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 October/November 2007
Note: Questions relating to state legislative activity or any of the items noted in ACS Cross Country may be directed to Mindy Baker, State Affairs Associate, at mbaker@facs.org. FYI: The 2007 State Legislative Wrap-up has been published in the November issue of the Bulletin of the American College of Surgeons and can be found online at http://www.facs.org/fellows_info/bulletin/2007/baker1107.pdf New York and CIGNA Agree on National Model for Physician Ranking Programs(Excerpted from an October 29, 2007, press release from the Office of the New York State Attorney General Andrew M. Cuomo)
Doctor ranking programs are a rapidly growing practice within the health care industry. CIGNA’s program alone operates in 28 states across the country. Major insurers nationwide either operate or are in the process of developing these programs. Under the agreement, CIGNA will:
For more information visit http://www.oag.state.ny.us/press/2007/oct/oct29a_07.html. General Surgery Makes Strides in Georgia
The proposed amendment to the CON rules is undergoing a public comment period, with a hearing scheduled for November 28 in Atlanta. Georgia surgeons are encouraged to attend this hearing, which will begin at 1 pm and which will be located at the Department of Community Health, 2 Peachtree Street, Atlanta. Also,
States Get More than $109 Million for Increasing Seat Belt Use and Highway SafetyAccording to the U.S. Department of Transportation, more than $109 million has been distributed to states for enacting and enforcing seat belt laws. According to a recent DOT press release, the 2005 grant program entitled the “Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users” (SAFETEA-LU) “encourage(s) states to enact and enforce laws requiring the use of seat belts in passenger motor vehicles. The 16 states receiving these grants had enacted and are enforcing a primary belt law before December 31, 2002. This year Indiana amended its primary belt law to include all vehicles and is receiving over $15 million. In May of this year Kentucky received over $11 million for its recently passed primary belt law... Under the program states may use these grant funds for any highway safety purpose either for behavioral programs or for infrastructure.” If you don’t know what your state’s laws are, a list can be found at: http://www.ghsa.org/html/stateinfo/bystate/index.html, or you can find out more about this and other state highway safety grants at http://www.ghsa.org/html/stateinfo/grants/index.html.
New Florida PIP Law Benefits PhysiciansChristopher L. Nuland, Esq. With mandatory no-fault personal injury protection (PIP) having expired on October 1, 2007, the Florida State Legislature took action during a special session to reenact the law with several changes designed to curb abuse and to produce a fairer system. First and foremost, the bill (HB 13C) reenacts mandatory PIP as of January 1, 2008. While earlier dates were debated, the ultimate legislative decision was that the logistics of undoing imposing rules retroactively were not feasible; therefore, incidents involving uninsured motorists until December 31, 2007, will be subject to lawsuits, and the benefits for uninsured motorists will be determined by their respective health insurance policies. As of January 1, 2008, however, the landscape will change dramatically. For the first time, a $5,000 “reserve” will be established for each case to reimburse physicians and dentists who provide emergency care and inpatient services. Covered providers will have 30 days from the date of the accident to file for these benefits, after which any remaining amount will be available not only to the physicians and dentists, but also to hospitals, chiropractors, and other covered providers. It should be noted that this $5,000 is not subject to hospital liens. While the law does establish a PIP fee schedule for the first time, its terms are not oppressive. Physicians who provide emergency services and related inpatient care may still charge their full usual, customary and reasonable rates. Other physician services may be billed at 200 percent of the Medicare fee allowance (hospitals receive 75 precent of the UCR for emergency services and 200 percent of Medicare for other services, and all others may bill no more than 200 percent of the Medicare allowable). Recognizing that scheduled Medicare cuts could reduce this amount, the law contains a clause that the 2007 Medicare fee schedule will be used if the Medicare fee schedule is ever cut below that level. While not perfect, the new PIP law is the product of meaningful, negotiated compromise involving physicians, chiropractors, dentists, hospitals, ambulances, and lawyers. Physicians should be proud of the improvements that were gained, improvements that should drastically improve the likelihood of receiving adequate reimbursement for emergency room accident cases.
New York Liability Battle ContinuesThe New York Chapter, the Manhattan Council, and the Brooklyn & Long Island Chapter of the American College of Surgeons, along with several medical specialty societies, have been participating in a task force, convened by Governor Spitzer and chaired by Insurance Superintendent Eric Dinallo and Health Commissioner Richard Daines, to make recommendations to address the fiscal solvency of the medical liability insurance companies and address the fundamental drivers of high medical malpractice costs. In a recent task force meeting, as well as in follow-up speeches to physician groups, Superintendent Dinallo has made the startling statement that, in the absence of action by the state legislature to control the cost of medical liability insurance, he will be forced to:
The Superintendent’s office will be issuing a report by the end of 2007 that outlines recommendations to the legislature to address these problems. As this deadline rapidly approaches, representatives of the New York State Academy of Trial Lawyers and the New York State Trial Lawyers Association are lobbying the New York State Senate and Assembly to block any proposed reforms. For more information please contact the New York Chapter’s Executive, Amy Clinton at 518-283-1601.
Past Issues of ACS Cross Country:
Revised November 13, 2007
by the American College of Surgeons, Chicago, IL 60611-3211 |
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New York’s Attorney General recently announced an agreement with CIGNA regarding its physician ranking program. Under the agreement, CIGNA will enhance this program, fully disclosing to consumers and physicians all aspects of the ranking system. In addition, an oversight monitor will be retained to oversee compliance with all aspects of the agreement.
This past October, Georgia’s Board of Community Health unanimously voted to define general surgery as a single specialty under the state’s certificate-of-need (CON) rules. For many years, Georgia has defined general surgery as a multispecialty under its CON requirement for ambulatory surgical centers (ASCs). Under the current Georgia statute, single specialties are exempt from the state’s CON requirement for ASCs. Previous legislative, judicial, and regulatory efforts to address this incorrect and discriminatory definition of general surgery have been unsuccessful due to strong opposition from the hospital community.