Newsletter 71 December
05
Contents
Malpractice Filings Against Health Care Providers, Jan 2001 – Oct 2005
Allscripts Electronic Prescribing Program
Cultural Competency (Re) Licensure Mandate in Our Future
Clark County Health District Report
Clark County Health District Disease Statistics – October 2005
President’s Message
By Ron Kline, MD,
2005-2006
May you live in interesting times...
I recently had the chance to attend the 2005 Wellpoint West Region Leadership Conference as a representative of the Clark County Medical Society. The experience felt a little like being behind enemy lines, but one must know your enemy if you are to battle him effectively. I learned a lot of new words at the conference. I always thought I was a doctor taking care of patients, but I learned that I was a part of an ISD (that is an Integrated Delivery System to the uninitiated) taking care of covered lives. I met administrators of small healthcare networks and CEO's of physician IPA's. The network administrators were trying to figure out a way to make a living off the inefficiency and complexity that is our current health care system (crumbs from the pie), while the CEO's were trying to figure out ways to keep their physician groups financially viable in the increasingly consolidated health insurance industry.
A few themes kept reappearing throughout the conference that I wanted to share with our physician members so that we can all plan for the changes that lie ahead in medicine. Dr. Samuel Nussbaum, the CMO of Wellpoint cited data showing large variations in cost and outcome across a variety of high dollar medical procedures such as coronary artery bypass grafts. The data has a great deal of scatter, with both high cost, low quality providers, as well as low cost, high quality providers spread across the Wellpoint network. The obvious inference is that patients will increasingly be directed to the low cost, high quality providers. Dr. Nussbaum made the point several times that the quality of care was not necessarily related to volumes.
Several speakers also referred to data published in the New England Journal of Medicine that cited a 55% rate of appropriate care (using evidenced based guidelines) given to hospitalized patients for various diseases. This data was the premise for discussions about the need for "pay for performance" (P4P) in both government and private health insurance systems.
“Disease
management" will also increasingly become a fact of life for
physicians. Statistics repeatedly thrown
about at this meeting referred to the fact that 1% of patients are responsible
for 25% of health care costs and 5% were responsible for over 50% of
costs. Pilot studies from Wellpoint showed a 10% cost savings when nurses and other
ancillary health personnel were involved in the process, providing a 400%
return on investment with a 97% patient satisfaction rate. Wellpoint has now
taken the unusual next step of placing nurses in physician's offices (at their
cost) to help in disease management.
Medicare in
It is fair to be skeptical when profit-driven insurance
companies talk about quality, since what they are usually referring to is
cost. I was impressed, however, that the
data presented on cardiac surgery used risk stratification parameters and guidelines
for the assessment of complications developed in collaboration with the
Clearly there is a strong push on the part of both government and insurers to measure and publish outcomes data and to make this information widely available to the public. As physicians we can either fight to prevent the collection and publication of this data, or accept that it will be published and work collaboratively with government and insurers to ensure that this complex task is carried out correctly, and that quality outcomes data is, in fact, quality data, and not simply economic credentialing.
It must also accurately take into account the expected poorer outcomes of high-risk patients. Nothing could be worse than to have high risk patients not receive necessary care because they might adversely affect someone's "numbers." All of us as physicians (and hospitals) think we are doing as good a job taking care of our patients as our peers (maybe better). None of us intends to provide a lower quality of care. The truth is, however, that we simply don't know. Outcomes data will allow those of us who are not doing as good a job as we thought, to improve, and to adopt the best practices of our peers. Hopefully, outcomes data will be used as an inducement to help all of us (including hospitals) improve, rather than as a club with which to beat us down. If done correctly, this has the possibility to be a win for our patients, ourselves, and healthcare as a whole. But we must participate to make sure that it is done correctly and that the ultimate goal is good patient care.
Our own data from respected peer-reviewed journals shows that often we are not providing the care that evidence based guidelines say we should. Undoubtedly, the reasons for this are complex and multifactorial. P4P, although insulting at one level has the potential to improve medical care by providing financial incentives to follow evidence based guidelines. As objective physicians, we must acknowledge the data presented in our own journals, and accept changes that will move the system as a whole towards the provision of quality care to all of our patients.
Our primary duty is to our patients, and we must never lose
sight of that responsibility as we go through our days. If the changes coming down the road are a
"win" for the quality of medical care in the
Clark County District Court Medical Malpractice Filings
Against Health Care Providers, Jan 2001 – October 2005
2001 2002 2003
2004 2005
Jan 39 33 108 61 41
Feb 20 14 98 72 63
Mar 35 30 169 123 64
Apr 37 34 111 81 70
May 37 35 126 65 14
Jun 27 24 103 90 65
Aug 54 51 76 67 33
Oct 37 83 110 59 26
Nov 38 184 59 78
Sum
372 823
1246 867
New Members
Congratulations and Welcome to the
October 2005
- Reuel Aspacio, MD – Dermatology, 911 N Buffalo Dr 113, Las Vegas, NV 89128
- Iulia C Ionitoaia-Chaudhry, MD, Internal Medicine, 7373 Peak Dr 160, Las Vegas, NV 89128
- Jerry J Marty, MD – Anatomic/Clincial Pathology,
- Mark R Parson, MD – Dermatology, 801 S Rancho Dr D-1B, Las Vegas, NV 89128 NV 89109
- Randell E Yee, DO – Orthopaedic Surgery,
9280 W Sunset Rd 422,
Reinstated Members
- Daniel H Kim, MD, Otolaryngology
- William R Wise, MD, Urology
- Demeterios Mavroidis, MD, Thoraci Surgery
- Darlina K Manthei,
DO, Family Practice
Applicants To Go Before Credentialing Committee
If you have any pertinent information about
the following membership candidates, please contact:
·
Munira Dubhbhai, MD, OB-Gyn
·
·
Jon L Siems, MD, Ophthalmology
·
Robert H
Wang, MD, OB-Gyn
For information on becoming a member of the
***New Member Special*** $390 New members can join for half
price their first year.
“Dear Doctor”
The Clark County Medical Society's Community Health/Community Relations Committee is developing a weekly column called "Dear Doctor" with the Las Vegas Review-Journal. We encourage any interested physician members to submit a brief article on a mainstream health topic of your choice. If you would like to submit an article for publication in our new "Dear Doctor" column with the R-J, please submit it to the Clark County Medical Society.
Specifications: Articles should be of 750 words or less. The
articles should be placed in the form of a Question/Answer and printed for
legibility.
Medicare News
MEDICARE TAKES KEY
STEP TOWARD
VOLUNTARY QUALITY
REPORTING FOR
PHYSICIANS
Medicare will make it easier for physicians to participate in a voluntary program to report evidence-based, consensus quality measures, an important step toward supporting higher quality physician care, Centers for Medicare & Medicaid Services (CMS) Administrator Mark B. McClellan, M.D., Ph.D., announced today.
"Physicians are in the best position to know what can work best to improve their own practices and ultimately the quality of care available to all patients," Dr. McClellan said. "Through these voluntary reports by physicians on evidence-based quality measures, we can take an important step together to help them improve care, and ultimately to help make sure that they are adequately compensated for that care."
The action today creates the Physician Voluntary Reporting Program. In the first phase of the program, beginning in January 2006, Medicare will enable physicians to voluntarily report information to CMS about the quality of care they provide to Medicare beneficiaries. The 36 evidence-based measures to be reported in the first phase of the program are a result of collaborative efforts with physicians, physician organizations and other experts involved in the review of the quality of the nation's health care.
The new voluntary reporting system comes as Medicare physicians face payment rates reductions for the next seven years, triggered by a statutorily imposed payment formula.
"Medicare remains dedicated to preserving access to quality care and avoiding unnecessary costs and that requires finding better ways to support quality care instead of simply adding more dollars into a system that focuses on volume," Dr. McClellan said.
To help support better health outcomes for people with Medicare at a lower cost, CMS is working closely and collaboratively with medical professionals and Congress to consider changes to increase the effectiveness of how Medicare compensates physicians for providing services to Medicare beneficiaries, while avoiding increases in overall Medicare costs.
As part of this effort, the Physician Voluntary Reporting Program will begin to phase in voluntary reporting of performance measures developed in collaboration with physicians and physician organizations, as well as other stakeholders. The work by the National Quality Forum (NQF), the Ambulatory Care Quality Alliance, the AMA Physician Consortium for Quality Improvement, the National Committee for Quality Assurance (NCQA) and RAND provided the basis for the selection of these measures.
CMS relied heavily on measures that had either completed or were close to completing the NQF's review process because the NQF is a primary consensus-development body for health care quality measures. Additional quality measures are under development now and may be phased in during the year.
As part of the first phase, CMS will begin to collect the information through the use of a dedicated set of Healthcare Common Procedure Coding System (HCPCS) codes, called G-codes, which will supplement the claims data doctors currently submit to CMS with clinical data. This clinical data will then be used to measure the quality of services provided to Medicare patients. CMS anticipates that these G-codes will serve as an interim step until the electronic submission of data through electronic health records replaces this process, and CMS expects to collaborate with participating physicians to develop such electronic data submission methods.
CMS will provide feedback to the physicians who submit the data by the summer of 2006 about the level of their performance based on the submitted data. The goal is to use this feedback to assist physicians in improving their data accuracy, reporting rate, and clinical care. CMS will also seek input from participating physicians on ways to improve the ease of reporting and usefulness of the quality measures, such as by promoting reports and analysis through electronic medical record systems.
"Reporting clinically valid quality measures is a proven approach to making significant improvements in clinical care," Dr. McClellan said. "We have been working closely with health professionals and other stakeholders on these measures, with the goals of making sure that we have low-cost and effective ways to report on quality and to help doctors use this information to improve care."
The Physician Voluntary Reporting Program is similar to previous CMS quality initiatives such as the hospital voluntary reporting program, which, after an initial collaborative process of evaluating and refining hospital data submission, resulted in the launch of www.HospitalCompare.hhs.gov in April, 2005.
HealthInsight,
the Quality Improvement Organization for
Allscripts Electronic Prescribing Program
By
Recent
publicity regarding a new
Technical
requirements
The hardware requirements are a standard desktop PC (or PC notebook computer) with at least 733 MHz processor speed, 256 MB RAM and 1 GB of hard disk space available. The program operates with Windows XP, Windows 2000 sp4, or Windows 2003. Peripheral hardware requirements are a CD-ROM, Network card 10/100, 800 x 600 resolution monitor, Fax Modem and Analog phone line (used to fax prescriptions). A high-speed Internet connection of at least 512 kbps is necessary. If you have purchased a PC computer with Windows within the last few years and you are connected to the internet via a cable modem or high speed phone line, you likely have all the computer hardware you need to get started. Macintosh computers are not supported and cannot be used by this program at this time. A printer connected to the PC is required because Schedule II controlled pharmaceuticals must be printed and signed by the prescribing physician. Prescriptions, with the exception of Schedule II medications, can be faxed or electronically submitted to the patient's pharmacy directly, or can be printed at the patient's request.
Security
The
database infrastructure is hosted by Allscripts who has contracted with Quest
Telco Corporation in
Accessing the
software
The software for the program can be downloaded from the internet at www.touchscript.net/nevada or can be
ordered in CD format (after
registration) to be shipped to the physician's office. The "eRx
software license" is free for 10 years to all
Technical support
For anyone
having a problem with the installation or operation with the program, technical
support is available Monday thru Friday,
Utility of the
program
A recent
demonstration of the operation of this program convinced the attendees of the
utility and functionality of electronic prescribing. Southwest Medical Associates 235 providers
implemented this program a couple years ago.
SMA reports over a million dollars in transcription cost savings with
substantially greater convenience and satisfaction by physician and patient alike. Patients' convenience is facilitated because
they can have their filled Rx ready for them when they arrive at their chosen
pharmacy. Michael Kriemelman,
phone number 314-359-1863, is the Allscripts executive in charge of this
Utilization of electronic prescribing reduces chart pulls and turnaround time for prescription renewal requests. Virtually all retail pharmacies are incorporated into the database. Illegible prescription handwriting, and the associated mistaken medication errors, is eliminated. The program contemporaneously provides warnings of medication conflicts or replication of drugs prescribed in the same category. Formulary and non-formulary medications for each payor are indicated along with a selection of generic equivalent medications, when available.
What if I need
additional hardware?
For physicians without a PC readily available, Allscripts has a program with HP for a market desktop PC (dc5000 Small Form Factor) computer which sells for $665 (list price $829). For those physicians who wish to utilize a server, and use wireless communication devices in patient exam rooms, Allscripts offers the HP ProLiant Entry Level Server-ML110 for $929.00. There is no requirement to purchase any of these products. Wireless systems, as well as any compatible server, can be obtained from any vender. Many physicians will elect to implement the program with their current office PC. Others may additionally employ wireless technology to communicate with their PC. This will permit electronic prescribing from exam rooms. Those with established electronic medical record programs can purchase compatibility software from Allscripts which will permit incorporation of the electronic prescription program into their current EMR system.
The Board
of Trustees of the Clark County Medical Society is please to make this program
available as a membership benefit. There
is no obligation to utilize the program.
There is no obligation to remain in the program after the program is
implemented. After two years use,
We think our members will find this electronic prescribing program beneficial to their practices.
Cultural Competency (Re) Licensure Mandate in Our Future
By
A few
states have taken steps to "reduce health care disparities" and
ensure that physicians are more responsive to cultural and language differences
among their patients. The Federation of
State Medical Boards (of which the
The New
Jersey legislature, in the body of the Bill, referenced a New England Journal
of Medicine article which indicated that physicians were far less likely to
refer blacks and women (than white men), with identical complaints of chest
pain, to heart specialists for cardiac catheterization. The authors of this study suggested that the
difference in referral rates stemmed from racial and sexual biases. The Surgeon General of the
A
(1) Cultural Competency … meaning a set of integrated attitudes, knowledge, and skills that enable a health care professional or organization to care effectively for patients from diverse cultures, groups and communities which, at a minimum, is recommended to include the following:
(a) applying linguistic skills to communicate effectively with the target population.
(b) utilizing cultural information to establish therapeutic relationships.
(c) eliciting and incorporating pertinent cultural data in diagnosis and treatment.
(d) understanding and applying cultural and ethnic data to the process of clinical care.
(2) Linguistic Competency which means the ability of a physician and surgeon to provide patients who do not speak English, direct communication in the patient's primary language.
(3) A review and explanation of relevant federal
and state laws and regulations regarding linguistic access, including, but not
limited to, the federal Civil Rights Act (42 USC 1981, et. Seq.),
Executive Order 13166 of
Three other
states have cultural competency bills moving through their legislatures:
The
The
There
appears to be substantial evidence, at least in some parts of the
Our legislators and regulators would do well to heed this approach to problem analysis and problem resolution. Their current well intentioned approach will not resolve the problem and is fraught with potential adverse unintended consequences.
Clark County Health District Report
By Donald Kwalick,
MD, MPH, Chief Health Officer
Effective use of volunteers during an emergency
Following
Hurricane Katrina, the U.S. Surgeon General asked the Medical Reserve Corps to
provide volunteers. In response, more than 170 volunteers from MRC units were
activated by the
These
volunteers included two RNs, Kathy McGonigle and
Patty Murphy, who were assigned to set up and assist with staffing a clinic
aboard the MS Holiday, a Carnival cruise ship used to house evacuees.
Additionally, a local MRC veterinarian, Jon Pennell
responded to requests by
Volunteers play an integral role in a disaster response. However, coordinating well-intentioned volunteers who self-deploy in times of need can be an overwhelming task for local emergency management personnel.
This is why it is important for health care professionals to be aware of the systems already in place for recruiting, credentialing and managing volunteer personnel. Established mechanisms for deploying volunteers provide for a better coordinated relief effort and ensure volunteers are afforded protections from liability and appropriate reimbursement.
The Medical
Reserve Corps is one such mechanism to ensure volunteer efforts are effectively
coordinated. Another established system is the Emergency Management Assistance
Compact (EMAC). The EMAC was ratified by Congress in 1996 and is the
cornerstone of mutual aid agreements between states and
Using EMAC, a state impacted by a disaster can receive assistance from other member states in a timely manner. EMAC is deployed at a state level - after the Governor of the state has declared an emergency. EMAC is administered by the National Emergency Management Association (NEMA), a professional association of state emergency management directors and is an affiliate organization of the Council of State Governments.
All member states are required to ratify the language of the compact in statute. By operating under this compact, assisting states are afforded protection from liability because requesting states assume responsibility for the volunteers deployed under the compact. Additionally, by agreeing to a standard legal process, member states are guaranteed reimbursement for all eligible assistance provided through EMAC.
It is also important to keep in mind the relief and recovery activities associated with events such as Hurricane Katrina are long-term efforts. When requested by other states, state and local emergency management agencies will call upon local volunteers with needed expertise (health care professionals, animal control, etc.) to respond to a disaster in another state. By volunteering through established organizations and systems we help ensure a better coordinated response and the optimal use of available resources.
If you are interested in signing up as a Medical Reserve Corps volunteer, contact Paula Martel at 759-0877.
Alliance
By Shanila Choudhury,
2005-06
This month the Membership Committee, headed by Estela Hansen has been working very hard to get out our yearly directory. She, Peggy Ho, Cheryl Samlaska, and Andrea Yu put a lot of effort into the design and content. Those who attend our next lunch at the Capital Grille will be receiving it. I want to commend them for their efforts.
The Greeting Card
Project needs your support so please send in your request letters with your
donation so we can fulfill our goals of offering ten Nursing School awards as
well as donating to the Nevada Benefits Society. We will be having a get together at Annette
Mohs' home on Thursday, December 1 at
We are excited
about our upcoming Fashion Show at
Please join us at
our next meeting which will be a breakfast at the elegant Bouchen
Restaurant in the Venetian Hotel. We
will have a morning meeting from
Nevada
State Medical Association ’s 102nd Annual Meeting and
Scientific Session
Mark Your Calendars!
This is the first time in years that this meeting will be
held in
1. A half day Scientific Session
2. President’s Luncheon (usually has an interesting speaker)
3. Very Informative Governmental Affairs Meeting
4. Reference Committee meetings where resolutions are discussed and perfected to become policy
5. Dinner and Awards ceremony where the NSMA and NSMAA Presidents are inaugurated
This year the
Delegation Chair for
Minutes Synopsis
Executive Council
MEETING
Tuesday,
Minutes Synopsis
The minutes for the
September meeting were approved unanimously.
Compilation of Financial Statements
Richard Bowler, CPA
from Piercy, Bowler,
Credentials Committee
Five applicants were
recommended for active membership: Reuel M Aspacio, MD, Dermatology; Iulia C
Ionitoaia-Chaudhry, MD, Internal Medicine; Jerry J
Marty, MD, Anatomic/Clinical Pathology; Mark R Parson, MD, Radiology; and
Randall E Yee, DO, Orthopaedic Surgery.
There were 2 student member applicants approved, both from the
There were 4
reinstatements: Daniel H Kim, DO - Otolaryngology; William R Wise, MD -Urology;
Demetrios Mavroidis, MD -
Thoracic Surgery; and Darlina K Manthei,
DO - Family Practice.
Dr. Kline reported
the Chancellor gave the Dean of the School of Medicine 30 days to determine a
vision or plan regarding the
Financial Report
Revenue was
$70,084.98 for the first 3 months of the new fiscal year which is down about
$30,000 from last year at this time.
Expenses were less than those at this time last year. The bank account balance at the end of the
last month was $268,264.58.
Membership Report
There were 433 dues
paid members, a decrease from the 536 paid members last year at this time. At this time there are total of 558 members,
which includes the dues exempt members.
Staff was directed
to send a letter to the malpractice insurance companies, not currently offering
a discount, asking them to offer
Community Health Committee
Work continues on
the "Dear Doctor" project.
They have 20 articles and more coming in. The Review Journal wants to put two articles
in the Sunday papers, and hopes to have readers send in questions. Dr. Jameson hopes to have this start in
November. She stated the committee wants
medical care service opportunities added to the website on an ongoing basis.
Access Health Info
Dr. Jameson
explained the Access Health program. Nancy
Whitman, the director of the program, and Dr. Jameson are to write an article
for the
Bylaws, Policies and Procedures Committee
After discussion,
the revisions were approved and staff was directed to send these changes to the
membership in the spring at the usual time.
Health District Report
Dr. Kwalick was
unable to attend the meeting but sent a report to the Board on current Health
District concerns.
Scholarship Report
Dr. Ellerton
reported he is re-negotiating with the University system because they want
scholarship donations to go through the various university Foundations. Dr. Ellerton will call a meeting of the
Scholarship Committee to discuss this request.
NSMA Report
Larry Matheis stated
they are in the process of getting the legislative strategy developed. He passed out packets to each Board member
regarding Medicare Part D.
Delegates
Dr. Nelson reminded
everyone that the NSMA Annual meeting will be in the spring and she asked each
Board member to work on bringing one additional person to be a Delegate. She suggested the Board consider giving each
Delegate $100 for participating, and asked this issue be on the agenda for the
next meeting.
President's Report
Dr. Kline stated the
AMA News is going to run a story on Allscripts and
New Business
The NAWBO nominees
were presented to the Board members. Dr.
Carol Vanderharten was chosen as
The Board decided that
articles and items submitted for publication in the
Future Meetings
The next BOT meeting
will be on
Adjournment
There being no
further business, the meeting was adjourned at
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Physician Reviewers Needed:
HealthInsight, the Quality Improvement Organization for the Medicare
Beneficiaries of the state of
CME CALENDAR
Bechtel
NV Chapter AACE 434-8400
Pri-Med Institute (877) 4PRI-MED
Sierra Health Services 242-7735
12/8 - “Hand and Arm
Problems from the Neurologist’s Perspective”
1/12 – “Diabetes
Update”
2/9 – “Updates on
Viral Hepatitis (Hepatitis A-E)”
Southwest Medical Associates 242-7735
UMC 383-2604
12/13 - “Chemodenervation: Pros and Cons
Only CME Activities held at the
Clark County Health District Disease Statistics* - October 2005
CLARK
COUNTY HEALTH DISTRICT
DISEASE
STATISTICS* - October 2005
DISEASE
CASES REPORTED YEAR
TO DATE
Oct
2004 Oct 2005 2004 2005
VACCINE
PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 1 0 6 11
HEPATITIS A 0 3 6 8
HEPATITIS B 6 1 46 20
INFLUENZA 0 0 53 119
MEASLES 0 0 0 0
MUMPS 0 0 0 1
PERTUSSIS 3 3 7 29
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY
TRANSMITTED DISEASES
AIDS 15 18 216 169
CHLAMYDIA 253 161 4012 4502
GONORRHEA 146 71 2087 1967
HIV 25 29 250 217
SYPHILIS
(Early Latent) 1 4 9 22
SYPHILIS
(Primary & Secondary) 4 2 32 83
ENTERICS
AMEBIASIS 3 2 12 13
BOTULISM-INTESTINAL
0 0 0 1
CAMPYLOBACTERIOSIS 10 14 77 75
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 2 6
E. COLI
O157:H7 6 1 16 11
GIARDIA 8 13 59 59
ROTAVIRUS 5