Vol. 4 No. 9 Winter, 2006
Vol. 3 No. 8 Fall, 2005
Vol. 3 No. 7 Summer, 2005 |
Massachusetts Academy of Dermatology
N E W S
VOL. 4 NO. 9 Winter, 2006
President’s Message
by Kathryn Bowers, M.D.
We move out of the winter and our thoughts turn to spring and the start of the baseball season, we are facing a busy period for the Mass Academy of Dermatology. Our Spring Meeting will take place
on Wednesday, May 24th at the Mass Medical Society Conference Center and I hope everyone is making plans to attend.
On March 22nd, we will co-sponsor a Skin Cancer Screening Program with the Massachusetts Melanoma Foundation at the State House. We conducted this program last year and it was a big success.
Volunteers for part of the day are still needed.
With the Legislature ending its formal sessions in July, our lobbying activities are very active. You will note from Marty Cohn’s report elsewhere in this newsletter that we are involved in a
number of bills. The time spent discussing legislative and other issues affecting our practices at the Spring Meeting will be helpful to us in to gauge the membership’s consensus on each item.
A new issue that is growing in size and importance is the physician report card for use by consumers in selecting a doctor. There is a proliferation of insurers, government agencies and private
companies rushing to develop protocols that attempt to identify doctors who deliver the highest quality healthcare services.
We are already seeing financial incentives for patients to use a physician or group identified by the insurer “as better” than others. For instance, beginning July 1st The Group Insurance
Commission, which administers health insurance for 250,000 state employees, retirees and their families, will require higher co-payments from patients using “lower rated” physicians.
This concept is fraught with problems, especially for specialists. Obviously, they include how the measurements are decided upon, how the data is collected, how it is interpreted and how it is
used. In response to the pressure being brought by these efforts, the AMA recently announced an agreement with Congress promising to develop more than 100 standards of measures of performance for
doctors to report to the federal government. Most specialties societies are working to develop their own measurement tools for use in these “pay for performance” programs.
Meanwhile, I suggest each of us should follow this developing issue closely. As indicated in our newsletter, check with any insurer or government agency that lists your performance for public
review for its accuracy. This subject will be on our agenda at the Annual Meeting on May 24th and is another good reason for you to attend.
Finally, we have a report in this newsletter on a number of occasions where we have interceded with insurers on problems, policy changes and other issues. Sometimes we have been successful and
other times not.
I hope you can see through this newsletter the many issues that your Board and staff are pursuing on behalf of all the dermatologists practicing in Massachusetts. Your dues are what allows this
organization to move forward.
I’ll see you at the Spring Meeting and, as always, call or email me with your questions, thoughts or ideas.
Annual State House Skin Cancer Screening Set for Wednesday, March 22
On Wednesday, March 22, 2006, the Massachusetts Academy of Dermatology and the Massachusetts Melanoma Foundation will conduct its second annual State House Skin Cancer Screening. Last year more
than 100 state employees and elected officials took part in the program.
Dr. Karen Rothman of Westboro and Deb Girard, executive director of Mass Melanoma, are co-chairs of the program. Working with the office of State Senator Resor of participants will be encouraged
to have a checkup, have questions about skin cancer answered and received informative publications on the subject.
Not only will we be providing an important public service but we will be able to educate our state legislators and their staff people about an important dermatologic issues.
We are still in need of two or three doctors to assist us for an hour or two between 10 a.m. and 4 p.m. that day. If you can spare some time, please let us know.
Legislative Matters
by Martin Cohn, Associate Director
Proposed bills at the State House move at their own pace. Since the beginning of the year, both the House and the Senate have enacted little in the way of significant legislation. The delay is
caused by a stalemate over the two versions of comprehensive health care reform bills passed by each side that are currently being settled in Conference Committee.
The main stumbling block is whether to fund a health insurance program for those residents not now covered from the general budget or through payroll taxes. There are a number of important issues
for practicing physicians contained in both bills.
At this writing, Senate Bill 2191, which would establish a task force to study med spas, remains in the House Rules committee where it has been since November, 2005. Also, House Bill 2635 which
would allow for direct billing of pathology and had a public hearing last October, is still in the Public Health committee.
The Massachusetts Academy of Dermatology board of directors voted to oppose House Bill 2689 and Senate Bill 408. These two bills, known as "drug collaborative management" would allow pharmacists
to not only participate in the prescription of patient medications but also override physicians’ orders. The House Bill had a public hearing last October and remains in the Public Health
Committee. The Senate Bill did not have a public hearing but was moved to Elder Affairs. MAD has sent a letter to the chairs of these committee to voice its opposition.
On a very positive note, MAD is working with a coalition of organizations, including the Massachusetts Melanoma Foundation, to generate a late-filed bill that would tighten the enforcement of
Massachusetts sun tanning salon laws. The bill would provide funds through fees and permits to enable local boards of health to inspect sun tanning salons within their city or town. We are hoping
to file the bill in March and have a public hearing sometime in April.
The Legislature will soon begin formal hearings and deliberations on the budget, which is always a time consuming process that causes other initiatives to be held up. Some of the issues affecting
physicians contained in the Health Care Access bills that don’t survive are expected to be taken up again in the bedget. We will be watching these developments closely.
Finally, the Legislature is expected to end its formal sessions in early summer, a custom it has followed in election years. There is much to be done and not much time and veteran State House
people do not have high expectations for the first six months of this year.
CME Green Card Problem
Upon receiving their CME transcript from the American Academy of Dermatology many physicians found they had not received credit for attending the MAD Annual Meeting last September. We contacted
the AAD and they acknowledged the mistake and will correct the record. Doctors reported other errors on their transcript and everyone is urged to examine it carefully. You should contact Kimberly
Hoarle, Director of Membership Services, at 866-503-7546
Programs to Measure Physician Performance and Quality of Care Growing Issue for Doctors
by Paul J. Wetzel, Executive Director
Pay for Performance. Doctor Report Cards. Quality of Care Ratings. Whatever it is called the effort to provide consumers with more information to help them choose their doctors is one of the
fastest growing issues facing physicians today. State and Federal agencies, insurers, consumer groups and private companies are all becoming involved in establishing measurements they claim are
aimed at "improving the quality of medical care" for patients.
Eventually, and in some cases very soon, these report cards will be used to provide financial incentives to patients by requiring higher co-payments for using a "lower rated"physician. In
addition, fears exist that Medicare will use the system to reduce reimbursements to some doctors.
The AMA recently signed a pact with the Congress to develop more than 100 measurement standards for doctors to report to the federal government by 2007.
Many specialty societies protested the agreement with a typical comment coming from Dr. Frederick Blum, President of the American College of Emergency Physicians, who said, we are concerned that
the push to measure quality will become just a smokescreen to cut costs and reduces resources devoted to health care." Dr. Stuart Weinstein, AAOS’ President, who called the timetable "unrealistic"
and added, "performance measures need to be developed by specialty societies, then tested and validated, to confirm that they really affect patient care in a positive way."
In Massachusetts the three major insurers all have some type of information to the public on their websites primarily evaluating performance by primary care doctors. In addition to their
"physician profiles" developed earlier, each uses data collected from other internal information, mainly claims reviews, physician profiles and patient surveys.
The most pressing initiative comes from The Group Insurance Commission which administers health insurance for 250,000 state employees, retirees and their families which intends to charge higher
co-pays of $5 to $15 more to see doctors with lower ratings beginning July 1st. Each of the plans will use a different system to rate the physicians ranging from Harvard Pilgrim which will
evaluate only cost and use of services to Harvard Pilgrim which is developing a measurement framework.
All the plans have publicly stated they recognize the difficulties in rating specialists citing doctors who regularly deal with complex and difficult cases versus those that do not treat many such
patients.
At this time it is important that physicians access any websites that supposedly are listing information on their performance and check it for accuracy. Two that should be checked are the Board of
Registration in Medicine (massmedbd.org) and the Executive Office of Health and Human Services (mass.gov/eohhs, click on "health care quality and cost information"). The Board of Registration
contains information on every doctor including any closed malpractice claims. The EOHHS site lists data on ten procedures including total knee and total hip replacement surgery for each
orthopedist in the Commonwealth.
Board Members and Staff Work on Issues Affecting our Practices
In recent months members of the Board, other doctors and our staff have been addressing a number of issues of significance to our practices.
In December Blue Cross Blue Shield of Massachusetts began reimbursing repair codes at 50% contrary to its rules and practices followed by Medicare and other insurers. We contacted BCBS and they
said it was a software error and would be corrected. However, the correction did not occur as promised and we continue to push them to fix the problem.
Several doctors have recently received notices from BCBS that as a result of an audit, it was discovered that they were “overpaid” for claims going back to 2004. The problem occurred with doctors
who see patients at a suburban office and also at Mass General Hospital. BCBS paid all the doctors claims as if they occurred at Mass general allowing for a higher overhead allowance. The doctors
are working on a negotiated settlement and a payment plan but the issue remains unsettled. Everyone should review their BCBS reimbursements to determine if they have the same problem.
Mass Health announced a new policy whereby they would require pre-authorization for prescribing acne medicines for patients older than 21. They also included certain medicines used for treating
rosacea in the over 21 policy. Dr. Gerry Gladstone has been negotiating with Mass health and says they seem to acknowledge the mistake but as yet have not rescinded the policy.
SAVE THE DATES!
2006 Business Meeting
Wednesday, May 24
Massachusetts Medical Society
Waltham, Massachusetts
2006 Annual Meeting
September 15-17
Marriott Hotel
Newport, Rhode Island
Please mark your calendars and plan to attend.
Massachusetts Academy of Dermatology Recognized as Model State Society for third year in a row
The Massachusetts Academy of Dermatology has once again been recognized by the American Academy of Dermatology as a Model State Society. The award was presented at the State Society President’s
Breakfast at the Academy Convention in San Francisco. The Academy instituted the award in 2002 to encourage state societies to become better organized and more active on behalf of its members.
Societies are measured in a variety of categories including having a paid staff, an executive committee that meets regularly, a newsletter, an annual meeting, and other programs.
While in San Francisco, MAD Executive Director, Paul Wetzel and MAD Associate Director Marty Cohn participated in the State Society Executives Conference and the AADA State Affairs meeting.
(l-r) MAD Executive Director Paul Wetzel, MAD Board Member Dr. Louis Kuchnir and MAD Associate Director Marty Cohn received AAD Model State Society Award 3rd Year in a Row
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