Newsletter XXI October 2001
Bioterrorism Preparedness for Community Physicians
Clark County Medical Society CME Calendar
Clark County Medical Society New Members for August 2001
Applicants To Go Before Credentialing Committee
Executive Director Notes – Prompt Payment Act: SB 99 becomes effective October 1, 2002
Clark County Medical Society Executive Council Meeting
Sunny Lucia, MPH,
Bioterrorism Preparedness Training Program Coordinator,
Office of Epidemiology,
Clark County Health District
The threat of bioterrorism has
provided the impetus for development of domestic bioterrorism preparedness
plans as part of public health infrastructure.
In the past, an attack with a biological agent in the civilian
population was considered very unlikely; however, today many experts believe it
is no longer a matter of “if” but “when” such an event will occur. Reasons for this belief include the
following: the Aum Shinrikyo
cult’s 1995 release of nerve gas in the
Assuming that a bioterrorist event is covert, recognition of the event is dependent on several factors including the following:
Physicians play a critical role as the “early identifiers” of unusual or suspicious infectious disease syndromes. The Council of Scientific Affairs of the American Medical Association has identified community physicians as the key sentinel in the identification of disease outbreaks, and recommends that physicians receive education regarding the signs and symptoms of potential bioterrorist agents and the notification process to public health departments.
The Clark County Health District
Office of Epidemiology (OOE) has initiated a Bioterrorism Preparedness Training
Program (BPTP) funded by the Nevada State Health Division through a grant from
the Centers for Disease Control and Prevention.
More than one-third of the
physicians in
Only 6.4% of physicians surveyed have had any bioterrorist preparedness training. Of those who have had training, 66% have received less than four hours in three preparedness areas: awareness, surveillance and medical management [Chart 1].
Physicians were given the opportunity to select multiple categories for training preferences. The most frequently chosen training venues for physicians were those settings that require an on-site trainer at professional society meetings, seminars and hospital in-services [Chart 2]. Office in-services were preferred for education of staff [Chart 3].
In accordance with the survey results, the BPTP Coordinator will design training in bioterrorism preparedness awareness and surveillance that will be delivered at various sites. Internet-based education and home study programs, which were the second most requested formats, will also be developed.
Scheduling of training programs will begin in 2002. If you have questions about the survey or about bioterrorism preparedness training, please call Sunny Lucia at 383-1378.
Due to the tragic events of September 11, Dr. Chanderraj was
stranded in
October
13 – “CPT Coding Strategies to Improve Reimbursement”
October 27 –
“OSHA For Physicians”
November
3 and January 5 – “Artificial Reproductive Technology, Ethical Issues and
the Law”
November
17 – “Pain Management and
December
15 – “HIPAA Privacy Standards for Physicians”
Courses are FREE to members and $75 for non-members. You
must RSVP and registration is on a first come, first serve basis. Classes are
held at CCMS,
Khoi Dao, M.D., Hematology, 10001
S. Eastern Ave. #108,
Harold Tate, M.D., Diagnostic Radiology,
Frank Tiffany, M.D., Internal Medicine,
Peter Weidenfeld, M.D., Diagnostic
Radiology,
J. Werner Ziegler, M.D., Diagnostic Radiology,
If you have any pertinent information about the following
candidates, please contact: Clark County
Medical Society,
James Atkinson, M.D. - General Surgery
Mahfoud Beajow, M.D. - Internal Medicine
Ronald E. Costin, M.D. - Preventive Medicine
Maria R. Desquitado-Tabora, M.D. - Pediatrics
Michael Fitting-Karagiozis, D.O. - Osteopathic Medicine
Catherine N. Ghanem, M.D. - Emergency Medicine
David L. Ginsburg, M.D. - Neurology
Steven Glyman, M.D. - Neurology
Eric H. Grant, D.O. - Ob-Gyn
Robert C. Gutierrez, M.D. - Orthopaedic Surgery
Ralph T. Ho, M.D. - Diagnostic Radiology
Farrukh Iqbal, M.D. - Endocrinology
Mike Ys Jeong, D.O. - Internal Medicine
Steven E. Kolker, M.D. - Pathology
Kim Lamotte-Malone, M.D. - Pediatrics
Eddy Hi Luh, M.D. - General Surgery
Todd C. Murry, M.D. - Pathology
Mohammed Os Najmi, M.D. - Internal Medicine
Richard W. Naylor, D.O. - Orthopaedic
Van T. Nguyen, M.D. - Diagnostic Radiology
Neil A. Phillips, M.D. - Pediatrics
Michael A. Prater, M.D. - Anesthesiology
Carolyn Price, M.D. - General Practice
Amir Z. Qureshi, M.D. - Infectious Disease
Raj Y. M. Rouweyha, M.D. - Ophthalmology
John D. Schaeffer, D.O. - Neurology
Tapan R. Shah, M.D. - Ophthalmology
Randal G. Shelin, M.D. - Diagnostic Radiology:
Camilo B. Tabora, Jr, M.D. - Internal Medicine
Jason M. Tarno, D.O. - Family Practice
Cynthia E. Teh, M.D. - Internal Medicine
Lisa Underwood, M.D. - Gynecology
Michael P. Verni, M.D. - Urology
Carrie G. Wijesinghe, M.D. - Pediatrics
Chihuang E. Yee, M.D. – Ophthalmology
Weldon (Don) Havins,
M.D., J.D., CCMS Executive Director and Special Counsel
SB 99,
SB 99 applies to the following entities, all under the jurisdiction of the Division of Insurance:
1. an insurer that issues a policy of health insurance,
2. an insurer that issues a policy of group,
3. a carrier serving small employers,
4. a fraternal benefit society,
5. a hospital or medical service corporation,
6. a health maintenance organization,
7. a plan for dental care, and
8. a prepaid limited health service organization.
Medicaid and Workers Compensation are specifically included in the provisions of SB 99.
One may download SB 99 through the Legislative Counsel Bureau’s website: www.leg.state.nv.us. If any CCMS member has difficulty finding or downloading SB 99, please give me a call and I’ll see that you get a copy promptly. CCMS has purchased its domain name: www.clarkcountymedical.com and will in the near future, hopefully, have an operating website with links to items such as the Prompt Payment Act, SB 99.
How does SB 99
benefit physicians?
An administrator of any of the above entities shall approve or deny a claim within 30 days of receiving the claim. If the claim is approved, the administrator must pay the claim within 30 days after it is approved. If that approved claim is not paid within the 30 days after approval, the administrator “shall pay interest on the claim at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the commissioner of financial institutions, on January 1 or July 1, immediately preceding the date on which payment was due, plus 6 percent” (prime plus 6 percent). SB 99 provides that this interest rate applies from 30 days after payment was due until the date on which the claim is paid. However, this late payment plus interest is waived if the delay occurred due to an act of God or another cause beyond the control of the insurer.
CCMS has received several calls
from members who are stating that the insurer has refused to accept claims
mailed to the payor certified with return receipt
requested. At least one payor has stated this refusal is based upon the payor having received “several” such packets containing no
claim forms inside the package. SB 99
clearly states that the administrator (payor) has 30
days after receiving the claim to either approve or deny the claim. Other than hand delivering the claim forms to
the administrator/payor, how can a physician prove
the claims were received? This potential
problem, plus others, will likely be best solved through the good offices of
Tom Canfield of the Division of Insurance.
Mr. Canfield has been charged with enforcing SB 99. Mr. Tom Canfield can be reached at:
Collecting
Collecting from the payor violating SB 99 may initially seem daunting. SB 99 does not require the Division of Insurance to make the payors write the physician a check. SB 99 only states that interest accumulates at prime plus six percent until paid. Physicians may resort to Small Claims Court to obtain judgments for up to $5,000.00. No attorney may represent you in Small Claims Court.
District Court complaints must plead damages greater than $10,000.00. You will definitely want an attorney to wade through the procedural mire if you choose this route. The District Court judge can, and usually does, grant attorney fees (costs always) to the prevailing party when the award is less than $20,000.00.
It would appear in payors’ interest for one of them to challenge SB 99 through
the court system up to the Nevada Supreme Court. When a challenge occurs, it most likely will
occur in a suit brought in District Court.
Therefore, a prudent physician will bring cases to Small Claims Court or
CCMS, along with NSMA, will attempt to monitor the application of SB99 collections. Please call me at CCMS if you have any questions or any problems in utilizing the new Prompt Payment Act. Congratulations and our gratitude go to Larry Matheis and the NSMA lobbying team, along with Senator Ann O’Connell, who worked so hard to see this bill through the legislature.
Problems with
credentialing/recredentialing fees
The Commissioner of Insurance, Alice Molasky, takes the position that SB 99 applies to those entities under the jurisdiction of the Division of Insurance only. Thus, self-funded ERISA plans are not under the jurisdiction of the Division of Insurance because they are governed by federal law. Perhaps more significantly, "stand alone networks" such as Nevada Preferred Professionals (NPP) and Managed Care Consultants (MCC) are not under the jurisdiction of any governmental body, including the Division of Insurance. CCMS has received several calls from members who have received letters from NPP and MCC stating they are not bound by the provisions of SB 99 and therefore may charge credentialing and recredentialing fees. Moreover, the letters state that if the fees are not paid by a certain time, the physician(s) will be dropped from their provider lists.
The Commissioner of Insurance theoretically could take the position that the stand alone networks are, in effect, agents of the covered entities. While she has no direct authority over the stand alone networks, she could prohibit the covered entities from utilizing services (credentialing/ recredentialing) of these stand alone networks which the governed entities could not perform themselves under SB 99. This may be a bit of a stretch legally and the Insurance Commissioner has not demonstrated any interest in proceeding in this manner. NSMA’s executive director, Larry Matheis, has written the Insurance Commissioner reminding her that the intent of SB 99 was to cover all payors, whether directly or indirectly (stand alone networks). To the best of my knowledge, she has not responded to the letter.
CCMS obtained all legislative committee testimony regarding SB 99. The Insurance Commissioner consistently emphasized that she could only regulate those entities under her jurisdiction. Thus, ERISA plans and stand alone networks were not under her purview.
It appears the Nevada Attorney General could formally opine that the Insurance Commissioner has authority to prohibit entities under her jurisdiction from utilizing services of third party agents prohibited under SB 99. This has not yet happened.
Until clarification or resolution of this issue, CCMS recommends that members wishing to remain on panels or provider lists after October 1, 2001, pay those “reasonable” monetary demands made by ERISA self-funded plans and “stand alone networks” such as NPP and MCC for credentialing, recredentialing, or "database maintenance" fees. Questions as to whether a particular entity is governed by SB 99 would best be directed to Mr. Tom Canfield of the Division of Insurance.
Availability of CCMS
staff
One of the many advantages of CCMS membership is the
availability of staff to answer questions and help resolve problems whenever
possible. The office is open from
CCMS CME courses
CCMS course notification occurs
primarily through the CCMS publication,
This course, like all our CME courses, is jointly sponsored by the University of Nevada School of Medicine. Should you misplace your certificate, both the UNSOM Department of Continuing Education and CCMS maintain copies and can provide you with another certificate at license renewal time.
UNSOM’s Director of Medical Education, Peggy Taylor, is attempting to obtain Continuing Legal Education (CLE) credits for this program also. If successful, local practicing attorneys may be attending on these dates. You may find interesting the differing perspectives between the two professions on the same issues.
Minutes Synopsis
Present: Raj Chanderraj, MD, Presiding; Raul Meoz MD, Past-President; Donald Kwalick, MD, President-Elect; Alonzo (Lon) Ashton, MD, Treasurer; and Warren Evins, MD, Delegate Chairman.
Staff Present: Weldon (Don)
The meeting was called to order at
Define Policy on Hiring Relatives
The Executive Council was asked to
define the policy on hiring or employment of relatives of CCMS’ employees. Several members of the Executive Council
iterated their workplace anti-nepotism policy.
Dr. Kwalick moved that CCMS adopt a policy
prohibiting the hiring or employment of relatives or quasi-relatives of CCMS’
employees with this policy to be implemented by
Financial Situation at CCMS
The Executive Council reviewed the financial materials previously mailed and faxed to the Trustees along with the detailed accounting and BOT Treasurer reports/records Dr. Meoz requested. The Executive Council approved closer scrutiny and timely reporting of CCMS’ accounting and financial status to Trustees. Trustees will now receive monthly accounting information prior to monthly BOT meeting so that Trustees may be afforded the opportunity to review the materials in detail. The Executive Council reiterated the importance of timely performance of annual audits of CCMS’ finances, as required in the CCMS Bylaws.
It was decided:
· The newsletter will go to members only and not to all physicians quarterly as has been done in the past
· The annual pictorial directory will go to CCMS members at no charge, but all others (including non-profit and hospitals) will pay $50 per directory.
· The Scholarship committee, being now a separate 501(c)(3) corporation with its own Board of Trustees, shall be in charge of its own fundraising henceforth, including the prior CCMS annual golf tournament.
· The Public Health and Community Relations committee shall evaluate whether CCMS should hold an annual charity gala. It was suggested the committee consider substituting an event such as a raffle where costs could be minimized and controlled, with proceeds going to the charity.
· The Public Health and Community Relations committee is to determine the need and financial viability of a Legislative dinner.
· Dr. Kwalick moved to sell three or four of the Apple computers to raise immediate funds. Dr. Havins noted that all employees except the Publishing Coordinator are now using PCs daily. Dr. Havins stated that he had ordered another Dell Dimension 4100 for the Membership Coordinator/Receptionist position and that he would formally donate that computer to CCMS. Dr. Ashton seconded the motion which passed unanimously.
Budget for 2001-02
The budget for the CCMS’ fiscal
year
Reinstatement of Delinquent Dues Members
Dr. Evins moved to allow former members to pay their dues and reinstate their membership without having to reapply. The member only gets credit for years of dues paid. Dr. Meoz seconded the motion and it passed unanimously.
Provisional to Full Members
The following physicians were approved to full membership having completed a six month provisional membership term: Beheshti, Hossein MD; Batlan, Daniel MD; Farzin, Farzaneh MD; Gomez, Hector MD; Kleinman, Robert MD; Lee, Garry MD; Miller, Kevin MD;
Montes, Arthur MD; Nathan, Edward MD; Resnick, Michael MD; Rush, John J MD; and Sanchez, Luis MD.
Bylaws Questions
The Executive Council is in the process of looking at the Bylaws regarding employing a Chief Executive Officer. Dr. Havins’ title is Executive Director. The Executive Council determined they could indeed employ him as the Executive Director.
Administrative Report Regarding Website
Marie Ellerton, J.D., CCMS Counsel, concluded CCMS business with LVD.com by obtaining a “satisfaction and accord” release of liability regarding the contract dispute. CCMS also purchased from LVD.com the domain name of “clarkcountymedical.com” for $120.00.
Committee Chairs
Dr. Chanderraj appointed Ron Slaughter, MD to Chair the Bylaws Committee for 2001-02. Further appointments tabled until the next Executive Council meeting.
Malpractice Insurance Surveys
Dr. Meoz stated that CCMS still needs to make a decision regarding further action on malpractice insurance alternatives. Dr. Chanderraj suggested that CCMS explore self insurance as well as take any and all bids from other brokers for medical malpractice insurance alternatives. Most Executive Council members felt that CCMS should take a lead role in looking for insurance premium relief in the face of the proposed increases in medical malpractice insurance premiums. Dr. Meoz will continue to shepherd this issue and report back at the next meeting.
Set Date for August Executive Council Meeting
The next Executive Council meeting
is scheduled for Monday night,
There being no further business, the meeting was adjourned
at
The following referrals were provided to CCMS members in the third quarter of 2001 (through September 15)
|
Specialty |
Referrals |
|
Allergy |
4 |
|
Anesthesiology |
0 |
|
Cardiology |
13 |
|
Cardiovascular Surgery |
5 |
|
|
0 |
|
Dermatology |
10 |
|
Diagnostic Radiology |
1 |
|
Ear, Nose & Throat |
6 |
|
Emergency Medicine |
1 |
|
Endocrinology |
8 |
|
Family Practice |
21 |
|
Gastroenterology |
12 |
|
General Surgery |
9 |
|
Genetics |
0 |
|
Geriatrics |
2 |
|
Gynecology |
2 |
|
Hematology |
0 |
|
Infectious Medicine |
3 |
|
Internal Medicine |
26 |
|
Nephrology |
2 |
|
Neurology |
16 |
|
Neurosurgery |
6 |
|
Ob-Gyn |
21 |
|
Oncology |
9 |
|
Ophthalmology |
14 |
|
Orthopaedic Surgery |
21 |
|
Pain Management |
13 |
|
Pathology |
0 |
|
Pediatrics |
6 |
|
Ped. Endocrinology |
0 |
|
Ped. Neurology |
0 |
|
Ped. Psychiatry |
0 |
|
Ped. Surgery |
2 |
|
Plastic Surgery |
18 |
|
Psychiatry |
25 |
|
Pulmonology |
7 |
|
Radiology |
3 |
|
Rheumatology |
8 |
|
Urology |
9 |
|
Vascular Surgery |
2 |
|
Other |
0 |
|
Totals |
305 |
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