REPORTS ISMA ISMA ISMA
Tuesday, February 17, 2009
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Update on Medicaid rate cut ISMA staff participate in ongoing meetings Legal reminders Charge correctly for medical records; prepare for new office sedation rule Give your opinion Public health leaders propose accreditation standards New ISDH reporting rules Read about birth defect and communicable disease report changes
Federal mental health parity law to bring changes A new federal mental health parity
law will expand access to mental health care for 57 million Americans next January. The law was part of the economic bailout package Congress approved and President Bush signed in October. While the law does not mandate mental health coverage, group health plans for businesses with more than 50 employees that offer medical, surgical, mental health and substance use disorder benefits will need to have equity coverage for all financial requirements. That means, there can no longer be higher co-pays and deductibles or stricter limits on mental health and addiction treatment, compared to physical care and surgical treatment. There must be equal coverage of mental and physical illnesses. The American Psychiatric Association, which worked for a dozen years for passage of this legislation, developed a fact sheet to help physicians and patients better understand how the law will impact them. To view the fact sheet, visit www.ismanet.org/links/psych.htm.
Physicians fill Medicine Day with legislative action Indianapolis otolaryngologist Heidi Dunniway, M.D., and Elkhart neurologist Thomas Vidic, M.D., did not know they would be addressing the House Committee on Insurance when they came to ISMA’s Medicine Day at the Statehouse, Feb. 4. In an unexpected move, the committee chairman called for a hearing on an amendment to HB 1086 concerning Assignment of Benefits that contained ISMA-supported language. Drs. Dunniway and Vidic testified in favor of the proposal and emphasized the importance of patient choice. While the committee did not vote on the amendment Feb. 4, the timing was perfect for ISMA’s voice to be heard loud and clear on the issue. Medicine Day allows physicians to observe – and sometimes participate in – the legislative process and meet personally with legislators. This year, several important issues concerning health care were heard in committee. Physicians listened to testimony in the House Committee on Public Policy about a bill that would ban smoking in public places. Internist, health officer and Fort Wayne Medical Society President Deborah Mc Mahan, M.D., stood ready to testify in favor of the measure on behalf of the ISMA, but the four-hour hearing did not allow her time to speak. However, her prepared comments were distributed to committee members. Other ISMA members made their way to the Senate Committee on Health and Provider Services to watch legislators vote in favor of a bill requiring physicians to use tamper-resistant prescription drug forms issued by the Indiana Board of Pharmacy. (See the enclosed Legislative News for details.)
Reactions from ISMA members
Winamac family physician Rex Allman, M.D., attended Medicine Day for the first time. The event helped him understand that legislators value physician opinions. “If our representatives do not hear from us, they will listen to someone else,” he said. “Physicians should make themselves available to legislators. They look to us as reliable sources.” Bloomington physician Todd Rowland, M.D., also reflected on the day. “It was eye-opening to me how intense activities are at the Statehouse,” he said. “The most interesting part for me was meeting physicians from around the state who are engaged in their local medical communities and understand that physicians need to have a role in the process.” 1. Fort Wayne physician Thomas Gutwein, M.D., (left) talks to Dick Conklin, Dr. Rowland teamed with a Medicine executive director of Tobacco Free Allen County. 2. Deepak Azad, M.D., (left) Scottsburg, greets Rep. Ed Clere, R-New Albany. Day veteran, Burlington family physician 3. Columbus physician Richard Miethke, M.D., (left) discusses health care issues Don Wagoner, M.D., who provided advice with Sen. Greg Walker, R-Columbus. and introduced him to key legislators. 4. Heidi Dunniway, M.D., and Thomas Vidic, M.D., testify before the House To see more photos visit ISMA’s Web site Committee on Insurance. 5. Medicine Day activities helped Rex Allman, M.D., of Winamac, understand at www.ismanet.org/resources/ the importance of communicating with legislators. Medicine_Day/meddayphotos.html.
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Meetings about future changes in Medicaid ongoing
The ISMA’s Physician Medicaid Task Force met Jan. 21 with Jeffrey Wells, M.D., director of the Office of Medicaid Policy and Planning (OMPP). Initial discussions centered on the proposed 5 percent holdback in reimbursement for physicians set for July 1. (See Jan. 5, 2009 ISMA Reports or visit www.ismanet.org/news/e-reports/2009_Reports/1-5-09/ medicaid.html.) Because of state budget constraints, OMPP plans the rate cut and a prescription drug carve-out that will place all Medicaid managed care organizations under one standardized drug list controlled by the state agency. The carve-out will net the state about a 35 percent rebate from drug suppliers, which would mean revenue of $40 million a year. Dr. Wells told the task force members he believes the holdback to physicians would be unneeded if the pharmacy carve out moves forward. Michael Rinebold, ISMA director of Government Relations said the ISMA is waiting to learn more before lending support to the carve-out proposal. “Information is flowing daily between the ISMA and the Daniels’ administration,” Rinebold noted. “We also are awaiting committee hearings on these issues that will have an impact on the final outcome.” Along with other key ISMA staff, Rinebold has met with Ann Murphy, the newly appointed Family and Social Services Administration secretary. Murphy replaced Mitch Roob who departed early in January.
Popularity of retail health clinics may be slowing The number of retail clinics may be increasing, but a new study reveals few are taking advantage of them. Research released by the Commonwealth Fund revealed that in 2007, only 2.3 percent of American families had ever used a retail clinic, and most were uninsured and under age 34. It is too soon to determine the impact the current economy will have on retail health clinics, but the study noted use may increase as health care costs and the number of uninsured continues to rise. “While overall use of retail clinics remains modest, families with unmet medical needs tend to use the clinics more than the rest of the population,” explained Ha T. Tu, M.P.A., a study researcher.
The study also found: • Nearly half of those surveyed used retail clinics for diagnosis and treatment of a new illness or symptom, and almost as many said their visits included prescription renewals. • Almost two in three people said the clinic’s convenient hours with no appointment was a major factor in choosing it over another source of care. • Nearly half of all users cited the low cost of a clinic. The national study was conducted between April 2007 and January 2008 using telephone interviews. Approximately 18,000 people in 9,400 families were surveyed. The response rate was 43 percent. Find the study at www.commonwealthfund.org/index.htm.
Casinos, all workplaces should be free of secondhand smoke Ventilation systems in Indiana casinos aren’t much help when it comes to reducing toxic secondhand smoke pollutants, a Purdue University study has revealed. The research showed air in casinos is 14 times more polluted than outside air, exposing workers and patrons to significant and harmful levels of secondhand smoke. In response, the Indiana Campaign for Smokefree Air (ICSA) and the Indiana Academy of Family Physicians are urging legislators to adopt a comprehensive statewide smokefree air law for all workplaces, including casinos and bars. A bill, HB 1213, was introduced in the House of Representatives to prohibit smoking in any workplace throughout the state. The ISMA
supports the bill. Only 24 states have enacted smokefree laws that cover all workplaces. (See enclosed Legislative News for status.) “No worker should have to choose between breathing these cancer-causing agents and a paycheck,” said Patricia Ells from the ICSA. “It doesn’t matter if you work in an office, restaurant, bar or casino all workers deserve a smokefree workplace.” Indoor air quality in all 11 Indiana casinos, which employ more than 16,000 workers, was tested during April and May 2008. Tests found that full-time casino employees were exposed to secondhand smoke three times the annual limit that is considered healthy.
Hot line offers smoking cessation help to patients Patients who want to quit smoking can find help by calling:
Find more information online from the Indiana Tobacco Prevention and Cessation at www.in.gov/itpc.
In 2006, the U.S. Surgeon General reported that ventilation, air cleaning systems and separation of smokers from nonsmokers were ineffective measures to eliminate the
serious negative health hazards of secondhand smoke. It also concluded secondhand smoke causes heart disease, lung cancer and respiratory illnesses.
Free CME activity explains dangers of secondhand smoke The new year is often a time for making resolutions, improvements and changes, and it’s a common time for patients to have thoughts about quitting smoking. The AMA is offering a continuing medical education (CME) activity to help guide you when advising patients – and particularly parents – on this topic and the dangers of secondhand smoke. “Secondhand smoke: Changing clinical practice to improve children’s health from the American Medical Association” describes health consequences associated with exposure to secondhand smoke, especially for a child with asthma. The program summarizes research on clinical interventions for counseling a patient’s parents and analyzes smoking cessation tools and resources. It also identifies strategies to ensure reimbursement for counseling and treating smoking cessation. The free CME activity is part of a three-year initiative the AMA launched with funding from the Environmental Protection Agency. Visit www.medscape.com/viewprogram/14921 to view the course and obtain CME credit.
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Here are some important legal reminders from the ISMA Know what to charge for medical records to meet Indiana law
Start considering accreditation if you do office-based sedation
You can bill patients for copies of their medical records as long as your fees are within the limits determined by Indiana law. The amounts are: • $20 labor fee (includes first 10 pages) • $0.50 per page (pages 11 through 50) • $0.25 per page (pages 51 and higher) • Actual mailing costs • $10 rush fee if records are to be provided within two business days • $20 certifying fee (if certified) Medicaid considers the provision of medical records to be part of its covered services, so providers probably cannot charge Medicaid patients for copies of records. Physicians are supposed to consider waiving or reducing copy fees if the records request is from
Last year, new rules became effective for offices performing any in-office procedures using moderate sedation or higher, deeper levels of anesthesia. A law was recommended by the Commission on Excellence in Health Care and passed by the Indiana General Assembly in 2005. (See May 19, 2008, ISMA Reports or go to www.ismanet.org/ news/e-reports/2008_Reports/519-08/office-based_surgery.htm.) The Medical Licensing Board adopted rules implementing the law that became effective May 24, 2008. Section 20 of the new rule requires that all affected office-based surgery settings must be accredited by Jan. 1, 2010. While that date may be many months away, now is a good time to begin exploring your options for accreditation in preparation for meeting the deadline. Find a list of approved accredit-
a provider to whom a patient was referred or who is giving a second opinion. They should also consider waiving or reducing fees if the patient is requesting records for personal use and the fees will cause undue financial hardship. Also, the Attorney General’s office has determined physicians cannot refuse to provide medical records to patients for a past-due balance. Physicians may refuse to provide medical records when they reasonably decide releasing information to a patient would be detrimental to the physical or mental health of that patient, or would likely cause the patient to harm himself or another. Read more about managing patient medical records at www. ismanet.org/legal/faqs.htm. For questions, call Julie Reed, ISMA legal counsel.
ing agencies on the Medical Licensing Board of Indiana Web site at www.in.gov/pla/2879.htm. Accrediting entities do not operate uniformly. Their fees differ and the reaccreditation timelines vary. You’re encouraged to study the accrediting agency options and select the one that best fits your practice situation. Keep in mind, the accreditation process will take several months to complete, depending on the types of procedures you perform and the entity requirements. The ISMA recommends you begin now so you are in compliance on Jan. 1. If you have further questions, contact Julie Reed, ISMA legal counsel.
PHAB seeks opinions on proposed accreditation standards Public health providers and leaders are encouraged to provide feedback on standards for a national voluntary accreditation program. The Public Health Accreditation Board (PHAB) seeks to have the standards in place by 2011. The proposed draft touches on a wide range of public health services, including the ability to engage community partners, solutions for health problems and enforcement of public health laws.
“I urge practitioners and stakeholders to take advantage of this opportunity and help shape the voluntary, national accreditation program by providing feedback,” said PHAB President and CEO Kaye Bender. The draft standards will be available for review until April 30, 2009. Comments may be submitted online or by hard copy vetting forms. View the proposed accreditation program at www.phaboard.org or contact Bender at (703) 778-4549.
AMA Past President Donald J. Palmisano, M.D., (seated) visited Indiana Feb. 7 to speak at the Leadership Development Conference of the North Central States Alliance, comprised of 11 state medical alliances, including the ISMA Alliance. In addition to an address entitled “On Leadership,” Dr. Palmisano signed copies of his book with the same title. Pictured here with Dr. Palmisano are (left to right): Hallie Gorup, ISMA Alliance President; her husband, John Gorup, M.D., orthopaedic spine surgeon, from West Lafayette and Isa Canavati, M.D., neurosurgeon from Fort Wayne.
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Important news and updates for physicians from the ISDH New method of reporting aims to improve data on birth defects The Indiana State Department of Health (ISDH) reminds you that health care providers are required by law to report all children under 3 years of age with at least one birth defect to the Indiana Birth Defects and Problems Registry (IBDPR). Children with autism and fetal alcohol syndrome up to 5 years of age must be reported. The IBDPR collects data on reportable congenital anomalies in order to: • Monitor the frequency of birth defects in Indiana
• Detect trends and clusters • Develop education and prevention programs • Establish referral systems Information from physicians and other health care providers is essential to the validity of the IBDPR prevalence data, and some conditions, such as autism and fetal alcohol syndrome, require physician reporting since they are not usually diagnosed at birth. These conditions have been severely underreported to date.
About the new system
To improve data collection from
physician offices, ISDH has begun utilizing a Web-based reporting system called the Health Data Center Gateway. All health care providers need to create an account within this system. To do so: 1. Obtain a security code by calling Ruwanthi Silva at (317) 233-7571. 2. Access the ISDH Health Data Center Gateway at https:// healthdatacenter.isdh.in.gov/ Gateway/RegisterUser.aspx. 3. Enter the required fields. 4. Enter the security code. 5. Choose your organization type and organization.
6. Click “Submit” when finished. After registering, you can log into the ISDH Health Data Center Gateway at https:// healthdatacenter.isdh.in.gov with your username and password. If activation takes longer than 24 hours, send a message via the “Contact Us” link. The IBDPR is a public health authority as defined in the HIPAA Privacy Rule and is authorized by Indiana Code to collect Protected Health Information. Find more information about reporting and the IBDPR at www.birthdefects.in.gov.
The ISDH updates its communicable disease reporting rule for physicians The Indiana State Department of Health (ISDH) has issued changes to the Indiana Communicable Disease Reporting Rule for Physicians, Hospitals and Laboratories. Part of the state’s Administrative Code, the rule defines the responsibility of medical providers to report certain suspected and confirmed medical diagnoses to local health departments or the ISDH. The rule also outlines the authority of both the local health departments and the ISDH to investigate, isolate and treat individuals with suspected or confirmed medical diagnoses – in the interest of public health.
Diseases and conditions the ISDH added which are now reportable include: • Dengue and dengue hemorrhagic fever • Giardiasis • Hepatitis, viral, type E • Influenza-associated death
• Neonatal herpes • Powassan (type of arboviral encephalitis) • Severe Staphylococcus aureus in a previously healthy person • Shiga-toxin producing E. coli infections • Varicella (chickenpox) – all cases • Vibriosis Physicians and hospitals are required to report cases to the local health department of the county or city where the patient normally resides. Changes specific to laboratories are: 1. CLIA ID number is required on lab reports. 2. Nocardia and polio laboratory results are now reportable. 3. Isolates must be submitted to ISDH Laboratory within 5 days. 4. Requirements for isolate submission now include: Certain E. coli isolates, S. pneumoniae isolates from those under 5 years of age, Nocardia isolates Remnant HIV isolates
A few reminders
information to the local health department or the ISDH. Physicians and hospitals must The ISDH recommends you still report cases within required review the rule in its entirety and time frames. Many conditions refer to disease-specific sections are reportable immediately once as needed for investigation or suspected. Others are reportable reporting. within 72 hours. Please refer to For questions or more informaSection 47 of the rule for diseasetion, please contact the ISDH specific information. Epidemiology Resource Center, Laboratories must continue to Surveillance and Investigation report lab evidence of reportable Division, at (317) 233-7125. infections to ISDH at least weekly. Find medical laboratory reporting requirements Read the complete Communicable Disease in Section 48 of Reporting Rule at www.in.gov/isdh/files/ the rule. comm_dis_rule.pdf. Case reports See a quick reference list of reportable comsubmitted to local municable diseases and conditions and reporthealth departments able laboratory results at or ISDH may be www.in.gov/isdh/files/Communicable_ used for epidemioDisease_Rule_Reportable_List_Dec2008.pdf. logical investigation or other disease intervention activities as warranted. Patient consent is not required to release medical or epidemiological
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S T A T S Happenings
Ball Memorial tower named
Ball Memorial Hospital in Muncie has named its new south tower the “John W. Fisher Heart Center.” Fisher, a local businessman and philanthropist, served five decades on the hospital board. The new $87 million facility is scheduled to accept patients in March and will be home to Ball Memorial’s intensive, cardiac intensive, progressive, diabetic and cardiac rehabilitation units.
Clarian reducing costs further Clarian Health, based in Indianapolis, has announced temporary cost reductions to take effect immediately in response to the current economic climate. Executive salaries for vice presidents and above will be reduced by 10 percent. Supply and drug prices will be renegotiated. Payment for 2008 incentives will be delayed, and the initial construction phase of the Riley Simon Family Tower will be postponed. Opening date for the tower remains set for 2013.
Group to terminate Anthem contract Union Hospital Health Group in Terre Haute plans to terminate its contract with Anthem effective July 31. The contract includes Union Hospital and West Central Community Hospital, and covers all services and locations. The termination would affect only Anthem’s commercial PPO products, with additional changes at Anthem’s discretion.
• Coding Symposium, Feb. 26-27, Thursday-Friday, The Fountains Banquet and Conference Center, Carmel • Indiana Medicaid Update - March 4, Wednesday, Airport Marriott, Evansville - March 5, Thursday, Radisson Hotel, Bloomington - March 11, Wednesday, Hilton Garden Inn, South Bend - March 25, Wednesday, Fishers Conference Center, Fishers • The Independent Medical Practice, April 8, Wednesday, Renaissance Indianapolis North, Carmel • Basic CPT Coding, April 15-16, Wednesday-Thursday, ISMA headquarters • Intermediate CPT Coding, May 20, Wednesday, ISMA headquarters * Approved for CME ** Approved for CEU Call the ISMA to register or e-mail email@example.com.
• Medicare Coalition meeting, 10 a.m., and Medicaid Coalition meeting, 1 p.m., March 13, Friday, ISMA Headquarters. For information, contact the ISMA, (800) 257-4762 or (317) 261-2060. • Raising the Dead: When Our Ancestors are Evicted, March 25, Wednesday, 4 p.m., Indiana Medical History Museum, Indianapolis. Find information at www.imhm.org or call (317) 635-7329. • National Public Health Week Conference, April 7-8, Tuesday-Wednesday, IUPUI, Indianapolis. Sponsored by Indiana MAPHTC. For information, visit www.publichealthconnect.org or contact Kate Nicholson at (317) 274-3178 or e-mail firstname.lastname@example.org. Unless noted, all Happenings are held at the ISMA, 322 Canal Walk in Indianapolis (Canal Square Apartments at New York and West streets). Call the ISMA at (317) 261-2060 or (800) 257-4762 for more information.
Short online program offers CME credit The AMA’s online continuing medical education (CME) initiative, Educating Physicians on Controversies and Challenges in Health, has added a new program. The five-to-10 minute video, Motivating Patients to Change Behavior, provides patient-centered, goal-oriented counseling and interviewing strategies. The program also identifies how motivational interview-
ing differs from traditional patientphysician interactions. Other modules in the series include: • Patient Sexual Health History: What You Need to Know to Help • Connecting Patients to Community Resources • Preparing Your Practice to Address Family Violence • Use of Complementary and
Alternative Treatment by Patients • Self Management Strategies for Vulnerable Populations • Universal HIV Screening and Reducing HIV Disparities • Binge Drinking Each educational activity offers AMA PRA Category 1 Credit for CME. Find the programs at www. ismanet.org/links/CMEvid.htm.
David J. Welsh, M.D.
Comments? WRITE ISMA Reports 322 Canal Walk Indianapolis, IN 46202-3268 CALL (800) 257-4762 or (317) 261-2060 or VISIT www.ismanet.org Advertisements appearing in ISMA Reports do not necessarily represent the position of nor an endorsement from the ISMA.
Dunn Memorial talking to St. Vincent Dunn Memorial Hospital in Bedford is in discussions with St. Vincent Hospital about a lease for the Lawrence County facility. Dunn had been talking with Clarian Health about a merger, but the Letter of Intent for exclusive negotiations expired Jan. 1.
ISMA REPORTS Published for member physicians. Nonmember subscriptions are $75 per year. Copyright 2009 Indiana State Medical Association
PRESIDENT EXECUTIVE VICE PRESIDENT COMMUNICATIONS DIRECTOR
James G. McIntire Adele M. Lash
PRODUCTION AND GRAPHICS EDITOR COMMUNICATIONS ASSISTANT/WEB EDITOR
Nicholas Peetz Daniel Springer
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Indiana is the home of David Letterman, champion of having Top 10 Reasons to do anything!
PRESORTED FIRST-CLASS MAIL U.S. POSTAGE PAID INDIANAPOLIS, IN PERMIT NO. 952
322 Canal Walk Indianapolis, IN 46202-3268
So, in the spirit of that famous native son, the ISMA gives you our Top 10 Reasons to subscribe to e-mail news from your state association. One or two reasons from this list will surely convince you to send us your current e-mail address today!
TOP 10 REASONS to subscribe to ISMA e-mail news: 10. 9. 8. 7. 6. 5. 4. 3. 2.
Give your fax machine a rest. Impress the kids with your use of e-mail. Save trees and “go green.” Increase your personal comfort with technology. Get information in a quick-read, time-saving format. Share news with staff just by clicking Forward. Help the ISMA maximize your dues dollars. Know what your colleagues know at the time they know it. Protect your patients with access to immediate safety and security bulletins.
AND the TOP reason to ensure the ISMA has your e-mail address:
1. Learn news of importance to physicians as soon it’s available. To make sure you, like your colleagues, are getting e-mail news and bulletins of importance to Indiana physicians, send an e-mail message to email@example.com. If your e-mail has changed – or whenever it changes – make sure you send your new address to the ISMA.
Summer camp needs volunteers
The American Diabetes Association, Indiana Area, needs health care professionals to staff Camp John Warvel, a summer camp for diabetic children. The residential camp, held June 7-13 in North Webster, hosts more than 200 children with type 1 and 2 diabetes. Medical professionals are asked to volunteer a minimum of three days. Licensed professionals and students are welcome. For information and a staff application, contact Jackie Johnson at (317) 352-9226, ext. 6727 or e-mail firstname.lastname@example.org.
ISMA Annual Coding Symposium The Fountains Banquet and Conference Center 502 East Carmel Drive • Carmel, IN 46032
February 26-27 Indiana State Medical Association
For more information or to register, call (317) 261-2060 or (800) 257-4762 or e-mail email@example.com.