currently, we have 128 members, 8 of whom are Senior Members (retired), 1 inactive member, leaving 119 dues-paying members.  As of the writing of this report, Aug 7, 101 of the 119 dues-paying members have paid.  Colleen Zittel, MD, Treasurer, has organized a phone campaign amongst the Executive Committee to try and retrieve these 18 members.

 In an effort to continue building membership, in accordance with our decision at our May meeting, we have used the 2002 AAPMR directory to add those members who practice in FL, but are not yet FSPMR members.  At the May meeting we decided that we would add those who had emails to our broadcast database, as this incurred no additional expense for the society.  In the 2002 directory, there were 118 FL members who were NOT FSPMR members.  Of these 118, 48 were not retired and had email addresses.  Once those email addresses were tried, 7 of them came back, leaving 41 additional PMR docs in FL who will regularly receive our broadcast.  As of this report, they have received 2 broadcasts, and an invitation to join with an attached membership application.  Most likely, the repetition of these broadcasts will net FSPMR a few more members.

 Another membership tool which we will be discussing in a bit is the possibility of paying AAPMR a fee for sending FSPMR recruitment material to all members in FL who are NOT current FSPMR members.

 3. Dr Zittel’s Treasury Report:  Specific information on the Treasury Report can be obtained by members from Lorry S. Davis, Executive Director, PO Box 330298, Atlantic Beach FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net 

4. Dr Zittel’s Medicare Report:  There has been an error on the reimbursement by Medicare on Motor Nerve conduction studies with F wave.  Medicare has been reimbursing only for Motor Conduction studies instead of motor with F wave (See E below and the attached AAEM Practice Topics June 2002 handout):

 Medicare/ CAC Update for FSPMR Meeting  Tues Aug 20, 2002

A.  New Local Medical Review Policy: S-I Joint Injections FL Medicare is making a new policy to cover the indications, frequency of, and other aspects of SI injections.  I have received input for this policy from helpful FSPMR members including Matt Imfeld, Marc Gerber and Jim Zebranek- thank you!  The rough draft will be presented at the Sept 14th CAC meeting which Walt Conlan and I will attend.  Anyone performing these injections in practice, or anyone willing to help critique this policy, we need your help, please contact me (cgzittel@aol.com, or work phone 407-643-1328), up until the date the policy becomes final, October 30th 2002.  Will keep you posted. 

B. Recent Policies- Comprehensive Motion Analysis (aka gait lab) (Policy # 96000). With help from Mitch Freed and his contacts, we submitted requests to broaden the scope of this policy, change wording.  Final policy to be posted on website www.floridamedicare.com (click Part B, policies).  Medicare will now cover this for certain diagnoses.

 C. Recent Policy- Debridement Services (aka wound care) (Policy# 11000). Walt Conlan did a great job reviewing this.  It is a good policy, stating what diagnoses debridement can be billed for, documentation requirements, etc.  See it on above website.

 D.Upcoming CAC Issue:  Updating Florida Medicare NCV and H-Reflex Policies

Recent Medicare Memorandum (B-01-61 from 9/26/01) on "ICD-9 Coding for diagnostic Tests" requires us to use "symptom codes" rather than dx codes if test results are normal.  The current NCV/H-Reflex policies do not allow enough of these symptom codes in order to bill correctly.  I sent a certified letter to Sid Sewell, MD, Director of Florida Medicare, requesting they update both policies, using the AAEM's newly updated "Recommended Policy for Edx Medicine".  They will consider the change and I am waiting a final response from them.  Will keep you posted.

 E. Important Correction to Nov 2001 Medicare Fee Schedule Improve your NCV reimbursement on CPT 95903.  Medicare made an error in initial fee schedule, reimbursing 95900 higher than 95903.  According to AAEM, "physicians must resubmit claims for all Motor with F-wave (95903) tests performed between Jan 1 2002 and April 1 2002 to receive the adjusted reimbursement for these tests."  If you did not receive this AAEM email/ flyer, contact AAEM @ 507-288-0100.

 F.  Central Florida Physiatry Journal Club Dinner meeting Tues Sept 17, 6:30 pm, in Winter Park, FL.  All Florida physiatrists invited to attend!  For more info contact Colleen Zittel @ 407-643-1328.

5. There is Journal Club at Ruth’s Chris Steak House with Central Florida PMR group.  Contact Dr Zittel, # above.

6. There is a consensus on deleting non paying members from FSPMR email broadcasts and other messages.  There is a suggestion of giving them an ultimatum prior to finally taking them off the email distribution.

7. There is a discussion concerning the possibility of joining the Florida Academy of Pain Management meeting in Clearwater, FL, in the spring of 2003.

8. FSPMR’s next meeting will be in November, 2002, at the Orlando World Marriott in conjunction with the AAPMR Annual Meeting.

 Respectfully submitted,

 Venerando Batas, MD, FSPMR Secretary

AAEM Practice Topics
In Adobe Acrobat format. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.

JW Marriott Hotel Lenox

May 25, 2002
Atlanta, Georgia

Minutes

Present:  Oregon Hunter MD, President; Jairo Parada MD, Vice President; Enrique Monasterio MD, Treasurer; Venerando Batas MD, Member-at-Large; Mitchell Freed MD, Immediate Past President; Victoria Rabe-Tagala MD; John Muenz MD; Robert Christopher MD; Anthony Dorto MD; Marc Reiskind MD; Lorry Davis MEd, Executive Director.

 Introductions were made all around.

 Old Business: 

1. Minutes of the August 21, 2001, Orlando meeting were approved.

 2.     Membership Report – approved:  Dr Parada reported:  we have 128 members, 9 of whom are retired, leaving 119 dues-paying members.  Changes since we last met:  Margarita Borrero MD has retired (still a member).  Ann Breuer MD and David Lipkin MD are no longer participating.  Fritz Friedland MD has passed away.  He died in 1999, but we did not receive word until March of this year. 

 Three new members were approved today: 

 Alan F Doyle DO, West Palm Beach, recommended by Mark Rubenstein MD

Dagoberto J Garcia MD, Miami, recommended by Enrique Monasterio MD

Nicholas S Potochny DO, Melbourne, recommended by Oregon Hunter MD

 3.  Treasury Report – approved.  Dr Monasterio reported:  we have $7884.44 in our treasury.  Other expenses this year:  $7650.00.  Other possible income this year:   unpaid members - $1500.00 (15 unpaid members @ $100).  Later this summer, we will have a phone campaign, physician-to-physician, to see if we can’t get the rest of the nonpaid members to participate.  3 different notices went out regarding dues from our Executive Director, Lorry.  If you paid up after the first notice, you didn’t get the second one, etc.  Then, in March, Dr Hunter wrote to the remaining members who still had not paid and that resulted in some more participation.  More possible income:  Fall meeting sponsorships, up to $3000.00.  Elan Pharmaceuticals had committed to sponsoring our fall luncheon (which we split with FAOEM) for $2000 (we’d get $1000, FAOEM would get $1000).  However, Elan is having corporate financial difficulties, and this sponsorship may not come through.  If anyone has any other drug company or vendor contacts, and thinks we can get some sponsorship for either the luncheon or the hospitality suite ($4000 or $2000 level of sponsorships available here), please talk to Lorry Davis.

4.  FMA Report – Here are some highlights from the EVP/CEO of the Florida Medical Association, Sandra Mortham:  The FMA was able to kill a number of legislative proposals that would significantly affect your ability to practice medicine.   Issues defeated:

        Scope of Practice
ARNPs - prescribing of controlled substances
ARNP's being able to admit patients to Pediatric Extended Care Facilities
Acupuncturists - expansion of scope and use of title "Physician"
Chiropractors and school services
Pharmacists second guessing physician Medicaid prescribing and receiving payments
Naturopaths scope of practice expansion
Physical therapists scope of practice expansion

        Medical Malpractice
Prevented Wrongful Death Changes
Prevented Mandatory Medical Malpractice Insurance (protected ability to self insure)
Stopped an amendment that would have made it harder to hold out of state expert witnesses accountable

        Insurance / Managed Care
Defeated a "Bare Bones" Health Insurance proposal where no present mandates would have been covered – these stripped down policies would have failed to provide adequate health care for patients.  The FMA successfully put the following amendments on the bill before the bill died:

        Requiring proper disclosure of what the policy does NOT cover
        Increasing the maximum yearly pay-out from $10,000 to $50,000
         Limiting the policies to the uninsured
        Adding mandates back in

Defeated amendment that would have required AHCA to submit to the Governor and the Legislature a report that contained a list of all physicians who failed to comply with timeframes or for not complying with orders issued by claim dispute panel. Defeated a required study of all existing mandates in present law.

        Medical Regulation
Prevented a mandatory increase of licensure fees for physicians
Protected the 10% cap on increase of licensure fees
Prevented fee caps from automatically increasing year after year
Protected the mandatory 24 hour notice, peer review protections, and case mix requirement for Medicaid audits
Prevented the passage of Foreign Medical Graduate changes, allowing them to practice without passing an exam
Helped to prevent an additional biomedical waste fee
Helped stop a bill that would override physician discretion regarding when it is medically appropriate to administer infant eye exams

ISSUES PASSED:

• Workers Compensation Fee Study (SB 108) – studies the adequacy of the medical fee schedule and provides data regarding reimbursement levels. A report is due to the Legislature by January 1, 2003.
• Repayment of physician student loans (HB 1405) – requires repayment of federal student loans or your license can be suspended.
• Bioterrorism Bill/ Good Samaritan (SB 1262) – allows healthcare providers to be covered under the Good Samaritan law when there is a declared public emergency.
• Controlled Substance (SB 640) – allows criminal penalties for inappropriate writing of controlled substances.
• Organ Transplant (SB 2048) – covers lung transplants for Medicaid.
• Nursing Shortage Bill (HB 519) – encourages retention of qualified trained nurses in Florida.

Dr Hunter reported that Dr Michael Webb, an occupational medicine physician from Ocala, is to be greatly acknowledged for continuing to bring work comp reimbursement (and other) issues to the FMA table.   A motion was made and carried to send a letter of appreciation to Dr Webb, stating that it was unanimous at FSPMR’s spring meeting that he be thanked for his efforts on behalf of all physicians in Florida who practice workers’ compensation medicine, and on behalf of all injured workers in Florida.

Dr Hunter discussed the various ways that FSPMR members could participate with organized medicine, and he encouraged all members to join the FMA, FLAMPAC, and the 1000 Club.  People for a Better Florida, Dr Hunter explained, is more controversial, and each member needs to decide for him or herself if participation is warranted.

Citizens for Tort Reform, the FMA’s effort to deal with the malpractice insurance crisis, was discussed.  The FMA is fundraising to gather $15 million.  That amount will probably not be reached this year, and what is gathered will be put into escrow.  If the FMA can’t fundraise this amount, they won’t tackle the issue, and the monies will be returned to the donors.

5.      Medicare CAC Update:  Colleen Zittel, MD, Secretary, was not present, but sent this report: 

1. Medicare Multi Carrier System Conversion
As the Medicare CAC rep for FSPMR, I was invited to attend a limited meeting for providers re: the MCS conversion, on Fri, April 26th in Orlando.  As I was unable to attend, My group's Asst Director, Dan Salm, went in my place.   This meeting did not disseminate any new info other than what is frequently updated on Medicare's website (www.floridamedicare.com).  The purpose was to hear provider's concerns and answer specific questions from providers.  Basically, Medicare wants to have all the 52 state's Medicare computer systems all on one computer system.  Despite their planning, this resulted in certain procedure codes & claims not being paid.  Cardiology as a specialty was very hard hit, w/ echo's and other procedures.  Instead of provides resubmitting ALL their medicare claims, we are instructed to only resubmit those denied claims, and to keep checking the website for further instructions, updated several times per week.  Corrections to the computer system are ongoing but it will take months for the backlog of claims to be readdressed by Medicare.  All FSPMR members should be recieving Lorry's Medicare e-news update, which I forward to her whenever I recieve them.  Any interested FSPMR members should subscribe to this news service free of charge by Medicare, and they will get the updates as soon as they are put online.  The website should tell you how to subscribe.

2.  Medicare Carrier Advisory Committee (CAC)- general
   A.  CAC meetings have been changed from quarterly to 3 time a year.  Walt Conlan is doing a great job as my alternate rep.  We both attended the last meeting Jan 19th, and he attended the most recent one May 18th.  The only relevant policy Jan 19th was a policy on Kyphoplasty, in which I suggested adding certain ICD-9 fracture codes; orthopedics recommended changing the wording quite a bit.  It is now a covered procedure, along with vertebroplasty.

3.  New Local Medical Review Policies (CAC)
   A.  Debridement Services  (Policy # 11000)
Dr. Conlan who is active in wound care took charge of reviewing this policy and gave feedback to FL Medicare a