County Line
Newsletter XLVIII January 2004
Contents
Nevada Requires Reporting of STDs to CCHD
Group Works to Reduce Antibiotic Resistance
Tillinghast Study: U.S. Tort Costs Climbed to $205 Billion in 2001
Malpractice
Filings against Health Care Providers, Jan 2001 - Nov 2003
Nevada
Board of Medical Examiners Competency/Proficiency
Licensure Renewal
Requirements – Proposed Regulations
Clark County
Health District Disease Statistics – November 2003
Nevada Requires Reporting of STDs to CCHD
By Donald S. Kwalick, MD, MPH, Chief Health Officer, Clark County Health
District
Health care practitioners complete a variety of forms on a daily basis in order to comply with Nevada Revised Statute (NRS) 441A.240 and Nevada Administrative Code (NAC) 441A.225 requirements mandating the reporting of sexually transmitted disease. These laws and regulations apply to all health care providers in order to ensure timely and accurate reporting to the health authority. This information allows the Clark County Health District to formulate an accurate accounting of our health status in this area and to adjust or implement programs in response to the needs of our community.
Currently the health district is receiving accurate information in the following areas: date of birth, address and phone number. Problems with incomplete information are usually identified in two areas: race of the patient and prescribed treatment. The identification of race is specifically cited in statute as a reporting requirement and is important information used to enhance and enact public health policy decisions.
While laboratories are also required to report cases of STDs to the health district, it is important to remember that this information does not replace the requirement for health care practitioners to report their own results. The clinician's input is needed to create an accurate medical record and subsequent morbidity report. (A morbidity report form is included in this bulletin for your review.)
The health district does plan to review the current reporting process to determine if it can be streamlined. In the interim, health district staff will continue to work with practitioners to report complete and accurate information in order to maintain an accurate profile of sexually transmitted disease statistics in Clark County.
Group Works to Reduce Antibiotic Resistance
By Nevadans for
Antibiotic Awareness
At the turn of the century, physicians had few medicines to treat infectious diseases, and elixirs were prescribed with little effect. Although Dr. Fleming discovered penicillin in 1928, it wasn't until March 1942 that a 33-year-old woman treated with penicillin became the first U.S. civilian whose life was saved by this miracle drug. By 1945, war-motivated industries spurred full-scale production, and penicillin became widely used by the armed forces.
1945 was also the year scientists isolated the first Staphylococcus aureaus bacterium resistant to penicillin. The introduction of methicillin in 1960 advanced treatment of resistant organisms, but by 1991, 29% of S. aureaus in the U.S. were resistant to methicillin. Today in Clark County, Nevada, it is estimated that 62% of S. aureaus are methicillin resistant. Antimicrobial resistance has spread to almost all pathogenic organisms, and unless action is taken quickly to revert this trend, previously treatable infections will again become untreatable, as in the pre-antibiotic era.
Although it is widely known that flu and colds are caused by viruses, patients still demand, and doctors still prescribe, antibiotics for these maladies. As a result, many antibiotics are taken inappropriately, which unfortunately leads to the rise of bacteria that are resistant to the antibiotics.
In 2001, Nevadans for Antibiotic Awareness (NAA) was formed. It is now a coalition of over 50 state and local, public and private agencies and companies committed to reducing the spread of antibiotic resistance by decreasing inappropriate use and improving infection control.
Working in partnership with the Centers for Disease Control (CDC), NAA has developed educational programs to increase awareness of this important public health issue for medical professionals, hospitals, childcare centers, urgent care facilities, learning institutions, and the public.
For more information about ways you can help fight antibiotic resistance, we encourage you to visit the NAA web site at www.nevadaaware.com. With all of us working together, we can help ensure that antibiotics will still be there for us when we need them most.
President’s Message
By Ed Kingsley, M.D.,
2003-2004 CCMS President
Several newsworthy events that affect the doctors in Clark County have occurred over the last four weeks that deserve close scrutiny and discussion. I would like to speak about two of them. The most important I believe is the Medicare Prescription Drug Bill signed into law by President George W. Bush this week that the Senate passed 54-44 on November 25th after months of contentious wrangling on the floor and in conference committee. This is the single largest modification of Medicare since its inception in 1965 and will impact all physicians who treat Medicare patients. It will affect doctors differently depending on their specialty and location of practice (rural vs. other). The full impact of this bill will not be known until CMS (Centers for Medicare and Medicaid Services) has thoroughly digested it and then converts the congressional intent into the regulatory language that will lay out the specifics. Space does not allow me to discuss every aspect of medical care that will be affected, but I will touch on those that will affect us the most. At this time it appears that:
1. The 4.5% cut in physician reimbursement scheduled to take effect in 2004 will instead be replaced by a 1.5% increase for 2004 and 2005.
2. The bill will reimburse the cost of an initial routine physical when a beneficiary becomes eligible for Medicare.
3. Will cover costs for screening tests for diabetes and cardiovascular disease.
4. Office-based drug expense reimbursement will be severely reduced. Currently, most drugs are reimbursed at Average Wholesale Price (AWP) minus 5% and that will be reduced to minus 15-20% in 2004. This cutback alone could force many oncology practices to quit treating Medicare patients altogether.
5. Increase practice expense reimbursements for drug administration.
6. A complicated prescription drug benefit program will be implemented. Medicare-endorsed prescription drug discount cards should be available to all Medicare beneficiaries by April 2004. Savings for beneficiaries are estimated to be 15-25% per prescription. The savings will vary according to the income of the beneficiary (with the poorest paying the least out-of-pocket) and the plan chosen.
7. Geographic payment disparities will be reduced with a $1 billion increase in the work component to the fee schedule in rural and underserved areas. There will be an additional $700 million in incentives to maintain and enhance the physician supply in rural and underserved areas.
8. There will be many changes affecting hospitals (rural more favorably than urban), home health agencies and even ambulance services. New cost containment measures for CMS will be implemented. Tax-free Health Savings Accounts (HAS's) will become available for qualified medical expenses. There will also probably be new certification requirements for drugs that are re-imported from Canada.
And that's just the beginning. One thing is for sure: it's going to take some time to digest all of the changes that will be implemented within the next few months. Your County Society is going to take steps to provide its members with information regarding this new law as it becomes available. I invite all physicians to inform me by letter, phone or email (Edwin.kingsley@usoncology.com) how this law affects their medical practice as it becomes enacted over the next several months.
On December 1st, the Federation of State Medical Boards (FSMB) submitted the results of its performance audit of the Nevada State Board of Medical Examiners (BME) as mandated by our last legislature. This was a comprehensive review and evaluation of the "methodology and efficiency of the BME in responding to complaints filed by the public against a licensee" (doctor) and filed by a licensee against another licensee; how the BME conducts investigations of licensees who have had two or more malpractice claims filed against them within a period of 12 months or have been the subject of one or more peer review actions at a medical facility that resulted in the licensee losing his professional privileges for more than 30 days within a period of 12 months; what steps the BME is taking to remedy or deter unprofessional conduct by a licensee before such conduct results in a violation that warrants disciplinary action; and, the efficiency of the BME in using its fees that it collects from its licensees (that's us!).
The FSMB recommended that the BME "implement a system through its database management software for assigning and tracking high, medium or low priority to investigative cases that suggest risk to the public". They also recommended that "communication should be improved between the Board and the source [any person originating any complaint against a doctor]" in the form of regular communications regarding the status of the complaint. They recommended the BME make its actions and findings in disciplinary cases available to the public electronically, an excellent idea. They recommended the BME do a better job educating the public and its own licensees (us!) of its own duties and its role in protecting the public. Specific recommendations included hiring "a full-time public information/media/communications specialist and implement a proactive communications program that explains the BME, its mission and what it does . . . on an ongoing and regular basis". They recommended that the BME provide "more reliable information about the physician workforce in Nevada". This point should not be lost on anyone in light of the misleading General Accounting Office (GAO, the investigative arm of Congress) report released earlier this year on the medical malpractice crisis in Nevada. That report relied on information provided by the BME regarding the status of the physician work force in our state and in essence concluded that there was NOT a crisis here and that "medical provider groups in some states manufactured a crisis of access to care to get lawmakers to change the laws to protect physicians more from medical malpractice suits" (Cy Ryan, "Medical board says no doctor exodus", Las Vegas Sun, 9/5/03). There were several other very unflattering reports in the local media about how Nevada doctors have been misleading the public regarding the very real deterioration of physician manpower in this state. The excellent article by Dr. John S. Williamson, NSMA president, "Nevada Physician Practice Closures" in November's "County Line", effectively countered this totally erroneous assertion by the GAO. Unfortunately, the damage was already done and I firmly believe that to this day, the public still has little idea exactly how badly this state is suffering from the ongoing loss of competent physicians who are either leaving the state or simply retiring early.
The FSMB audit pointed out how the BME has "been greatly disadvantaged in its ability to protect the public" by a recent statutory change made in SB 250 by our last legislature. Originally, grounds for disciplining physicians or denying licensure could be based on the "Conviction of a felony, any offense involving moral turpitude or any offense relating to the practice of medicine". SB 250 changed that to simply "Conviction of a felony." The FSMB audit contends that SB 250 changed that to "Conviction of a felony relating to the practice of medicine or the ability to practice medicine". This is factually incorrect. The FSMB recommended that the law be changed back to its earlier wording. In fact, the legislature did NOT change the language in SB 250 as asserted by the audit, and the phrase, "relating to the practice of medicine or the ability to practice medicine" was removed, with which I agree. The FSMB also recommended that the BME not follow the 2003 legislative mandate of granting licensure to a physician on the basis of "endorsement" since our legislature did not specifically also require core competencies and credentials such as graduation from medical school and completion of post-graduate training or residency training as part of that procedure. This is misleading. I believe that the granting of a license by endorsement places the power to license in the judgment of the duly appointed members of the Board and not in the power of the staff of the Board. The BME should have the authority to license doctors outside of the "toughest requirements in the United States" when its members feel exigent circumstances exist justifying such licensure. For example, southern Nevada currently has a desperate shortage of pediatric subspecialists. The BME could find this constitutes sufficient public interest need to license a qualified pediatric subspecialist through endorsement. The FSMB pointed out that "few, if any, states issue a medical license solely on the basis of a license from another jurisdiction" ("reciprocity"). This is factually incorrect. Other states have and continue to use this process, as they should when there are compelling reasons to do so.
The FSMB audit did not include an evaluation of the BME's compliance with Nevada's Open Meeting Act. Your CCMS Board is already taking steps to have the Nevada Legislative Counsel Audit Division investigate compliance with these acts.
In closing, I would like to thank our CEO, Don Havins, for the time and effort he regularly spends closely following the actions and decisions of our BME. This is the regulatory body that routinely makes decisions that profoundly affect the way you and I practice medicine in this state and it behooves all of us to stay informed of their activities.
New Members for October 2003
Congratulations and Welcome to the Clark
County Medical Society
- Stuart A Engel, MD, General Surgery, 3006 S Maryland Pkwy #465, Las Vegas, NV 89109
- Maureen K McCormack, MD, Diagnostic Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106
- Jason W Pollock, MD, Ob-Gyn, 1000 S Rainbow Blvd, Las Vegas, NV 89135
- Keita Sakon, MD, Ob-Gyn, 1000 S Rainbow Blvd, Las Vegas, NV 89135
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
- Bashab Banerji, MD, Internal Medicine
- Bess L Chang, DO, Neurology
- Arezo M Fathie, MD, Internal Medicine/ Pediatrics
- Bernadine A Hanna, MD, General Surgery
- Katherine A Keeley, MD, Oral/Maxillofacial Surgery
- Wai Li Ma, MD, Gastroenterology
- Mavis N Matsumoto, MD, Internal Medicine
- Neal L Ross, MD, Ob-Gyn
- Yousuf B E Schulz, MD, Radiology
For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989
Referral Tallies
The following referrals were provided to CCMS members in the fourth quarter of 2003 (through December 16)
Specialty Referrals
Addiction Medicine 0
Allergy 0
Anesthesiology 0
Cardiology 12
Cardiovascular Surgery 0
Colon & Rectal Surgery 4
Dermatology 4
Diagnostic Radiology 0
Endocrinology 5
Family Practice 23
Gastroenterology 8
General Surgery 8
Geriatrics 3
Gynecologic Oncology 0
Hematology 0
Infectious Medicine 3
Internal Medicine 27
Nephrology 2
Neurology 15
Neurosurgery 0
Ob-Gyn 6
Oncology 6
Ophthalmology 7
Oral/Maxillofacial Surg. 0
Orthopaedic Surgery 15
Otolaryngology 2
Pain Management 5
Pathology 0
Pediatrics 2
Ped. Psychiatry 1
Ped. Surgery 0
Physical Med/Rehab 0
Plastic Surgery 14
Preventative Medicine 0
Psychiatry 10
Pulmonology 5
Radiology 1
Rheumatology 6
Urology 4
Vascular Surgery 0
Totals 198
Tillinghast Study: U.S. Tort Costs Climbed to $205 Billion in
2001
Tort Costs Jumped 14.3%: Highest Percentage Increase Since 1986
New York, NY, February 11, 2003 - The U.S. tort system cost $205 billion in 2001, or $721 per U.S. citizen, representing a 14.3% increase in tort costs since the year 2000. At current levels, U.S. tort costs are equivalent to a 5% tax on wages. These findings were reported by Tillinghast - Towers Perrin (Tillinghast) in U.S. Tort Costs: 2002 Update - the only study that tracks the cost of the U.S. tort system from 1950 to 2001 and compares the growth of tort costs with increases in various U.S. economic indicators.
Key findings from the study revealed that:
- When viewed as a method of compensating injured parties, the U.S. tort system is highly inefficient, returning less than 50 cents on the dollar to people it is designed to help and returning only 22 cents to compensate for actual economic loss.
- As of 2001, U.S. tort costs accounted for slightly more than 2% of GDP, signaling the end of a 13-year decline in the ratio of tort costs to GDP.
- While the cost of the U.S. tort system has increased one hundred fold over the last fifty years, GDP has grown by a factor of only 34.
- Medical malpractice costs have risen an average of 11.6% a year since 1975 in contrast to an average annual increase of 9.4% for overall tort costs.
- The largest single factor in the rise of tort costs in 2001 was a significant reassessment of liabilities tied to asbestos claims. This accounted for $6 billion of the $26 billion increase over 2000 levels. Other contributing factors include: class action lawsuits and large claim awards; an increase in the number and size of shareholder lawsuits against Boards of Directors; an increase in medical cost inflation leading to higher costs of personal injury claims; and medical malpractice lawsuits.
"These trends continued and became even more pronounced in 2002, with large charges for upward revisions of asbestos liability and a jump in the number of directors' and officers' (D&O) liability lawsuits," says Russ Sutter, survey leader and Tillinghast principal. "Additionally, we believe 2002 data will begin to show the impact of 9/11-related lawsuits and will also show mold beginning to emerge as an important liability issue. Absent sweeping tort reform measures, we expect most of these trends to continue in 2003 and beyond."
Future Implications
While it is almost impossible to accurately predict future increases in tort costs, Tillinghast estimates annual increases will be in the 7% to 11% range for the next several years. At this rate of increase, tort costs could equal $1,000 per citizen by 2005.
"When the first Tort Costs Study was published in 1985, we attributed the rapid escalation in tort costs to an overall societal attitude of entitlement," says Jeanne Hollister, a Tillinghast consulting actuary. "But this sense of entitlement has now been coupled with rising anger toward and mistrust of U.S. corporations that can only serve to exacerbate tort costs."
Tillinghast expects the insurance industry to react to rising tort costs by placing further limits in policies as it did in the mid-1980s with the elimination of pollution coverage. The firm anticipates some insurers will withdraw completely from certain lines of business and markets, as is happening now in the medical malpractice market.
"We believe corporations will continue to shift toward self-insurance as they attempt to gain more control over costs and as insurance prices continue to rise," says Eric Speer, Tillinghast Region Manager for the Americas. "Rising tort costs, combined with the right congressional environment, will likely create more pressure for tort reform - particularly asbestos reform."
About the Study
U.S. Tort Costs: 2002 Update is an update of previous studies published by Tillinghast in 1985, 1992, 1995 and February 2002. For copies of the report, please contact Robyn Hennessy at robyn.hennessy@tillinghast.com.
About Tillinghast
- Towers Perrin
Tillinghast provides actuarial and management consulting to financial services companies and advises other organizations on their self-insurance programs. Tillinghast is a premier independent advisor to the insurance industry; its major clients include most of the world's top insurers. It operates as one global business, through a network of 42 offices in 20 countries. Tillinghast is a division of Towers Perrin, one of world's largest management and human resource consulting firms. The Towers Perrin family of businesses also includes Towers Perrin Reinsurance, a leading global reinsurance intermediary. Together, these businesses have over 9,000 employees in 23 countries. More information about Tillinghast is available at www.tillinghast.com.
Clark County District Court
Medical Malpractice Filings against Health Care Providers
Jan 2001 –
Nov 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 49
Dec 9 170
Nevada
Licensure Renewal Requirements – Proposed Regulations
By Weldon (Don) Havins,
M.D., Esq.
The NBME approved for Workshop
feedback new proposed re-license requirements for "demonstrated continuing
proficiency to practice medicine" regulations which, if approved in their
current form, would mandate compliance and completion by
Section 42 of Senate Bill 250 of the last (regular) session of the Legislature amended the medical practice act, NRS 630.003, to read as follows:
630.003 1. The Legislature finds and declares that:
(a) It is among the responsibilities of State Government to ensure, as far as possible, that only competent persons practice medicine and respiratory care within this state;
(b) For the protection and benefit of the public, the Legislature delegates to the Board of Medical Examiners the power and duty to determine the initial and continuing competence of physicians, physician assistants and practitioners of respiratory care who are subject to the provisions of this chapter;
(c) The Board must exercise its regulatory power to ensure that the interests of the medical profession do not outweigh the interests of the public;
(d) The Board must ensure that unfit physicians, physician assistants and practitioners of respiratory care are removed from the medical profession so that they will not cause harm to the public; and
(e) The Board must encourage and allow for public input into its regulatory activities to further improve the quality of medical practice within this state.
2. The powers conferred upon the Board by this chapter must be liberally construed to carry out these purposes for the protection and benefit of the public.
Thus, while there is no statutory provision to mandate "demonstration of proficiency" for re-licensure, the NBME clearly appears empowered to adopt these proposed regulations under the liberal construction clause of paragraph 2.
Do these proposed regulations of mandated demonstration of proficiency "ensure, as far as possible, that only competent persons practice medicine and respiratory care within this state"? Do these proposed regulations identify "unfit physicians" so that the Board can ensure that these "unfit physicians" are "removed from the medical profession so that they will not cause harm to the public"? The NBME likely would rely on the "as far as possible" phrase as the operational clause justifying these mandates.
Provision a. "Hold current certification or re-certification by a member board of the American Board of Medical Specialties" appears to apply to lifetime ABMS certificate holders, but this appears to be in conflict with the notion of demonstrating continuing proficiency in the paragraph above. Did the authors of the regulations mean to write:
"a. Be certified or re-certified by a member board of the American Board of Medical Specialties within the last 10 years"? This would be in concert with the Workshop discussions of the prior proposed regulations.
No other state has adopted or mandated competency or proficiency regulations for re-licensure. What effect will this have on the record number of NBME licensees practicing outside of Nevada? Will they simply non-renew their Nevada medical licenses? This could result in a $400,000 or more shortfall in expected revenues to the NBME. Will the NBME be required to increase licensure fees to compensate for the shortfall? Under the current statute the NBME can increase re-licensure fees to $800 per licensee.
All interested parties wishing to stay informed on this issue and wishing to receive notice of the NBME Workshops on these proposed regulations should write the NBME and request placement on their "mailing list". One can write to the Nevada Board of Medical Examiners, 1105 Terminal Way, Suite 301, Reno, Nevada, 89502 and request to be placed on the "MAILING LIST of the NBME." A mailing list request provides agendas of meeting, notice of proposed regulations, and notice of Workshops of proposed regulations for a period of six months. To continue receiving information, the request for mailing list information must be repeated every six months.
As with the last set of proposed "competency regulations", public and NBME licensees' input will be critical to either adoption (or non-adoption) of the proposed regulations, or to the specific provisions of the final regulations.
THE MEDICARE PRESCRIPTION DRUG,
IMPROVEMENT, AND MODERNIZATION ACT
The Medicare Prescription Drug, Improvement, and Modernization Act helps physicians and other healthcare providers in several ways. All healthcare providers, including physicians, will see a 1.5% payment rate increase under the House Bill instead of a 2.4% previously scheduled cut in reimbursement this year. The law provides for another 1.5% increase in 2005. The Physician Payment System formula to calculate reimbursement rates will be changed to use a 10 year rolling average measure of GDP rather than the current single year measure. Rural and other areas with lack of sufficient physician medical coverage will receive a 5% bonus reimbursement for providing care in the areas of medical scarcity - this applies to specialists as well as primary care physicians. Areas with geographic adjuster below 1.0 will have those adjusters raised to 1.0 for the next three years. This will increase payments to physicians in areas of below average reimbursement. Therapy caps will not apply in 2004; beneficiaries needing extensive therapy will not be denied services while the Administration works to devise alternative means to address the problem.
When President Bush spoke at Spring Valley Hospital in December, he noted that seniors (Medicare recipients) will be able to purchase a drug discount card in early 2004 which will be effective until the formal medication discount program is implemented in 2006. HHS estimates the temporary discount card will save seniors between 15% and 25% per year in 2004 and 2005. Low income seniors will receive $600 per year in assistance for prescription medications. Beginning in 2006, three-fourths of medication costs will be covered up to $2,250.
The average premium for this benefit will be $35.00. Medicare beneficiaries below 150% of the federal poverty level will have comprehensive coverage without charge. Premiums will be fully subsidized up to 135% of the federal poverty level and phased-out at 150% above the poverty level. Copays of $2 for generic and $5 for brand names apply to beneficiaries with incomes below 135% of the poverty level.
Employers will receive a percentage subsidy to maintain medication coverage for their retirees. This subsidy is "excludable from taxation." The Congressional Budget Office predicts that this will induce all but a few employers to maintain medication coverage for their retirees.
An amendment to the law by Senator Orin Hatch and Representative Henry Waxman provides mechanisms to speed approval of cheaper generic medications to the market. The law provides for coverage for an initial physical examination for seniors, as well as preventive benefits such as cholesterol and diabetes screenings.
In summary, beginning in 2006, the standard prescription drug benefit will include: a $250 deductible; 75% coverage to $2,250; $3,600 out-of-pocket catastrophic coverage (beneficiaries having incomes below 135% of the poverty level have no copayments above catastrophic, $2/$5 copayments between 135-150%, and above 150% of the poverty level a 5% coinsurance), all with a $35 per month average premium.
Chapter 630 of the Nevada
Administrative Code is hereby amended by adding thereto a new section to read
as follows:
NAC 630. Requirements for Biennial Registration.
1. In
addition to all other requirements for biennial registration, effective at the
biennial registration period commencing July 1, 2007 and for the biennial
registration periods commencing July 1, 2017 and July 1, 2027, respectively, no
physician licensee shall be registered to practice medicine in the state of
Nevada for that biennial registration period unless at the commencement of that
biennial registration period the licensee has demonstrated continuing
proficiency to practice medicine by accomplishing one of the following:
a. Hold
current certification or re-certification by a member board of the American
Board of Medical Specialties; or
b. Maintain
active or associate hospital privileges (or privileges to assist in surgery) at
a Joint Commission on Accreditation of Healthcare Organizations (JACHO)
hospital or hospital-affiliated surgical or medical center for the two years
preceding the commencement of the biennial registration period; or if
practicing as a pathologist, be associated with a laboratory accredited by the
College of American Pathologists for the two years preceding the commencement
of the biennial registration period; or if practicing as a Radiologist, be
associated with a laboratory accredited in one or more modalities by the
American College of Radiology for the two years preceding the commencement of
the biennial registration period; or
c. Pass
a board approved peer review of the licensee's medical practice, at the
licensee's cost, for the ten year period preceding the biennial registration
period, to be conducted by two physician licensees, approved by the board, who
practice 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; or
d. Have
taken and passed during the ten year period preceding the biennial registration
period one of the following examinations at the licensee's cost:
i. The
Special Purpose Examination (SPEX);
ii. The
United States Medical Licensing Examination (USMLE);
iii. A
practice specialty module of the Special Purpose Examination (SPEX);
iv. The
self-assessment and review examination offered by the American Psychiatric
Association, if the licensee practices as a Psychiatrist; or
v. Any
other formal examination, which has been validated under "Standards for
Educational and Psychological Testing," developed jointly by the American
Educational Research Association, the American Psychological Association and
the National Council on Measurement in Education, and approved by the board.
2. Any
licensee whose unique practice circumstances so warrant may apply to the board
for an exception to the requirements of subparagraphs a, b, c and d of
paragraph 1., and may at the board's discretion and approval be permitted to
demonstrate continuing proficiency by such other means as the board may deem comparable
and appropriate.
Minutes Synopsis
(Members can receive a full copy of meeting minutes by calling 739-9989.)
CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING
Tuesday,
Guest Presentation
Dr. Carl Heard presented information regarding the Specialty Care Access Network (SCAN) program to be operated by the Great Basin Primary Care Association (GBPCA).
Action Items
The minutes from the October 21st Board meeting were approved as revised.
Dr. Steinberg reported there is more money in the CCMS bank accounts at this time than there was last year. General office expenses are down this year compared to last year at this time. Operating expenses are overall flat compared to last year and Staff was commended for keeping expenses down.
Committee Reports
Dr. Bernstein reported the CME activity that Dr. Jay Levy presented at Sunrise Hospital was a success. There were around 50-55 participants. The Mini-Internship program is scheduled for the first week of February, with the dinner at McCormick & Schmick's on February 5, 2004. Financial support is being sought.
The following applicants were approved for membership: Stuart Engel, MD, General Surgery; Maureen McCormack, MD, Diagnostic Radiology; Jason Pollock, MD, OB-GYN; Keita Sakon, MD, OB-GYN.
Dr. Colletti reported the Southern Nevada Medical Industry Coalition meeting held at Sunrise Hospital last week was well attended. There were 3 state senators, heads of hospitals and heads of nursing associations in attendance. The Coalition is focusing on obtaining support for the nursing shortage and the passage of the KODIN Initiative Petition.
Recommended revisions to the Administrative Policy Manual were approved.
Alliance Report
Annette Mohs reported the CCMS Alliance has exceeded its goal of a 20% increase in membership in this year. Greeting card project goals are to provide ten $1,000 scholarships to nursing students and to donate funds to the Women's Development Center and to ALS medical research.
Nevada School of Medicine
Dr. Harter announced the University of Nevada Reno has approximately 80,000 graduates. Dr. Bill Zamboni, Professor and Chair of the Department of Surgery at the School of Medicine, was selected as the Outstanding UNR Alumnus.
Scholarship Fund Report
Drs. Colletti, Kingsley and Evins, who are the CCMS members of the Scholarship Fund Corporation's Directors, scheduled a meeting of the Scholarship Board of Directors for December 15, following the Executive Council meeting.
NSMA Update
The NSMA Council meeting was held last weekend. The NSMA is working with the AMA on the Medicare bill.
President's Report
Dr. Kingsley stated Chancellor Jane Nichols was one of the speakers at the Southern Nevada Medical Industry Coalition meeting at Sunrise Hospital. At that meeting, she reported that nursing schools will comply with the legislative mandate to double their enrollment within the next two years. Mr. Bill Welch, executive director of the Nevada Hospital Association, reported there are 1,300 hospital nursing vacancies. Dr. Rudy Manthei spoke at the meeting and reported that KODIN has hired two PR firms to help pass the KODIN initiative petition. Dr. Kingsley will be the medical/physician representative on the KODIN task force. Information packets for distribution to patients should be available in January for physician's offices.
Administrative Report
Dr. Havins informed the Board of an attorney's request to present a talk on asset protection to CCMS members. Dr. Havins was directed to offer him the opportunity to purchase mailing labels if he desires to hold a seminar whereby he may so solicit attendance of CCMS members, as can any other law firm should they wish to the same.
Dr. Jones reported he has approached several hospital CEOs who are willing to allow their volunteer forces to assist in registering voters beginning in January. Dr. Jones and Annette Mohs will also work with individuals located in major medical office buildings to register voters. Dr. Mulkey was asked to check into the viability of setting up voter registration for patients when they are seen at Quest Labs for lab work.
Dr. Havins announced the first CME on Weapons of Mass Destruction formulated by Southern Nevada Area Health Education Center (AHEC), intended especially for individuals interested in becoming a trainer for these programs.
The next Executive Council meeting will be Tuesday, December 16, 2003 at 6 pm.
There being no further business, the meeting was adjourned by Dr. Kingsley at 8:05 pm.
Saving Private Practice
By Gale Koch, Health
Care Advantage
The Federation of Physicians and Dentists has arrived in Clark County, supporting the preservation of private practice medicine. This is a national organization that currently has 8,500 physician members and growing. For less than $2.00 per day you can join the expanding ranks of physicians/surgeons and dentists and become a member. In less than 120 days, more than 150 of your colleagues did just that. Many physicians have and are joining including the following specialty groups - orthopaedic (including the President of the Nevada Orthopaedic Society), cardiology, infectious disease, pediatrics, ob-gyn's, anesthesiology, ENT, family practice and internal medicine just to name a few.
Recently, Utah physicians had a very good experience with the Federation of Physicians and Dentists. As in other parts of the country, physicians had experienced a downward spiral of reimbursements. A grassroots campaign was started when physicians realized that physicians needed to put down the sword of competition that was dividing them from fighting the true enemy of their practice - managed care companies. The Federation of Physicians and Dentists were successful in improving their reimbursements. In closing, the Utah experience reminds us that managed care companies have no product if it was not for the physicians.
Testimonial
We are all aware as physicians that reimbursements have been declining and costs are on the rise. I chose to become a member of the Federation of Physicians and Dentists because they offer an opportunity for the private practice physician's voice to be heard. I recognize FPD as being a force for helping physicians navigate through the complicated system of health care reimbursements. For a minimal cost, they analyze my contracts and provide information so I can make a good business decision, because practicing medicine is also about making good business decisions. More and more physicians in Southern Nevada are closely looking at the environment here, some have made the tough decision to leave a community they have enjoyed because they can no longer afford to stay. I think the Federation of Physicians and Dentists can assist us in offering a voice of reason to the managed care community. I hope you will join me.
Gary Podhaisky, MD, FAAP
SAVING PRIVATE
PRACTICE
Federation of Physicians and Dentists
Benefits
- FPD representatives review all contracts and draft proposed changes.
- FPD uses a messenger-model protocol to deal with Insurance Companies and the self-insured market.
- FPD is an affiliate of the AFLCIO, which gives them strong lobbying power. FPD is currently supporting the Collective Bargaining bill for physicians that is currently in Congress.
- FPD representatives work closely with other unions concerning healthcare issues.
- They have used their antitrust attorneys to defend their position of the messenger model in Delaware and won at a cost to the Federation of one and a half million dollars. This was at no additional cost to the physician members.
- Under the Federation there is no limit to the number of physicians joining. That means it could be 100% of any specialty in Clark County if all should decide to join.
The best part is the cost is under $2.00 a day. One less cup of coffee and all the benefits above are yours! Total cost is $58.84 per month.
The next meeting of the Federation of Physicians and Dentists is 6:30 p.m. Thursday, January 29 at Sunrise Hospital Auditorium.
Local Contact:
Gale Koch
phone number: 812-3128
e-mail address: kochgale@aol.com
and/or
Jack Seddon, CEO
1-800-373-5777.
Join Today!
Members supporting Members
That's what it's all about!
CME Calendar
Cardiovascular Cardiovascular Consultants 691-9154
Clark County Medical
Society 739-9989
St. Rose
Hospital 616-5832
Southwest Medical
Associates 242-7347
Summerlin
Hospital 233-7572
Sunrise Hospital 731-8210
1/9 - “Pediatric Pathology,” 7:30 a.m., 1 CME hour
1/9 - “Primary Care: Smallpox,” 12:15 p.m., 1 CME hour
1/15 - “Medical Ethics: Ethical Issues in Cancer Genetic Testing,” 5 p.m., 1 CME hour
1/16 - “Primary Care: Anti Fungal,” 12:15 p.m., 1 CME hour
1/20 - “Clinical Grand Rounds: HIV,” 7:30 a.m., 1 CME hour
1/23 - “Pediatric Grand Rounds: Circumcision,” 7:30 a.m., 1 CME hour
1/30 - “Primary Care: Pre-skin Cancer,” 12:15 p.m., 1 CME hour
UMC 383-2604
1/8 - “Update on Hodgkins,” 12:15 p.m.
1/16 - “Overactive Bladder,” 7:30 a.m.
1/23 - “West Nile Virus,” 7:30 a.m.
1/29 - “Radiation Therapy of Hodgkins Disease,” 12:15 p.m.
1/30 - “Atherosclerosis & Insulin Resistance,” 7:30 a.m.
Valley Hospital 388-4847
1/13 - “Procrit: Use and Abuse,” noon
1/27 - “Telemetry: Pulse Ox & Heart Monitoring,” noon
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
*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* -
November 2003
DISEASE CASES REPORTED YEAR TO DATE
Nov 2002 Nov 2003 2002 2003
VACCINE PREVENTABLE DISEASES
HAEMOPHILUS
INFLUENZA 0 0 8 8
HEPATITIS A 2 1 23 15
HEPATITIS B 6 4 45 59
INFLUENZA 0 1 59 48
MEASLES 0 0 1 0
MUMPS 0 0 4 2
PERTUSSIS 1 0 23 20
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES **
CHLAMYDIA 350 401 4128 4305
GONORRHEA 157 182 1600 1850
SYPHILIS (Primary & Secondary) 0 1 7 8
SYPHILIS
(Early Latent) 0 0 6 19
ENTERICS
AMEBIASIS 5 2 23 16
BOTULISM-INTESTINAL
(Infant) 0 0 0 1
CAMPYLOBACTERIOSIS 6 9 108 93
CRYPTOSPORIDIOSIS 0 0 2 0
E. COLI
O157:H7 1 0 14 17
GIARDIASIS 15 8 113 89
ROTAVIRUS 20 8 365 481
SALMONELLOSIS 15 5 168 107
SHIGELLOSIS 2 2 29 49
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 4 2 39 31
DENGUE 0 2 0 2
ENCEPHALITIS 0 0 2 2
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 1 0 1
SYNDROME (HUS)
HEPATITIS C 0 0 3 3
HEPATITIS D 0 0 1 0
LEGIONELLOSIS 1 4 5 8
LEPROSY (HANSEN'S DISEASE) 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 0 0 1 3
LYME
DISEASE 0 0 0 3
MALARIA 0 1 3 2
MENINGITIS,
ASEPTIC/VIRAL 8 12 92 130
MENINGITIS,
BACTERIAL 3 1 25 21
MENINGOCOCCAL
DISEASE 0 0 14 6
Q FEVER 0 0 1 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
RSV
(RESPIRATORY 53 52 1955 1431
SYNCYTIAL VIRUS)
ROCKY
MOUNTAIN 0 0 2 0
SPOTTED FEVER
TOXIC SHOCK
SYNDROME 0 0 1 2
TUBERCULOSIS 6 9 56