Your Doctor Believes in the Governor's MRT

The Governor has asked the Legislature to stay in Albany rather than returning to their home district offices this week to resolve the NYS budget. Please contact your NYS Assembly members and NYS Senator to support the Medicaid Redesign Team's budget recommendations which include comprehensive medical liability reforms, innovative programs to improve medicaid waste, and careful regulation to control costs. You can support the MRT recommendations (as your doctor has) by clicking here or on the link below. If you've already sent a letter or email, please CALL your legislators Albany offices today to keep this issue top of mind. The message is clear. MRT recommendations are good for New York, for our doctors, our hospitals, and our patients. It is a package deal and should not be dissected and dismantled.

We could have meaningful Medical Liability Reform in New York State by April 1st, or even by this weekend, but only if we act, in great numbers, to show support for redesigning the medicaid system now.

HR 3459: To provide comprehensive reform regarding medical malpractice

IN THE HOUSE OF REPRESENTATIVES
JULY 31, 2009

Mr. BAIRD introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on the Judiciary,
for a period to be subsequently determined by the Speaker, in each
case for consideration of such provisions as fall within the jurisdiction of
the committee concerned

A BILL
To provide comprehensive reform regarding medical
malpractice.

HR 3459 full text .pdf

CLINICAL INTEGRATION: will it be this community's response to "The Cost Conundrum?"

As the conversation concerning US Healthcare reform focuses on cost containment and quality improvement, with emphasis being placed on technologic developments and harnessing the power of the Internet to improve communication, pressure is being placed on your doctors to collaborate to develop and drive more cost-efficient systems of healthcare delivery while improving quality.

WHAT IS PHYSICIAN CLINICAL INTEGRATION?
Defined by the Federal Trade Commission as “An active and ongoing program to evaluate and modify the clinical practice patterns of the physician participants so as to create a high degree of interdependence and collaboration among the physicians to control costs and ensure quality, (FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, Statement 8.B.1 , 1996, http://www.ftc.gov/bc/healthcare/industryguide/policy/statement8.htm )

This definition was developed by the FTC in attempts to define acceptable models for physician collaboration that would not be challenged as activity prohibited by Sherman Anti-Trust Act, such as price-fixing, market allocation, concerted refusals to deal, and boycotts. Strict interpretation of this act in the past has discouraged competing physicians from sharing information, as agreements among competing physicians on price or fees is considered per se, or automatically, illegal.

Joint ventures (by independent physicians), however, are analyzed under the rule of reason if they are integrated in a way that is likely to produce significant efficiencies and the agreement on price is “ancillary,” or reasonably necessary, to the achievement of the joint ventures’ efficiencies.

WHAT TYPES OF ORGANIZATIONS HAVE BEEN SUCCESSFULLY “CLINICALLY INTEGRATED?”
To pass FTC muster, entities through which the physicians can act and interact must include the following elements:
1) Integration of institutions and practitioners that presents the opportunity for true collaboration and productive sharing of information reflecting actual “interdependence”
2) Participation of both specialists and primary care physicians with a requirement of in-network referrals
3) Treatment of a broad spectrum of diseases and disorders and corresponding clinical protocols
4) Integrated information technology whereby network participants can efficiently exchange information regarding patients and practice experience
5) Integrated information technology whereby utilization and claims information can be gathered, analyzed, and communicated in order to improve treatment quality, rates of utilization, and cost containment
6) Integrated information technology whereby physician compliance and performance, in accordance with collective, physician-authored benchmarks and standards, may be measured
7) A high level of physician investment, both economically and in terms of time for training and utilization of the system, and agreement among physicians to comply with the standards, benchmarks, and protocols put in place by the network
8) Enforceable consequences for noncompliance by physicians and institutions, and systems for improving performance and compliance

This list, as taken from rulings (advisory opinions) on previous successful networks (GRIPA, 2007) and unsuccessful networks (Suburban Health Organization, 2006) is not exhaustive, and the FTC has indicated that it will “focus on substance, rather than form, in assessing a network’s likelihood of producing significant efficiencies,” such as the impact of integration efforts on utilization, cost, and quality. (FTC Healthcare Statements Statement 8.B.1 , 1996, http://www.ftc.gov/bc/healthcare/industryguide/policy/statement8.htm )

WHY CONSIDER CLINICAL INTEGRATION NOW?
Clinical integration is an opportunity for this medical community to gather and share the medical information about the care that we provide in such a way that will improve physician communication, physician-hospital relations, healthcare quality, and healthcare costs. Clinical integration is a way to have more bargaining power with managed care, vendors, even liability insurers. And it is a way to harness our ability to communicate in a politically important, grassroots way. It’s taking what we already do, measuring it in a way that we can help ourselves and each other continually improve, and finally showing exactly how much what we do is worth. We as a profession have stood by too long letting others define what it means to be a good doctor and care for our patients in an efficient and valuable way. We have let others determine what our time, training, and talents are worth and been chastised as poor businessmen, defensive, or greedy.

With advances in technology like cloud-computing, Web 2.0, and government incentives based on adoption of such technology and measurable quality improvements, clinical integration is an idea whose time has come. We must consider working together in this way. We must get started today.


References

Gawande, Atul, The Cost Conundrum, The New Yorker, June 1, 2009, http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

United States Department of Justice and Federal Trade Commission, 1996 Statements of Antitrust Enforcement Policy in Health Care, Statement 8.B.1, http://www.ftc.gov/bc/healthcare/industryguide/policy/statement8.htm

TRIAL BAR LAUNCHING ATTACK ON PHYSICIANS AND PATIENTS

(Your Doctor received this information in an email today and thought you might be interested, too -- mab)

by Michael Rosenberg, MD
President, MSSNY

Despite the fact that the New York State fiscal situation is at the breaking point and that health care resources are slated for dramatic cuts, the trial lawyers are making another attempt to jam even more money in their pockets through legislation (S.1729, Schneiderman) to eliminate the statute of limitations for medical liability actions.
A bill being considered by the Senate Codes Committee tomorrow (Tuesday, February 10) could, if enacted, increase medical liability premiums by as much as 20% or more. The bill would eliminate the statute of limitations for the filing of medical liability claims by making the statute a “date of discovery” rule, no matter how long ago the alleged event occurred. Even worse, it reopens previously barred actions. This bill would have a devastating impact on patient access to the health care system.
It is critical that all physicians call and write their Senators to express their opposition to this catastrophic bill. Particular focus should be made on those members who are on the Senate Codes Committee.

The members of the Senate Codes Committee are:
Eric Schneiderman, Chair (D-Manhattan)
518-455-2041
212-928-5578
Neil Breslin (D-Albany County)
518-455-2225
Tom Duane (D-Manhattan)
518-455-2451
212-633-8052
Kevin Parker (D-Brooklyn)
518-455-2580
718-629-6401
Shirley Huntley (D-Queens)
518-455-3531
718-322-2537
John Sampson (D-Brooklyn)
518-455-2788
718-649-7653
Jeff Klein (D-Bronx)
518-455-3595
718-822-2049
Bill Perkins (D-Manhattan)
518-455-2441
212-222-7315
Dan Squadron (D-Manhattan)
518-455-2525
212-298-5565
Dale Volker (R-Erie County)
518-455-3471
716-656-8544
Steve Saland (R-Dutchess County)
518-455-2411
845-463-0840
John DeFrancisco (R-Onondaga County)
518-455-3511
315-428-7632
John Bonacic (R-Orange, Ulster Counties)
518-455-3181
845-344-3311
Martin Golden (R-Brooklyn)
518-455-2730
718-238-6044
Andrew Lanza (R-Staten Island)
518-455-3215
718-984-4073
John Flanagan (R-Suffolk County)
518-455-2071
631-361-2154
Call immediately AND send an e-mail to your NYS Senator by clicking here. Please do this IMMEDIATELY. Your voice counts and they need to hear from you today.

Is YOUR DOCTOR Disappearing?

Wow! The lead/cover story in this week's LONG ISLAND PRESS is entitled, "Disappearing Doctors," and outlines the healthcare crisis on Long Island, emphasizing increasing liability insurance costs and decreasing managed care reimbursements to doctors as factors actually driving doctors out of business or off of Long Island!

My only nit to pick with this article is the sad and helpless tone with which it ends. They quote one doctor suggesting people do whatever they can to stay healthy and avoid being involved with our broken healthcare system. I see our patients, however, as a doctor's most powerful advocates. No one wants to see their doctor leave or even cut back hours. We won't even discuss the mess when a doctor drops out of the "Preferred Provider" Network!

Help your doctor today, by clicking on one of the links to the right and getting involved by contacting our local legislators. The men and women who make and vote on laws to protect all of us listen to the people who vote for them! Some of our legislators have told me they didn't even realize there was a problem, because no one ever speaks up. Some will not listen to one doctor and are waiting to hear from our professional societies.

They will, however, listen to you, our patients, and THEIR constituents. They say when a constituent calls or writes to a state or federal congressman, that person represents 10,000 voters. A click on a link to the right of this page would be that powerful. Could you lend your voice to the 10,000 people who will lose their doctor if the "perfect storm" of increasing liability insurance costs and decreasing doctor reimbursements from Medicare and HMO's goes on unchecked?

Would you do that for Your Doctor?

WHO IN THE WORLD IS PAUL NEWELL?

Paul Newell is a 33 year-old progressive Democrat running for a seat in the NYS Assembly in the 64th Assembly District. This district covers the lower end of Manhattan from the Bowery to Battery Park City. Some of the wealthiest New Yorkers live and work there. Some of the poorest New Yorkers live there as well. This district's current Assemblyperson is Sheldon Silver, who as speaker of the Assembly is arguably one of the most powerful people in NYS government. Many people blame Mr. Silver for the closed-door, "Three men in a room," style of government that seems to dominate the NYS legislature. Many physicians can recite a story of his response to civil justice reform on the State House floor in the 1990's, when he said, "Tort Reform? Over my dead body!"

This may be the kernel of why Your Doctor, and other Long Island physicians have chosen to support Mr. Newell's campaign, setting up a donation portal through ActBlue to spread the news online, holding fundraisers at hot spots in the Hamptons and even in their own backyards to help spread the news that this election season, change really may be coming. Not living in his district, Your Doctor can't actually vote for him, but there's no reason she cant support him. Newell is finding support from other areas outside of his district and even outside of New York, endorsed by political bloggers at The Albany Project, and the BlogPAC Blue to Bluer campaigns.

Governor Paterson released a statement in late August that brought many NY physicians a wave of relief. Malpractice insurance premiums are frozen at their current rate, and the threatened $50,000 surcharge will not be levied during the current policy year (July 1, 2008 - June 30, 2009). While that gives Your Doctor some breathing room, she (and reportedly more than half of NYS physicians) is running late on her premiums, and has been since the 14% increase in the summer of 2007. The system is broken, and only real legislative reform, improved quality control, and a culture shift away from the personal injury/lottery windfall mentality will fix it.

Perhaps a win for Paul Newell in the September 9 primary will be a start.

Click here to read The New York Times and The New York Post endorsements of Paul Newell.

FREEZE...HOLD IT RIGHT THERE!

0% RATE INCREASE.
NO $50,000 SURCHARGE.

During Governor Paterson's Emergency Legislative Session to rework the budget this week, both the Senate and Assembly approved a provision brought forth by the Governor's office to stabilize insurance premiums for the 2008-2009 policy year at the current rates and prohibit the levy of any surcharge on the insured physicians to make up for losses incurred by the insurance carriers and the state. Phew, what a relief.