Spa Botox Injections
Total Page：16
File Type：pdf, Size：1020Kb
0 1 0 2 R E B O T C O | Inactivity in Tennessee 9 . O N Smoking Cessation , 3 0 1 Ask TMA: Spa Botox Injections . L O V Volume 103, Number 9 + October 2010 President’s Comments 5 “It’s The Cost, Stupid!”—B W. Ruffner, Jr., MD, FACP CONTENTS Ask TMA 11 Are Medical Spas Violating the Practice of Medicine Statute with Botox Injections? Member News 15 UHG Settlement Claims Deadline; TMA Elections: How They Work; Online Membership Renewal; ICD-10 Transactions Testing; Claims Process Checkup in November; First EHR Certification Bodies Named; TMA Photo Gallery; Member Notes Practicing Medicine 31 Health System Improvement: Developing Regional Capacity across Tennessee—Jill D. Nault; James E. Bailey, MD, MPH, FACP 35 Loss Prevention Case of the Month—“My Stomach Hurts”—J. Kelley Avery, MD Special Feature 23 39 Saving Money on Supplies – A GPO Strategy—Kathy Spratt Cover Story The Journal Get Off the Couch! Tennessee Wages a Battle to Become a 41 Original Contribution—Correlates and Predictors of Physical Inac - Healthier State—Brenda Williams tivity among Tennessee Adults—Peter D. Hart, MA; Tiago V. Barreira, PhD; Minsoo Kang, PhD 45 Original Contribution—Smoking Cessation: Barriers to Success and 7 Readiness to Change—Alexander B. Guirguis, PharmD, BCPS; Editorial Shaunta’ M. Ray, PharmD, BCPS; Michelle M. Zingone, PharmD, Why Aren’t Doctors Allowed to Care about Money? BCPS, CDE; Anita Airee, PharmD, BCPS; Andrea S. Franks, PharmD, —David G. Gerkin, MD BCPS; Amy J. Keenum, PharmD, DO 37 For the Record Special Feature 50 TMA Alliance Report—Alliance Works to Help the Health of Tennessee—Gail Brabson Plan Your Steps to a Smooth ICD-10-CM Transition New Members —Ken Bradley 51 53 In Memoriam 54 Statement of Ownership; Advertisers in this Issue; WWW.TNMED.ORG Instructions for Authors Tennessee Medicine communications submitted to Tennessee Medicine Copyright 2010, Tennessee Medical Association. All Journal of the Tennessee Medical Association for publication. The author or communicant shall be material subject to this copyright appearing in (ISSN 1088-6222) held entirely responsible. Advertisers must conform Tennessee Medicine may be photocopied for noncom - Published monthly under the direction of the Board of to the policies and regulations established by the mercial scientific or educational use only. Trustees for members of the Tennessee Medical Board of Trustees of the Tennessee Medical Periodicals postage paid at Nashville, TN, and at Association, a nonprofit organization with a definite Association. additional mailing offices. membership for scientific and educational purposes, Subscriptions (nonmembers) $30 per year for US, devoted to the interests of the medical profession of $36 for Canada and foreign. Single copy $2.50. POSTMASTER: Send address changes to: Tennessee. Payment of Tennessee Medical Association member - Tennesssee Medicine This Association is not responsible for the authen - ship dues includes the subscription price of PO Box 120909, Nashville, TN 37212-0909 ticity of opinion or statements made by authors or in Tennessee Medicine. In Canada: Station A, PO Box 54, Windsor, Ontario N9A 6J5 President Office of Publication Editor Editorial Board B W. Ruffner, Jr., MD 2301 21st Avenue South David G. Gerkin, MD Loren Crown, MD Greg Phelps, MD PO Box 120909 James Ferguson, MD Bradley Smith, MD Chief Executive Officer Nashville, TN 37212-0909 Editor Emeritus Ronald Johnson, MD Jonathan Sowell, MD Donald H. Alexander, MPH Phone: (615) 385-2100 John B. Thomison, MD Robert D. Kirkpatrick, MD Jim Talmage, MD Sr. Vice President Fax (615) 312-1908 Managing Editor Karl Misulis, MD Russ Miller, CAE [email protected] Brenda Williams Advertising Representative: Beth McDaniels – (615) 385-2100 or [email protected] Graphic Design: Aaron & Michelle Grayum / The Gray Umbrella PRESIDENT’S COMMENTS “It’s The Cost, Stupid!” 1 By B W. Ruffner, Jr., MD, FACP President e have all heard that healthcare costs are going up ONE NEUTRAL ISSUE: W faster than growth of the economy. The article referred • Comparative Effectiveness Research. This effort began in to in my title is a summary of the reality that one way the stimulus bill last year and received substantial funding in or another, costs have to be controlled. The issue goes beyond the ACA. As a result of aggressive lobbying (including by the Medicare and TennCare. Employers respond to increasing premi - AMA) the Act explicitly states the research cannot focus on ums by buying policies that shift more of their cost to their em - the comparative cost of treatments and cannot be used for ployees. With wages stagnating, workers are unhappy about coverage decisions. Even without these restrictions it would covering the extra cost. probably take 10 years to plan, initiate, complete, interpret Even most liberals agree the Patient Protection and Affordable and incorporate the results of CER into patient care. Care Act (ACA) does not do enough to constructively control costs. On the conservative side, the “tea partiers” want to decrease the size TWO POTENTIAL LANDMINES: of government but they have not acknowledged that Medicare would • Bundled payments . Some hospitals already offer a fixed be one of the targets. Medicare and Medicaid combined consume price for discrete services like coronary artery surgery. These about 19 percent of the federal budget. efforts will expand but seem unlikely to ever constitute a sig - The ACA does include some token benefits that physicians must nificant part of overall expenses. These payments would be be aware of. These include: controlled by hospitals and could not be easily expanded to • Funds to study tort reform. There is no question that de - outpatient care of chronic diseases. fensive medicine leads to waste but reform in this area alone • The Independent Payment Advisory Board (IPAB). The won’t solve the problem. The ACA includes only token IPAB has been strongly opposed by the AMA. It is the result of amounts of money to “study” the problem. Congress’ desire to insulate itself from the overwhelming po - • Medical homes . Again, the ACA includes money to fund litical pressures that will come to bear if draconian measures demonstrations but no commitment that would subsidize are necessary to finally “bend the curve.” In any year that development on a large scale. A medical home requires Medicare expenditures exceed a defined target, the IPAB investment in electronic health records and increased use would submit a resolution to Congress to effect the necessary of mid-level providers to coordinate care and expand serv - expense reductions. Congress must either accept the proposal ices in the physician’s office. A significant capitation will be or pass a substitute which accomplishes the reduction, in - necessary to recover the cost. Studies today show clear cluding a three-fifths vote of the Senate. If Congress’ alterna - benefit to the patients but only modest overall savings to tive does not pass, the IPAB resolution becomes law. the system. In my view, primary care should be the foun - Beginning in 2015, the spending rate reduction must be 0.5 dation of our system and anything that strengthens it is percent, rising to a 1.5-percent reduction in 2018. After that, valuable. Medical homes alone, however, will not control the target will be the rate of increase in the GNP (gross na - healthcare inflation. tional product) plus one percent. • Electronic Health Records. This initiative also began last The law puts limits on how the reductions can be achieved. year, with the HITECH Act. I believe EHRs will transform There can be no rationing of care and reduced benefits, eligi - healthcare as dramatically as cell phones and the internet bility or increased cost sharing cannot occur. Clearly the re - have transformed our daily lives. They will make health care ductions will come from providers, and hospitals are exempt better and more efficient but may not have much effect on from the cost reductions until 2020. Physicians, watch out! the overall cost. (Continued on page 12) Tennessee Medicine + www.tnmed.org + OCTOBER 2010 5 EDITORIALS CCOOMMMMEENNTTAARRY Y Why Aren’t Doctors Allowed to Care about Money? By David G. Gerkin, MD Editor few days ago I was skimming the medical blogs and came Aacross an article with the same title as my editorial subject. I Whenever it is in any way possible, thought back to my first days in practice to how uncomfort - able I was when patients broached the topic of my fee for various “every boy and girl should choose as his life treatments or procedures. My usual response was to “punt” the pa - work some occupation which he should like to tient to my assistant or business office after saying my escape com - ment, that it varies and I don’t “keep up” with such things. Back do anyhow, even if he did not need the money. then I just accepted my reticence to discuss money as being a new --William Lyon Phelps in practice; a product of the stance that medicine is one of most eth - ical professions, not to be tainted by any evidence of fiscal limita - ” tions; and my starting and current belief that health care is a basic are not gods, nor even divinities, but are human. They are subject to human right. the same frailties and errors of all humans. Then trial lawyers entered Many years ago doctors were considered members of one of the the picture in an aggressive way and patients begin to sue doctors for most trusted and admired groups in America, right up there with even frivolous reasons since contingency cases ruled. Driven by the ministers and bankers and well ahead of lawyers. They lived in nice publicity and by a few huge verdicts, lawsuits multiplied. Almost every homes in good neighborhoods and drove great cars.