County Line
Newsletter XLIX February 2004
Contents
Malpractice
Filings against Health Care Providers, Jan 2001 - Dec 2003
Home Health Compare:
A Resource for Consumers and Physicians
Clark County
District Board of Health initiates trauma system needs assessment process
Clark County
Health District Disease Statistics – December 2003
CCMS Position Paper: The
Federation of State Medical Board’s Audit of the Nevada Board of Medical
Examiners
By Edwin Kingsley,
M.D., President, Clark County Medical Society
The Legislative Commission selected the Federation of State Medical Boards (FSMB) to conduct the statutorily mandated performance audit of the Nevada Board of Medical Examiners (NBME) over the Legislative Council Bureau (LCB) Audit Division in part because of the cost of the audit. FSMB submitted a bid for $28,000. The LCB Audit Division indicated an audit would cost about $50,000. (NBME had budgeted $100,000 for the audit but this was not made known to the Legislative Commission at the time the Legislative Commission made its decision.)
The FSMB performance audit designated six specified areas for comprehensive review and evaluation. We concur with many of the FSMB audit's recommendations. In other areas, the FSMB auditors premised their recommendations on incorrect understanding of Nevada law or other incorrect information.
(The scanned text of the full audit can be viewed on the CCMS web site: www.clarkcountymedical.org)
The Clark County Medical Society agrees with
the following recommendations:
· In reference to the methodology and efficiency of the NBME's response to complaints filed by the public or physicians against a licensee, CCMS concurs with the FSMB audit's recommendations for changes in manner of evaluation and prioritization of complaints, and the recommendation to improve communications with the complainant of the investigation.
· The FSMB audit's recommendation to cease expending $5,000 per month on the ineffective NBME advertising campaign, and instead use that money in employing a full time Public Information Officer (PIO), should be implemented as soon as possible.
· The recommendation that Board members speak before "physician and specialty groups and hospital medical staffs to inform the physician population of issues facing the medical disciplinary and licensing community and to explain how the Board works" is an excellent recommendation. Many CCMS members feel that their questions go unanswered and that their opinions are ignored by the Board. The CCMS Board of Trustees routinely invites southern Nevada M.D. members of the NBME to attend CCMS Board meetings - not one has accepted the invitation and attended a meeting.
· Most state medical boards appear to have implemented annual licensure renewals via the internet, with credit card payments accepted. CCMS concurs with the FSMB audit that NBME should move to this form of re-licensure as soon as practicable.
· When traditional financial audits are conducted under Generally Accepted Accounting Principles (GAAP), a management evaluation letter (management letter) is included as a portion of the audit. According to the FSMB audit, those management letters, and their accompanying recommendations, have not been presented to the members of the Board of Medical Examiners. The FSMB's audit stated that the same recommendations appeared in those management letters year after year. The FSMB audit recommends that the management letters be presented to the Board members annually in a public meeting where the Board members should vote to accept or reject the recommendations made in the management letter. We hope the Legislative Commission ensures that these past management letters be made publicly available consistent with Nevada's Public Records Act.
The Clark County Medical Society contends that
the FSMB Audit is in error in the following areas and for the following
reasons:
· The FSMB auditors contend that the NBME "has been greatly disadvantaged in its ability to protect the public" by a recent statutory changes. The FSMB audit specifically states that that an amendment to NRS 630.301 prevents the Board from taking action "on the license of a physician convicted of murder or a serious sexual offense, whether or not the crime is directly related to the practice of medicine." This contention is derived from a "clean-up" bill, AB 5, passed in July during the special session of the Legislature. Clean-up bills are generally written by the Legislative Counsel Bureau staff to correct technical errors in prior bills. Section 15 of AB 5, however, materially and substantially altered the amendment to NRS 630.301 made in SB 250 by the 2003 Legislature. SB 250 provided that "conviction of a felony" constitutes grounds for licensure discipline or licensure denial. AB 5, the special session "clean-up" bill, added language to read: "Conviction of a felony relating to the practice of medicine or the ability to practice medicine." This was not the intent of the Legislature in passing SB 250. CCMS agrees with the Legislative amendments to NRS 630.301 in SB 250 and recommends that the statute be changed back to the language found in SB 250, i.e., "conviction of a felony."
· The FSMB audit's contention that inappropriate sexual behavior will not base a licensure disciplinary action ignores NRS 630.301 (10) which provides licensure discipline and licensure denial for "engaging in sexual contact with the surrogate of a patient or other key persons related to a patient, including, without limitation, a spouse, parent or legal guardian, which exploits the relationship between the physician and the patient in a sexual manner." CCMS contends that the modifications of the medical practice act found in SB 250 are appropriate and adequate.
· CCMS respectfully disagrees with the FSMB audit's recommendation that the NBME's ability to license via endorsement should be repealed. Authorizing the NBME members to license by endorsement places the power to license in the judgment and discretion of the duly appointed members of the Board. The Board members now have the authority to license doctors outside of the "toughest medical licensing requirements in the United States" when the Board members feel unique circumstances exist justifying such licensure. Of the 18 applicants for licensure by endorsement at the December 2003 NBME board meeting, only one applicant was granted licensure by endorsement "due to his unique background, training and capabilities." Licensure by endorsement of uniquely qualified physicians permits the Board members the discretion to act in the best interests of the public in licensing uniquely qualified physicians.
· The FSMB audit's discussion of "Physician Workforce Statistics" implies that reports of physicians relocating to other states, retiring or closing practices" were not accurate. Left unnamed was the Nevada State Medical Association as the source of these reports. In fact, NSMA reports were accurate and established utilizing the NBME's own data.
o Reviewing the NBME's 2002 Annual Report, the Nevada State Medical Association notes that 312 MDs left their Nevada practices in 2002. There was a net increase of 23 MDs in the State of Nevada in 2002, with a net gain of only 7 MDs in Clark County. This was the largest loss of licensees and the smallest gain in more than two decades. Also, for the first time in 20 years more newly licensed MD's moved into Nevada Counties other than Clark. Only 30% moved into Clark County, while in every other year approximately 70% moved into Southern Nevada. Normally, those percentages are reversed.
o In 2002, Nevada had a record number of licensee physicians practicing outside of Nevada (this correlates with Nevada physicians leaving the state but retaining their Nevada licenses). Nevada has fallen to 48th among the 51 U.S. licensing jurisdictions in the number of non-federal physicians per 100,000 population, according to AMA data. NSMA's comprehensive report can be read online in the November issue of the County Line newsletter of the Clark County Medical Society at: www.clarkcountymedical.org
· CCMS disagrees with the FSMB audit's recommendation that the annual audits be presented to an "audit committee" of the NBME. The audits should be presented by the C.P.A. auditors to the full Board in open public session. Disclosing the audit details only in a non-public committee hearing is contrary to the letter and spirit of the Open Meeting Act.
· The FSMB audit's criticism of Nevada hospitals for "not reacting to malpractice cases with limitations on privileges", or for "underreporting of hospital actions, or both" is entirely without evidentiary basis. No where in the FSMB audit is there mention of federally mandated reporting requirements to the National Practitioner Data Bank (NPDB) and the ability of the NBME to freely query those data both for hospital staff sanctions and for reporting of medical malpractice awards, settlements, and judgments. The NPDB reported information may be accessed by the NBME at any time. CCMS is disappointed that the FSMB audit neither mentioned the availability of these data to the NBME, nor suggested the NBME should be accessing this information routinely. The unsupported and reckless innuendos against our Nevada hospitals demonstrate the FSMB audit group's ignorance of Nevada hospitals' active peer review processes, quality assurance committees, our hospitals' re-credentialing processes (which routinely accesses NPDB information), and arduous accreditation of our hospitals by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Designated hospital committees review closed medical malpractice claims, as reported to the NPDB, and are aware of medical malpractice claims reported against physicians.
The Clark County Medical Society believes the
following issues were not sufficiently addressed by the audit:
· The FSMB audit considered the "methodology and efficiency of the Board in conducting investigation of licensees who have had two or more malpractice claims filed against them within a period of 12 months." Current law does not require the NBME to investigate every medical malpractice claim filed against a physician. See SB 250, sec. 39. SB 250, sec. 40, does require that claims resulting in an award, settlement, or judgment be investigated by the NBME. The NBME's management decision to investigate every claim filed against a physician would appear to be an inefficient use of resources.
o The Division of Insurance's Closed Claim Study, 1986-2001, demonstrated that two-thirds of claims filed for medical malpractice against physicians are closed without a payment to the plaintiff.
o Mr. Bob Byrd (president of the "Governor's insurance plan", the Medical Liability Association of Nevada) testified before the Senate Judiciary Committee, this last regular Legislative session, that in his experience, 70% of claims are closed without a payment to the plaintiff. The FSMB audit did not directly comment on the efficiency of investigating every claim filed against a licensee physician in light of the fact that the great majority of those claims are apparently without merit (assuming that no payment to the plaintiff is indicative of a non-meritorious claim). The FSMB audit did suggest that investigations be prioritized with resources aimed at that licensee conduct which most threatens the public health. Indeed, the question in the Request for Proposal (RFP) itself implies that an investigation should not be opened unless there are at least two claims filed against the physician within a twelve month period. The FSMB auditors might have made specific recommendations regarding the efficient use of resources in this area of inquiry.
· On page 10 and 11 of the audit report, the FSMB auditors address the allegations of delay in investigating and prosecuting sanctions against a "physician with a serious problem with malpractice" - an apparently thinly veiled reference to Dr. D'Ambrosio. Among the reasons proffered for delay was that it took "four years" to receive the reports from the Medical Dental Screening Panel. In contrast to that assertion, MDSP findings routinely arrived at the offices of the Clark County Medical Society within one week of the MDSP finding. The Division of Insurance contends that MDSP findings were mailed to the NBME and the county medical societies at the same time.
Not mentioned in the FSMB's audit is the California legal decision (Medical Board of California case number 16-2002-134658), dated May 28, 2003, holding that the actions taken by the NBME did not constitute discipline against Dr. D'Ambrosio's Nevada medical license. Dr. D'Ambrosio's California medical license was subsequently renewed without restrictions, and Dr. D'Ambrosio continues to practice spinal surgery in southern California.
· CCMS is disappointed to note that the Board has apparently decided not to implement the provisions of SB 250, sec. 36, in spirit or in substance, which would address licensees' nascent troublesome or unprofessional conduct before that conduct rises to a licensure disciplinary offense. The preventative measures provided in the amendment include sending a letter of concern or a letter of admonishment to the licensee before the licensee's conduct rises to a level requiring licensure disciplinary action. This excellent amendment to NRS 630 has the potential to modify many licensees' conduct before that conduct becomes actionable. This is in the public interest, as well as a motivation tool to stimulate better medical practice.
We understand that one of the NBME's attorneys has interpreted the new law to require that the entire Board must approve each letter to be sent. Indeed that is the literal wording of the amendment. This is impractical because the Investigative Committees of the Board are the ones receiving and addressing complaints, not the full Board. However, if the full Board delegated to the Investigative Committees the authority to write and send these letters, we believe it would not violate the statute. Perhaps the Legislative Commission would consider obtaining an LCB legal opinion, or an AG opinion, regarding the legality of the full Board delegating the authority to write and send these letters to the investigative committees of the NBME. A positive opinion would facilitate cessation of the internal NBME impediment to implementing this outstanding new provision in Nevada’s Medical Practice Act.
· The last mandate in the RFP charged the FSMB audit team with evaluating the "managerial and administrative efficiency of the Board in using the fees that it collects pursuant to NRS Chapter 630." The FSMB audit simply proffered one conclusory declaration: "[T]he Board uses its fees efficiently". The FSMB audit offered no information substantiating this conclusion. We expected the FSMB to present financial data comparing NBME with other component state medical boards. What amount of assets and/or cash (total and per licensee) do other boards maintain in a reserve fund? How many state medical boards maintain a reserve fund of over $800 per licensee ($3,678,003 in retained earnings for 4,537 active licensees at the end of 2002)? What amount and percent of funds collected are utilized for investigative functions, for executive staff salaries, for overhead expenses, and for advertising? How do the NBME’s numbers compare with other boards and with recommendations of the FSMB? Business ratios are commonly used to compare similar entities. The FSMB auditor presented no comparative ratio information.
At the time of the Legislative Commission's selection of the FSMB to conduct the performance audit, some expressed concern that an audit by the FSMB (of which NBME is a state member component) would result in a "whitewash" of the NBME. The FSMB auditors' lack of meaningful evaluation of the NBME's fiscal responsibility and efficiency did nothing to allay those concerns.
· The FSMB audit makes "other findings and recommendations" following the mandated portions of their audit. These include a recommendation that Board's orders and "statements of charges" be made available to the public at no cost, electronically, on the Board's website. Rather than publicizing the NBME's unproven allegations against a licensee ("statements of charges"), the hearing officer's "findings of fact and conclusions of law" should be made available on the Board's website, along with the Board’s action on the case. Ideally, all public records would be available on the Board's website, although CCMS lacks knowledge of the feasibility of this.
The FSMB auditors did not mention the NBME's failure to post financial information on the NBME's website as mandated in SB 250. SB 250 provides, in sections 182(3)(d) "[A]ll financial reports received by the Board"and 182(3)(e) [A]ll financial reports prepared by the Board", that the Board post the information on the Board's website. To date, this has not been done.
CCMS looks forward to working with the new Executive Secretary, Drennan "Tony" Clark, and the new General Counsel, Stephen Quinn.
Finally, CCMS wishes to acknowledge and thank the present appointed members of the NBME. They are all good people who are laboring under a tremendous new workload, and serving without compensation.
President’s Message
By Ed Kingsley, M.D.,
2003-2004 CCMS President
Six months have passed since I became your Society president and the new Board was formed. We set six goals for the Society at that time for 2003-2004 and now is a good time to review what's been accomplished toward achieving those goals:
1. FOCUS ON REDUCING THE MALPRACTICE INSURANCE CRISIS. We are striving to accomplish this through our work on the KODIN (Keep Our Doctors In Nevada) Initiative (see #5 below).
2. INCREASE THE SOCIETY'S NUMBERS BY INFORMING NON-MEMBERS OF THE BENEFITS OF MEMBERSHIP. We've done this by encouraging our members to speak to their non-member associates/friends of the benefits of the Society and by mailing letters to ex-members encouraging them to rejoin. We've also reduced the membership annual fee by 50% for first year members.
3. ENCOURAGE MEMBERS TO BE MORE ACTIVE IN THE SOCIETY. We've done this by assigning more members to various Society committees. All members who expressed any interest in any committee were invited to participate in that committee last summer.
4. PREPARE FOR THE LEGISLATIVE YEAR (2005). This is being done by the participation of your Society leadership in the Governmental Affairs Committee of the NSMA and the Society that are held on a regular basis. Join MedPAC by sending $300 to MedPAC at 2590 East Russell Road, Las Vegas, NV 89120 or call the CCMS office at 739-9989 for more information.
5. GEAR UP FOR THE KODIN INITIATIVE (NOVEMEBER 2004). I am representing the Society's members by attending the KODIN meetings and giving input. The Society Alliance will be helping us place KODIN materials in doctors' offices this coming year to educate our patients about the issues and encouraging them to vote for the initiative. We are also educating doctors on how to register their offices as voting registration sites. We continue to ask you, our members, to become involved in this project. This is one of the best ways of getting our patients to vote for the KODIN Initiative and assure its passage.
6. RECONSTITUTION OF THE MEDICAL-DENTAL SCREENING PANEL. Realistically, this will probably best be achieved legislatively next year. Since the screening panel was abolished over a year ago by the AB1 legislation, the number of medical malpractice lawsuits has increased 300-400%.
Could we be doing a better job? Yes, especially with more participation from our members. Of all of the members who asked to participate in one committee or another last June, only a handful has actually done so. We need YOUR help to be successful. I encourage those of you who signed up on a committee to participate. I urge all of you to talk to your non-member colleagues to join the Society. There really is a need for more participation by ALL doctors in southern Nevada to help solve the problems that face us, especially the malpractice crisis.
Many of you may be aware that the United Blood Services (UBS), the agency that supplies southern Nevada with all of its blood, declared an "emergency shortage" of blood January 6th after its supply was reduced to less than one day's worth. The date was ironic since January is "National Blood Donor Month". At the time this is being written, the shortage is still in effect, but so far very few elective surgeries have been cancelled. In response to this emergency, your Society faxed to the offices of our members a copy of the UBS press release and encouraged you and your patients to donate blood. The vast majority of eligible donors never donate, unfortunately. Please, if you have not made it one of your New Year's resolutions, do so and donate this year!
I'd like to provide an updated summary of Nevada's physician flux, courtesy of Larry Matheis, Executive Director of NSMA. In 2002, 312 MDs left their Nevada practices and 335 opened practices, for a net gain of 23. This has been the smallest increase in twenty years. Only seven additional physicians started practicing in Clark County. I don't have the data for DOs. In a related vein, there is a thought-provoking article in the January 6 issue of Annals of Internal Medicine entitled "Malpractice Reform Must Include Steps to Prevent Medical Injury" by Stephen Schoenbaum, MD and Randall Bovbjerg, JD. They persuasively argue that any "reforms that fail to harness the intellect and energies of physicians to address the largest problem - patient injury - miss a central cause of claims as well as a central issue for better health care". They point out that after the American Society of Anesthesiologists adopted practice guidelines over ten years ago "to reduce patient harm, deaths and premiums both decreased dramatically. The 2002 average premium was $18,000, about the same as in 1985. Anesthesia is the only health sector to achieve 'six sigma' quality, or fewer than 4 deaths per 1 million exposures. In contrast, a surgical instrument or sponge is left in 1,000 to 1,500 surgical patients each year, more than 15 times the six sigma rate". In an article by Joseph Conn (December 15, 2003), we learn that "tort litigation brought for medical malpractice cost Americans nearly $25 billion" for 2002, out of a total of $233 billion spent on tort costs for all of the US. That's almost $⁄ of a trillion! For the medical field, there has been an almost 12% increase in tort costs vs. 9% for all other areas.
As almost everyone knows by now, all MDs in Nevada must complete a one-time 4 hours of CME relating to bioterrorism. The Southern Nevada Area Health Education Center (AHEC), part of the University of Nevada School of Medicine, has developed an educational program for health providers entitled "Weapons of Mass Destruction: The Health Care Professional's Role in Nevada's Preparation and Response" which will satisfy the requirement for these CME hours. Additional information can be obtained by calling Karen Seale, Associate Director, or Teresa Levesque, Education Program Manager at 702-318-8452.
The Nevada State Board of Medical Examiners conducted workshops in late January to receive comments from physicians regarding proposed regulations for continuing proficiency in medical care. The proposed regulations were recently modified as a result of previous NSBME workshops and input from doctors. They currently read as follows: 1. Hold a current certification and required to recertify by a member board of the American Board of Medical Specialties. 2. Maintain active or associate hospital privileges at a JCAHO-accredited hospital or affiliated surgical/medical center during the preceding two years, or if practicing as a pathologist, be associated with a lab accredited by the CAP for the two years preceding, or if practicing as a radiologist, be associated with a radiology facility accredited in one or more modalities by the ACR for the two years preceding, or pass a board approved peer review of the licensee's medical practice, at the licensee's cost, for the ten year period preceding to be conducted by a physician licensee, approved by the Board, who practices in the same scope of practice as the licensee being reviewed. The peer review must include, but is not limited to, a personal interview with the licensee and a review of randomly selected patient charts of the licensee reflecting patient treatment for the preceding ten-year period. 3. Have taken and passed during the ten year period preceding one of the following exams at the licensee's cost: a. SPEX. b. US Medical Licensing Examination (USMLE). c. A practice specialty module of the SPEX. d. Any other formal exam, which has been validated under "Standards for Educational and Psychological Testing", or e. Any MD "whose unique practice circumstances so warrant may apply to the Board for an exception to the requirements" and NSBME may permit demonstration of continuing proficiency by such other means as the board may deem comparable and appropriate". These regulations would go into effect in 2007. Final action on this important matter is expected to be conducted at the next meeting of the NSBME on March 12 and 13. I should have an update on these workshops in my March County Line column.
Managed Care Consultants (MCC), a health insurance benefits administration company, recently sent physicians with whom it contracts a "Dear Provider" letter requesting a "fee" to partially offset the costs of its annual investigations. The Nevada State Division of Insurance found this to be in violation of AB320, which prohibits any health care entity from charging "panel fees", and ordered MCC to refund all of its providers who paid this fee. Larry Matheis, Executive Director of NSMA, was instrumental in getting the Division of Insurance to take this prompt action against MCC. If any of our members are being requested to pay these illegal "panel fees" to any contractor, please contact Mr. Matheis by fax at 800-719-1930, or email at lmatheis@nsmadocs.org.
New Members for December 2003
Congratulations and Welcome to the Clark
County Medical Society
· Hazem Y Afifi, MD, Thoracic Surgery, 3131 La Canada St. #217, Las Vegas, NV 89109
· James G Lenhart, MD, Family/Sports Medicine, 2410 Fire Mesa St., Las Vegas, NV 89128
· Todd K Malan, MD, Ob-Gyn, 1000 S Rainbow Blvd. , Las Vegas, NV 89146
· Demetrios Mavroidis, MD, Thoracic Surgery, 3131 La Canada St. #217, Las Vegas, NV 89109
Membership Applicants To Go
Before Credentialing Committee
If you have any pertinent information about the following membership candidates, please contact:
Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120
- John J. Minoli, MD, Plastic Surgery
For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989
Clark County District Court Medical Malpractice
Filings against Health Care Providers
Jan 2001 –
Dec 2003
2001 2002 2003
Jan 39 33 109
Feb 20 14 88
Mar 35 30 148
Apr 37 34 101
May 37 35 108
Jun 27 24 98
Jul 19 100 97
Aug 54 51 63
Sep 20 65 85
Oct 37 83 114
Nov 38 184 50
Dec 9 170 55
Sum 372 823 1116
Alliance Message
By Annette Mohs, 2003-2004 CCMS Alliance President admohs@earthlink.net
Happy New Year from the Clark County Medical Society Alliance!
We have wonderful news to report. The 2003 Greeting Card Project was a wonderful success. Estela Hansen had set a very lofty goal of ten $1,000 nursing scholarships. We met this goal and exceeded it with your help. We will be able to make 2 additional donations to the ALS Society and the Woman's Development Center. Congratulations to every one of you who participated, your generosity will be felt and have an impact on the lives of the recipients and in turn improve the quality of our lives as well. I want to thank our Corporate Sponsors, their $150 contribution made this project our most successful greeting card project to date. In addition, I especially want to thank the Greeting Card Committee whose toils and labor made this project possible, Estela Hansen, Peggy Ho, Swati Khamamkar, Kim Watson and Cindy Choi, and to all our members who helped stuff the greeting card and encouraged their friends and spouses and spouse's business partners to contribute.
Our Meetings for 2004 promise to be interesting and informative. Special thanks are in order for Desert Radiologist whose generous contribution is assisting us for our January meeting at the Four Seasons Hotel. Dr. Alan Weissman of Desert Radiology will speak to our members about Osteoporosis, and Dr. Ann Shah of Steinberg Diagnostics will speak about Mammograms. Dr. Aditi Sanatinia, our Alliance Treasurer, and an Ob/Gyn will moderate the discussion.
On February 17, our meeting is planned at the Sterling Club. A speaker from the National AMA Alliance will be coming to talk about Medical Marriage. We also will be celebrating our members at this meeting, and recognizing our members' lengths of service.
March 16 we have scheduled our Fashion Show. In April we will be having our general member meeting April 20 and on April 23 we will co-host the Legislative meeting with Clark County Medical Society at the Green Valley Ranch Resort. After the success last year of the Protect Nevada Dinner we have asked Dr. Donald Palmisano the President of the AMA to come and speak again about Nevada's current issues.
For more information about any of these meetings please contact Shanila Choudhury at 355-2019. For membership information please contact Christina Duke, 837-6553 or Heather Gerson, at 897-2081.
Home Health Compare: A Resource for Consumers and
Physicians
By Kristen Boucher, HealthInsight
The Centers for Medicare & Medicaid Services (CMS), a federal agency of the U.S. Department of Health and Human Services (HHS), launched a new initiative focused on providing consumers with quality of care information for home health agencies late in 2003. The Home Health Quality Initiative is part of an ongoing HHS Quality Initiative that also focuses on improving the quality of care in nursing homes and hospitals.
The role of the physician is pivotal in the beneficiary education process and when selecting a home health agency. Physicians can use the new publicly reported quality measures from CMS when advising individuals and families making decisions about home health care. The quality measures are available through Home Health Compare on www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). The CMS publication Medicare and Home Health Care is another resource with information on home health care and Medicare coverage, and provides suggested questions to ask prospective home health agencies.
CMS is committed to reporting quality of care measures for home health care agencies so that beneficiaries, their families and caregivers can make more informed choices when selecting a home health agency.
HealthInsight, a non-profit organization contracting with CMS to serve as Nevada's Quality Improvement Organization (QIO), implements the nursing home and home health care quality initiatives. HealthInsight works to improve the quality of care for Medicare beneficiaries through quality improvement activities and outreach to nursing homes and home health agencies. HealthInsight has educational materials available for physicians about the Home Health Quality Initiative.
For further information about the Home Health Quality Initiative, contact Kristen Boucher at (702) 933-7314.
Minutes Synopsis
(Members can receive a full copy of meeting minutes by calling 739-9989.)
CLARK COUNTY MEDICAL SOCIETY EXECUTIVE COUNCIL MEETING
Tuesday, December 16, 2003; 6:00 P.M.
Action Items
The minutes from the BOT meeting November 18, 2003 were approved.
Dot Freel reported the revenue received for this fiscal year was less than the revenue received last year at this time, mostly due to dues. New members revenue is down, mostly due to the half price special for new members.
The Board voted to give the CCMS employees each a small bonus. Dr. Havins refused to accept a bonus for himself.
Committee Reports
Staff reported the Chairman of the Membership Committee called a meeting last month to discuss increasing membership. The members were asked to look at the list of past members and contact any they know to ask them to rejoin. The Committee is working on additional ideas to increase membership.
Dr. Bernstein reported his Community Health/Relations Committee continues to work on the Mini-Internship. A letter was sent to the surgeons asking for volunteers to participate.
The Executive Council approved the Credentials Committee's recommendation to approve the four member applicants:
Hazem Afifi, MD; James Lenhart, MD; Todd Malan, MD; Demetrios Mavroids, MD
Dr. Colletti stated the Medical Industry Coalition's Nursing Committee designed a brochure and is working on a speaker's bureau. They intend to speak to the high school students and encourage them to pursue a nursing career.
NSMA Report
Dr. Evins reported NSMA has made nominations for advisory committees and for the Medicaid program. The NSMA discussed the many reimbursement problems with the First Health contract which began Oct 1st. Dr. Kline stated his office has taken a large financial hit, not being paid by Medicaid since September, and discussed this problem with Assembly Speaker Richard Perkins who theretofore was not aware of the problem. Speaker Perkins addressed the Executive Council, via speaker phone, and asked CCMS to poll the physicians and compile the data regarding the reimbursement problems, which is to be reported to him via Dr. Kline.
Alliance Report
Annette Mohs reported that the Alliance raised over $16,000 in their Greeting Card project. This met their goal for ten $1,000 nursing scholarships, in addition to providing funds for the Women's Development Center and for ALS medical research. They also completed their annual directory. Ms. Mohs received a request to set up a doctor's office to register voters, which she happily agreed to do.
AMA Report
Dr. Marietta Nelson updated the Board regarding the AMA's meeting held in Hawaii last month. She stated tort reform was discussed in depth. Dr. Nelson was invited to co-author an article for the County Line with Dr. Robert Lynn Horne regarding the AMA's annual meeting.
Dr. Kingsley asked Ron Kline, the Governmental Affairs Committee Chairman and his Committee to submit information for publication in the County Line explaining the changes in the Medicare law as detailed information becomes available.
New Business
Dr. Havins submitted a written report to the Board members on the full audit performed by the Federation of State Medical Boards (FSMB), as reviewed by himself and Dr. Kingsley. The Executive Council voted to have the written report used as the position paper of the Clark County Medical Society, to be published in the County Line newsletter.
Dr. Kingsley read a letter from Roger Miercort, President of Washoe Medical Society, to Senator Randolph Townsend concerning efforts to reform the Nevada State Medical Board of Examiners. Dr. Kingsley read a supportive response letter which the Board approved and directed staff to send to Dr. Miercort, Senator Randolph Townsend and the NSMA.
Dr. Kline asked the Board for direction regarding the CCMS Governmental Affairs Committee, which he chairs. He stated he does not want to duplicate the efforts of the NSMA Governmental Affairs. Dr. Evins suggested the Committee work on local legislative races and on KODIN. Dr. Havins suggested the Chairman attend the NSMA Governmental Affairs Committee meetings and only schedule a meeting of the entire CCMS Governmental Affairs Committee on an as needed basis. Both of these suggestions were accepted.
The next CCMS BOT meeting is scheduled for Tuesday night, January 20, 2003 at 6:00pm.
There being no further business, the meeting was adjourned at 7:40pm.
Clark County District Board of Health initiates
trauma system needs assessment process
By Dr. Donald Kwalick, Chief Health Officer, Clark County Health District
In November 2003, the Clark County Health District was asked to make recommendations to the Nevada State Health Division regarding the future trauma systems needs of Southern Nevada.
In order to make a well-informed recommendation the Clark County District Board of Health hired The Abaris Group, a consulting firm specializing in trauma system assessment. The needs assessment study will include a comprehensive public participation process that will consist of a three-pronged approach - a task force appointed by the board of health, focus groups composed of various stakeholders and public meetings.
The 11 members of the task force include: Veronica Arechederra-Hall, Richard Bunker, JaNell Cook, S. Max Doubrava, M.D., Robert Forbuss, Merlinda Gallegos, Steve Hill, William McBeath, Rose McKinney-James, Otto Ravenholt, M.D. and Danny Thompson. These individuals were selected for their professional expertise and proven commitment to the community. The task force will be co-chaired by Rose McKinney-James and Robert Forbuss.
The needs assessment and public participation process will take an estimated six months to complete. Many stakeholders have already been contacted and will be interviewed on issues important to the infrastructure of a trauma system including those outlined by the National Highway Traffic Safety Administration (NHTSA). These fundamental components and key elements identified by NHTSA include: Injury Prevention, Pre-Hospital Care, Acute Care Facilities, Post-Hospital Care, Leadership, Professional Resources, Education and Advocacy, Information Management, Finances, Research and Technology.
Another important component of the study will include a site visit from the American College of Surgeons Committee on Trauma (ACS COT). The ACS COT has developed an instrument they use to facilitate an objective evaluation of trauma systems at any stage of development. This independent evaluation will be a complementary component of the needs assessment process and dovetail into the work being conducted by the Abaris Group.
A trauma system is an integral part of any community's infrastructure and this assessment process will include all interested and affected parties to the fullest extent possible. The ultimate goal will be final recommendations that meet the short- and long-term trauma needs of our growing population. At the end of this process, the taskforce will present its findings and recommendations to the District Board of Health for its review. Final recommendations will be submitted to the Nevada State Health Division.
Task Force on Trauma System Development meetings:
Ravenholt Public Health Center
625 Shadow Lane - Clemens Room
1:30 p.m. until 3 p.m.
February 9, 2004
March 8, 2004
April 12, 2004
May 10, 2004
June 14, 2004
Access the Clark County Health District website at www.cchd.org/trauma for additional meeting dates and updated information.
CME Calendar
Cardiovascular
Consultants 691-9154
Clark County Medical
Society 739-9989
St. Rose
Hospital 616-5832
Southwest Medical
Associates 242-7347
2/12 - “Health Issues in Professionals in Nevada”
3/11 - “Disease Management Guidelines”
Summerlin
Hospital 233-7572
Sunrise Hospital 731-8210
UMC 383-2604
Valley Hospital 388-4847
2/10 - “Antibiotic Resistance: Local Trends of Importance,” noon
2/24 - “Use and Abuse of Narcotics (Medical Ethics),” noon
3/9 - “State Government Relations for Healthcare Professionals (Medical Ethics),” noon
3/23 - “Physical Rehabilitation,” noon
4/13 - “Pain Management (Medical Ethics),” noon
4/27 - “Trauma in the Community Hospital,” noon
*Special Note: CCMS members can receive free CME courses on the internet with World Medical Leaders.
To have your CME courses listed on our calendar, please contact Deborah Barton at 739-9989 prior to the deadline of the 12th each month.
Clark County Health District Disease Statistics* - December
2003
DISEASE CASES REPORTED YEAR TO DATE
Dec 2002 Dec 2003 2002 2003
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 0 8 8
HEPATITIS A 3 2 26 17
HEPATITIS B 8 3 53 62
INFLUENZA 0 159 59 207
MEASLES 0 0 1 0
MUMPS 1 0 5 2
PERTUSSIS 0 0 23 20
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES **
CHLAMYDIA 314 414 4442 4719
GONORRHEA 148 235 1748 2085
SYPHILIS (Primary & Secondary) 0 0 7 8
SYPHILIS
(Early Latent) 0 1 6 20
ENTERICS
AMEBIASIS 0 1 23 17
BOTULISM-INTESTINAL
(Infant) 0 0 0 1
CAMPYLOBACTERIOSIS 3 10 111 103
CRYPTOSPORIDIOSIS 0 0 2 5
E. COLI
O157:H7 0 0 14 17
GIARDIASIS 6 5 119 94
ROTAVIRUS 71 50 436 531
SALMONELLOSIS 8 11 176 118
SHIGELLOSIS 4 4 33 53
TYPHOID
FEVER 0 0 0 0
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM
INTOXICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 0 2 39 33
DENGUE 0 1 0 1
ENCEPHALITIS 0 0 2 2
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 0 0 1
SYNDROME (HUS)
HEPATITIS C 1 0 4 3
HEPATITIS D 0 0 1 0
LEGIONELLOSIS 0 2 5 10
LEPROSY (HANSEN'S DISEASE) 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 0 0 1 3
LYME
DISEASE 1 0 1 3
MALARIA 0 0 3 2
MENINGITIS,
ASEPTIC/VIRAL 3 6 95 136
MENINGITIS,
BACTERIAL 2 4 27 25
MENINGOCOCCAL
DISEASE 0 0 14 6
NORWALK-LIKE
VIRUS 0 1 0 1
Q FEVER 0 0 1 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
RSV
(RESPIRATORY 148 106 2103 1537
SYNCYTIAL VIRUS)
ROCKY
MOUNTAIN 0 0 2 0
SPOTTED FEVER
SCOMBROID 0 1 0 1
STREP-INVASIVE 0 1 0 1
TOXIC SHOCK
SYNDROME 0 0 1 3
TUBERCULOSIS 6 7 62 80
UNUSUAL
ILLNESS: 0 0 1 0
MICROSPORIDIA SPP.
VIBRIO PARAHAEMOLYTICUS 0 0 1 0
* Numbers
include confirmed and probable cases
** For
HIV/AIDS statistics please call the Clark County Health District Office of AIDS
at 759-0730.
County Line Advertisers
Bank of Commerce 949-9800 www.bankofcommerce-nevada.com
C D Smith Co. Medical Supplies 871-1877 www.cdsmithco.com
Colonial Bank 304-3770 www.colonialbank.com
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