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NEWSLETTER OF THE RHODE ISLAND MEDICAL SOCIETY The 2010 General Assembly session:  Volume 23 • number 2

september 2010 One for the record books

State legislation – But not because it was unusually productive . . . and politics 1 2010 General Assembly The 2010 session of the Rhode Island Committee members generally rely on session General Assembly was remarkable for collaboration from their Senate counter- 2 RIMPAC news: Reform two unheard of events: the mid-session parts in developing the budget, so Senate raises stakes in fall elections election of a new House Speaker, and the acceptance is normally preordained and

AMA news Senate’s rejection of the supplemental free of intrigue. Thus, the rejection of the 4 On system reform: budget proposed by the House. It was un- 2010 supplemental spending plan left vet- What were they thinking? remarkable for legislation passed, aside eran State House observers scratching their 4 Useful links for system from a new school funding formula. heads. Ultimately, the 2010 supplemental reform and federal The looming November general elec- budget was rolled up with the 2011 budget regulations tions and the State’s intractable fiscal and passed by both chambers in that form. 5 2010 House of Delegates straits combined to put a damper on leg- Aside from these two novelties – the Annual Meeting islative exuberance and may have killed new mid-session Speaker and the bud- From the President whatever appetite House Speaker William get surprise – the legislative year was 6 Reform brings opportunity Murphy (D-Warwick, Coventry) might memorable for little other than an early still have had for a fifth term at the ros- adjournment and stampede for the doors. Laurels for distinguished trum. In March the 47 year-old Murphy Among the relatively few bills left RIMS members announced that he was stepping down standing to become law were two initi- 7 Dr. Ed Forman on medical from the Speakership and would retire ated by RIMS. House bill 7450 Sub A, ethics as process from the General Assembly altogether and its Senate twin, S-2806 Substitute-A, 9 National honors for Drs. Aronson, Hamolsky at the end of this, his ninth term in the introduced by Representative Frank Ferri House. He thus paved the way for the rare (D-Warwick) and Senator Rhoda Perry rims news mid-session election of House Majority (D-Providence), respectively, allows 3 Annual Member Banquet Leader Gordon Fox (D-Providence) to the physicians, physician assistants and nurse 8 Briefly Noted Speakership. Usually, the election of a practitioners to treat the partner of a 9 Awards for Dr. Ettensohn Speaker is the first order of business in patient for certain sexually transmitted and Dr. Troise the January of odd-numbered years, when diseases without first examining the part- ® 14 Tar Wars the Assembly begins a new two-year ses- ner. Twenty-two other states already per- 14 Bike helmets sion. January 2011 will be no exception, mit “expedited partner therapy,” which is 17 Member outing but now Fox will face that election as consistent with the guidelines established at the Gamm the incumbent Speaker with enhanced by the Centers for Disease Control. Practice management news prospects for reelection, this time to a The second successful piece of RIMS 16 Workers’ compensation full, two-year term. legislation is a re-write of the licensing and Beacon’s divorce statute for radiological technicians (House 19 RI’s new Regional Extension Dropping the budget ball 7273-Aaa, by Pollard, and its companion Center for HIT The other curiosity was perpetrated by bill, Senate 2130-A, by Gallo). Rad techs 19 Useful links for practice the Senate, which broke with a 30-plus have been licensed in Rhode Island since management and HIT year tradition when it rejected the House’s 1994 under a statute co-authored by the 24 UnitedHealth settlement supplemental budget for the fiscal year techs and RIMS. Given advances in tech- Professional liability that ended June 30. Constitutionally, nology in the intervening years, RIMS saw 20 AMA’s recent survey it is the responsibility of the House to the need to work with the Rhode Island 21 Risk management tips formulate the budget and send it to the Radiological Society and the Department on pain management Senate for concurrence. House Finance of Health to update the statute. continued p.8 rimpac news

The new federal legislation raises the stakes for RIMPAC has made the maximum allowable contribution RIMS 198th Annual Member Banquet of $1,000 to the Kilmartin campaign and a $500 contribu- doctors and patients in this fall’s primary and tion to the Little campaign. Saturday, October 2, 2010 Squantum Association, East Providence ri medical society and RIMPAC executive committee general elections SECRETARY OF STATE GENERAL TREASURER generally does not make contributions to candidates for Look for your invitation in the mail president these offices. Vera A. De Palo, MD 2010 is an election year in Rhode Island. That means that all statewide general The following new leadership team was duly elected offices (Governor, Lieutenant Governor, Treasurer, Secretary of State and Attor- by the RIMS Council on June 6, 2010, and will be president-elect GENERAL ASSEMBLY A substantial number of new faces ney General), as well all 113 General Assembly seats, Rhode Island’s two seats installed in office on October 2: Gary Bubly, MD may grace both chambers of the General Assembly come in the U.S. House of Representatives (Patrick Kennedy and James Langevin are vice president January. Some fifteen seats are open (i.e., no incumbent the incumbents) and many mayors, town councils, school committees, etc. will Gary Bubly, MD President Nitin S. Damle, MD is seeking reelection), and most incumbents are facing be in play on November 2. Primary elections for all the intra-party contests will Nitin S. Damle, MD President-Elect secretary challenges – in some cases multiple challenges. Alyn L. Adrain, MD take place on Tuesday, September 14. Alyn L. Adrain, MD Vice President treasurer Rhode Island must elect a new governor and a new attorney general because Voters in the following five districts have a chance this Elaine C. Jones, MD Secretary Jerry Fingerut, MD the current incumbents are term-limited. Rhode Island will also elect a new year to vote for a physician or a nurse to represent them Jerry Fingerut, MD Treasurer general treasurer because the incumbent is running for governor. The First immediate past president in the General Assembly: Marlene Cutitar, MD Councilor at Large Diane R. Siedlecki, MD Congressional District is an “open seat” (i.e., no incumbent is running for Scott E. Wang, MD Councilor at Large ama delegate reelection this year) for the first time in decades, because Congressman Patrick Senate District 35 (East Greenwich/North Kingstown/ Michael E. Migliori, MD Kennedy will be retiring from Congress when his eighth term in the House Warwick): The Honorable Mark Schwager, MD, a two- Steven R. Fera, MD Councilor at Large councillors at large of Representatives ends this year. With more than a dozen retirements in the term member of the East Greenwich Town Council, is Martin R. Papazian, MD Councilor at Large Marlene Cutitar, MD General Assembly and with a sharp increase in the number of candidates who the endorsed Democratic candidate for this seat, which Joel M. Kaufman, MD Adjunct Councilor at Large Andrew J. Dowd, MD have filed for offices at all levels, this year’s general election promises to be became open when the incumbent retired. Dr. Schwager Steven R. Fera, MD Ira M. Singer, MD Adjunct Councilor at Large one of the most interesting and momentous in memory. faces a stiff primary battle on September 14, and whoever Martin R. Papazian, MD Michael E. Migliori, MD Delegate to AMA The new federal health care reforms raise the stakes for this year’s fall prevails in that contest will face a well-funded, business- elections, because the new law places much authority for implementation supported Republican rival in November. RIMPAC has Peter A. Hollmann, MD Alternate Delegate to AMA in the hands of the states. The general officers and the General Assembly who made the maximum allowed contribution of $1,000 to Rhode Island Medical News the Schwager campaign. More information on this cri- is the newsletter of the assume office at the start of2011 will bear historic responsibility for shaping Rhode Island Medical Society the future of Rhode Island health care. tical race is available at www.doctormarkforsenate.com. RIMPAC is a non-partisan medical political action com- 235 Promenade Street, Suite 500 Accordingly, RIMPAC, under the leadership of its Chair, former RIMS Supporters can also contact the campaign at doctormark- mittee that seeks to promote the election and re-election Providence RI 02908 President and former General Assembly member Nick Tsiongas, MD, MPH, [email protected] or 401-884-1388. of state and local public officeholders who are friendly to Phone: 401-331-3207 is especially active this year. A full listing of candidates who have received Fax: 401-751-8050 Senate District 11 (Bristol/Portsmouth): Christopher Ottiano, medicine and knowledgeable about health care. Neither con-tributions from RIMPAC is available on the homepage of RIMS’ website, Email: [email protected] MD, is making his third run for the seat held by Senator RIMS nor RIMPAC endorses candidates for any office. Website: www.rimed.org www.rimed.org. Below are brief notes on some of the key races this fall. Charles Levesque. Sen. Levesque is a member of the Senate RIMPAC advises AMPAC (the American Medical Political Subscription Information GOVERNOR The gubernatorial race became a little simpler with the withdrawal Committee on Health and Human Services and has spon- Action Committee of the AMA) on potential support for A one year subscription to of Democratic candidate Patrick Lynch, Rhode Island’s current Attorney Gen- sored legislation on behalf of RIMS during his three terms candidates for federal office representing Rhode Island. Rhode Island Medical News eral, but five candidates remain in the race as of this writing: Kenneth Block in the Senate and previously during his eight years in the RIMS and RIMPAC encourage physicians to be pol- costs $50. The publication is free to members. of the Moderate Party; current General Treasurer and former state senator House of Representatives. RIMPAC has contributed $250 itically engaged. RIMS routinely supports its members’ Frank Caprio, a Democrat; former U.S. Senator Lincoln Chafee, running as an to Senator Levesque’s campaign. involvement in political campaigns by helping physicians editor Newell E. Warde, PhD independent; and former state representative Victor Moffit and John Robataille, reach out to other physicians in support of candidates of both Republicans. RIMPAC has made the maximum allowed contribution of House District 3 (Providence): Daniel Harrop, MD, is making their choosing. graphic designer another run against the incumbent, Rep. Edith Ajello. Marianne Migliori $1,000 to the Caprio and Chafee campaigns. While the political arena is decidedly not for everyone, Rep. Ajello has long been a solid RIMS ally and has political competition does affect everything and every- LT. GOVERNOR The incumbent, Elizabeth Roberts, is seeking re-election and sponsored many bills on RIMS’ behalf. RIMPAC has one (and everyone’s children), for better or worse. Much The Rhode Island Medical Society faces a primary challenge from Red Sox advisor Jeremy Kapstein. Several contributed $300 to Rep. Ajello’s campaign. is always at stake for physicians and their patients in the was founded in 1812 to promote Republicans are competing in the September 14 primary for the privilege the art and science of medicine. political arena, and even more than usual is at stake in of running against Kapstein or Roberts. RIMPAC has made the maximum House District 49 (Woonsocket): Stuart Gitlow, MD, is RIMS is the eighth oldest state this time of change. medical association in the country. allowed contribution of $1,000 to the Roberts Campaign. making his first run for office challenging the incumbent in the Democratic primary. Supporters can contact Dr. It has long been a basic tenet of medical ethics that In cooperation with the Brown ATTORNEY GENERAL This seat is an open because the incumbent is term-limited. Gitlow’s campaign at [email protected] or 401-338-0493. physicians’ dedication to human wellbeing implies a pro- University School of Medicine, Democrats competing in the primary are Steven Archambault, Joseph Fernandez fessional responsibility for political awareness and political the Rhode Island Department and State Representative Peter Kilmartin. Christopher Little is running on the House District 20 (Warwick): David Bennett, RN, is seeking action. Professional associations like RIMS and the AMA, of Health, and Quality Partners of Rhode Island, the Society also Moderate Party ticket. Erik Wallin is the lone Republican in the race. Two in- to oust the incumbent in a democratic primary. Mr. Ben- and medically-oriented political action committees like publishes a monthly magazine, dependents have filed papers: Keven McKenna and Robert Rainville. The role of nett narrowly lost a Senate primary in an open district RIMPAC, AMPAC and many national and state specialty Medicine and Health Rhode Island. the Attorney General, as the state’s chief consumer protector and anti-trust en- in 2008. RIMPAC has contributed $100 to the Bennett PACs, make it relatively easy and painless for physicians forcer, has become increasingly important to health care in the past two decades. campaign. His campaign website is www.joinbennett.com. to fulfill this special responsibility to society. v

2 Rhode island medical news • september 2010 september 2010 • rhode island medical news 3 ama news What were they thinking? Reflections on recent history, U.S. health care policy and the role of organized medicine As part of the ongoing national debate • Ban on cancellation for illness The AMA was also successful in The road ahead over health care reform, hefty discus- • Mandate that parents’ coverage be improving the bill by removing a National health system reform will sion continues within the medical available to children up to age 26 provision that would have imposed remain a work in progress for at profession, much of it under the aegis an arbitrary 5% cut in payments least several more years. The official • Measures to sharpen competition of the AMA and its 500+ member to high-end physician outliers in timeline set forth in the bill itself for in the insurance marketplace House of Delegates. utilization and another that would implementation stretches through The AMA House has long been the • Requirements for transparency have extended Medicare coverage to 2019. Much has yet to be codified most representative and comprehen- and accountability of insurance people as young as 55. The original in regulation, and a good deal of sive policy-making body in American companies bill included Medicare and Medicaid responsibility and discretion for the medicine. Over many years and de- • Tax credits to enable small “enrollment fees” for physicians and ultimate shape of health reform is cades, the AMA House has developed, businesses to purchase coverage would have taxed elective medical left to the individual states. revisited and refined a comprehensive • Subsidies for low-income procedures. The AMA was able to These realities constitute a chal- body of policies that form the basis for individuals and families to eliminate all of these problematic ele- lenge to doctors, medical societies and AMA’s legislative and regulatory ini- purchase coverage ments from the bill before it became the AMA to be vigilant, organized and tiatives, and for the AMA’s responses law. Officially, the AMA remained engaged, now and for years to come. • Streamlined insurance to legislative and regulatory proposals neutral on the “public option,” which For news and information on health claims processing put forth by others. The final national did not survive in the final bill. system reform, visit the AMA’s special health reform legislation signed by • Elimination of the Part D coverage Liability and anti-trust remain site www.hsreform.org. For state ad- President Obama in March 2010 gap (“the donut hole”) AMA National Advocacy Conference in Washington, DC, March 2010 unaddressed vocacy and public policy information includes the following salient features • Protections against government and visit www.ama-assn.org/go/arc, the Gary Bubly, MD, RIMS President-Elect; J. James Rohack, MD, then-President of the AMA; and Of course, the final legislation is still that the AMA found to be consistent third-party misuse of comparative site for the AMA’s Advocacy Resource Vera A. De Palo, MD, RIMS President inconsistent with AMA policy in im- with established AMA policy: effectiveness research to dictate Center (ARC). v portant respects. Most notable is the treatment decisions or coverage • Coverage extended to 32 million absence of anything beyond lip service currently uninsured Americans • Disease prevention and to liability reform. While the new law • Ban on insurers’ denial of coverage for wellness promotion does provide still more funding for people with pre-existing conditions • A floor for primary care Medicaid “demonstration projects” in liability AMA House of Delegates: Chicago, June 12–15, 2010 • Ban on lifetime insurance caps payments at Medicare levels reform, these provisions can hardly While strong and diverse opinions persist within the AMA in Amesbury, MA, whom we have known for many years be taken seriously. They are transpar- House over national health system reform and the AMA’s through his long participation and leadership in the New ently a sop to those many, including posture in the long process to date, the actual voting at England Delegation. the Rhode Island Medical Society and this year’s Annual Meeting, held in Chicago, June 12–15, Governance continues to be an unsettled discussion Useful links for health system reform and federal regulations the AMA, who believe that liability amounted to a solid affirmation of recent AMA positions for the AMA House, in the sense that two-thirds the 500+ and anti-trust are the two principal and actions – even more so than was true at the Interim Delegates favor continuing with two big, policy-making forces distorting American health care From the AMA portal will be a platform for other Meeting last November, where a trend toward consolida- meetings a year, but 52% think the interim meeting – driving up costs, restricting access www.hsreform.org information as well, and includes tion and consensus was already evident. should be combined with another regularly occurring and confounding important efforts to The AMA’s comprehensive site an “Implementation Center” link At the heart of this more subdued and sober mood in AMA meeting, most likely the National Advocacy improve quality and patient safety. on national health system reform. (at the bottom under “Resources”) the House seemed to be a pragmatic sense that the world Conference, which currently takes place in March. Despite the substantial shortcom- has changed, that we need to move forward from where we As always, the scope of AMA House business, as well www.ama-assn.org/go/arc that provides easy access to pend- ings that persist in the bill, however, are, and that where we are is in many ways better for our as the thoroughness, efficiency and openness with which Presents state perspectives on health ing health reform regulations. the AMA did not impose any litmus patients than where we were before March 23. In addition, the House accomplishes its enormous work, represent reform and other aspects of public From the U.S. Department of test or walk away from the table. there was a largely unspoken realization that the AMA’s an impressive model of democratic process. The entire policy from the Advocacy Resource Health and Human Services  Walking away was an untenable careful navigation over the past eighteen months had suc- handbook for the June 2010 meeting (resolutions, coun- Center of the AMA. Office of Consumer Information option, tantamount to voluntary ceeded in preserving a positive public image for doctors cil reports, reference committee reports, etc.) is publicly From the U.S. government and Insurance Oversight self-disenfranchisement on behalf this time around, in contrast, say, to 1964–65. available online (www.ama-assn.org), as is a preliminary www.healthcare.gov www.hhs.gov/ociio of all physicians. Instead, the AMA Cecil B. Wilson, MD, an internist from Winter Park, agenda for the Interim Meeting, which is coming up in Includes a tool for consumers to This portal includes a tab for recognized that in a negotiation, get- Florida, was inaugurated President of the AMA at this early November. enter profile information and find “Regulations and Guidance” that ting 75% of your ask up front is some- meeting; and Peter W. Carmel, MD, a pediatric neuro- At this past June meeting, RIMS’ Executive Director which insurers are offering indi- provides links to regulations, fact- thing to affirm and accept in good surgeon from Newark, New Jersey, was chosen President- Newell Warde was reelected by his state medical so- vidual coverage in their state. This sheets, information on grants, etc. faith as a basis for further negotiation. Elect. Dr. Carmel had two strong competitors in the ciety peers to another two-year term on the Executive election, one of whom was a New Englander, Dr. Joe Com-mittee of the AMA Litigation Center. The Center’s Heyman, an obstetrician-gynecologist in solo practice Executive Committee subsequently elected him Chair. v

4 rhode island medical news • september 2010 september 2010 • rhode island medical news 5 FROM the president

Reform brings opportunity Dr. Edwin Forman on the nature and practice of medical ethics

vera a. de palo, MD just beginning. I joined the endeavor, PRESIDENT and a new element in clinical practice was opened to me. On March 23, 2010, providers. To complete the trifecta of awards, the RIQI A word about what Ethics is – an act entitled “The was selected as a Beacon Community which will use “no small matter but how we ought Patient Protection and IT resources as a foundation for bringing doctors, hos- to live,” said Socrates. While moral- Affordable Care Act” pitals, community health programs, federal programs ity is what we have been taught and was signed into law and patients together to design new ways of improving believe is right, and law is codified by President Obama quality and efficiency to benefit patients and taxpayers. morality with sanctions, ethics – as and became Public Earlier this year, Lieutenant Governor Elizabeth Rob- a branch of philosophy – is actually Law Number 111-148. erts invited Rhode Islanders in government, in the health a method for determining the right The following week care field, in business, and on behalf of patients and thing to do. Although not achieving the president signed “The Health Care and Education families to plan for the challenges and opportunities of final proofs like calculus, the posi- Re-conciliation Act of 2010.” Together these laws offer implementing national health care reform. She formed tion with the best arguments – which the opportunity for the most sweeping reform in health “The Healthy Rhode Island Task Force for National involve highly-prized human values care that has occurred in decades. Health Reform Implementation.” Stakeholders in the as well as scientific facts – ought to For years, we looked to the inefficiencies in the health health care discussion have met throughout the summer prevail. Thus ethics requires moral care system with a desire to make things better. Many to discuss important topic areas like insurance market The following remarks were delivered agonizing field?” My best answer, reasoning, utilizing principles such as involved in health care’s different aspects, whether reforms, coverage expansion, the design by Dr. Forman upon his receipt of RIMS’ after years of reflection, is that I thrive right, utility, and fairness. To explore it be paying for, delivering, or consuming it, hoped and building of the health insurance ex- Rakatansky Award for Medical Ethics on, and need, the intense relationships what great minds have written on “We must come for solutions which would streamline care and change, long-term care, payment and delivery and Professionalism on September 26, that develop. Sometimes there are these subjects and to engage in open- rein in costs. The health care reform bill now gives to the table to system reform, prevention, pilots and reform 2009, at the Dunes Club. The Rakatan- terrible, intolerable losses, other times minded discussions with one’s peers us that opportunity. shape our future initiatives, and workforce development. sky Award was established by vote of wonderful achievements, but always is an extraordinary experience. Rhode Islanders in health care have a long his- and the care On July 14, RIMS’ leadership and staff the Council in 2008. Dr. Forman was a rich and enduring closeness. I believe that moral reasoning, tory of collaborating, whether it be on a state level that will impact were among some 90 Rhode Islanders who the second recipient of the Award. There is an ancient Greek saying which gets better with practice, has using quality initiatives as the driving force, like our patients. participated in a Rhode Island Health care which I learned from a colleague and several rewards. It makes an individu- the Rhode Island Chronic Care Collaborative and Stakeholders Meeting in Washington DC orga- Thank you, Dr. Siedlecki, for your well-known pediatric ethicist – Dr. al a better listener and communicator the Rhode Island Safe Transitions Program, or in nized by Senator Sheldon Whitehouse. To face over-kind remarks. I am deeply Lainie Friedman Ross: “A doctor has and, by giving “reasoned recommen- initiatives launched by the Office of the Health Insurance the new and complex challenges as the implementation appreciative of this honor and grateful opportunities for studying human dations” which take into account a Commissioner like the Chronic Care Sustainability phase of reform begins, this forum gave Rhode Islanders to the Rhode Island Medical Society for nature which are given to no one else, patient’s values as well as the medical Initiative (also known as CSI, Rhode Island’s multi-payer an opportunity to discuss the provisions of the reform bill giving me this award. I also want to wherefore a philosopher ought to be- facts, more effective in persuasion. Patient-Centered Medical Home project). Insurers have with Secretary of Health and Human Services, Kathleen thank my wife, Sylvia, for her support, gin his life as a doctor, and a doctor It enhances the physician-patient collaborated with the process not only by funding quality Sebelius; Nancy-Ann Min DeParle, Director of the White and in particular for the innumerable should end his life by becoming a phi- relationship. And, finally, it enriches initiatives but also by working with hospitals and medi- House Office of Health Reform; and senior Senate staff. and valued discussions with me about losopher.” It was in 1974 that I faced one’s professional and personal life. cal practices to develop an extension of the medical home The implementation phase of health care reform offers the essence of patient care. And I a problem with one of my patients To paraphrase the eminent philoso- model of care. Quality measures in a Pay for Performance many opportunities for Rhode Island. The Healthy Rhode must express gratitude to my friends – – a fourteen-year-old young man I pher Bertrand Russell: “Ethics is to Program has yielded very positive results in some initiatives. Island Task Force has tried to identify pilots and initia- mentors – colleagues, the philosophers was treating for acute myelogenous be studied, not solely for the sake of Through the demonstration of a collaborative environ- tives that can build on the current collaborative activities John and Rosalind Ladd* who guided leukemia. After a few remissions, the any final answers to such questions, ment, the Rhode Island Quality Institute was awarded the in the state. The Patient Protection and Affordable Care me in the field of ethics. disease became resistant to standard since no such answers may, as a rule, federal Health Information Exchange grant, which will as- Act and the Health Care and Education Reconciliation The gracious introductory remarks therapy. His mother, desperate to be known to be true, but rather for sist in implementing an integrated, informative exchange Act of 2010 will change the landscape of our practice en- spoke of my efforts in research and keep him alive, urged me to try one the sake of the questions themselves, to improve health outcomes, reduce medical errors and vironment. Physicians and other health care stakeholders development of the pediatric on- experimental drug after another – each because these questions enlarge our make our health care delivery system more effective and have the possibility to shape reform. We must come to cology program in Rhode Island. But producing only a transient response conception of what is possible, enrich efficient. Additionally, the Institute was awarded the the table to shape our future and the care that will impact my primary focus has always been on and moderate toxicity. My patient our intellectual imagination and di- Regional Extension Center contract to assist providers in our patients. The time to get involved is now, the oppor- the cure of the afflicted children and indicated, indirectly but clearly, that minish the dogmatic assurance which integrating effective HIT systems and to provide techni- tunities are many! Together we can shape Rhode Island’s the support of their families. People he wanted no further treatment. Who closes the mind against speculation.” cal assistance to doctors, hospitals, and other health care health care landscape. v ask, “Why do you work in such an was I to serve? The answer was not in I invite you to study, reflect on, medical textbooks or literature. The and involve yourself in medical ethics. Try it – I’m sure you will like it! *John Ladd is professor emeritus at question concerned values, and, as I Brown University and author of a was to learn, required moral reason- Thank you for the opportunity to paper entitled “The Good Doctor ing. At that time, a Brown University speak with all of you. v and the Medical Care of Children.” program to study medical ethics was

6 rhode island medical news • september 2010 september 2010 • rhode island medical news 7 briefly noted FROM Page one

Joseph Lifrak, MD, is President of the AAO’s Annual Meeting in Budget – continued Drs. Aronson, Hamolsky receive national honors Awards for Drs. Ettensohn, Troise of the Rhode Island Orthopedic Chicago, October 16–19. The Sec- RIMS vs. tanning salons and sugary drinks Society. Richard Terek, MD, is retariat Award recognizes special The Federation of State Medical of Health H. Denman Scott, MD, The Medical Society will bestow RIMS initiated two other timely public health Vice President. Greg Austin, MD, contributions to the Academy and Boards has honored Dr. Milton W. MPH, recruited him to be the first special honors upon David Ettensohn, measures that failed narrowly because of the ab- is Secretary/Treasurer. Members to ophthalmology. In particular, Hamolsky and Dr. Stanley Aronson chief administrative officer of the MD, and Caroline Troise, MD, in the breviated Assembly session and will be back on At Large are Anthony Mechrefe, AAO will recognize Dr. Rizzuto with Lifetime Achievement Awards new Board of Medical Licensure context of the RIMS Annual Member RIMS’ legislative agenda next year. One measure MD, Sidney Migliori, MD, and for exemplary efforts as a member for distinguished leadership in and Discipline. The BMLD offi- Banquet on Saturday evening, October would have barred persons under the age of 18 Eric Walsh, MD. of the AAO’s Secretariat for State medical regulation. cially replaced the old Board of 2, at the Squantum Association in Affairs, as President of the Rhode from patronizing tanning salons. Jason Neus- The two Rhode Island doctors Medical Review on January 1, East Providence. Dieter Pohl, MD, is President of Island Society of Eye Physicians tadter, MD, a resident in dermatology, led the were only the third and fourth re- 1987, with Dr. Hamolsky at the Dr. Ettensohn will receive the Dr. the Rhode Island Chapter of the and Surgeons and as a teacher charge for this legislation. His worthy efforts cipients in the entire history of helm. Dr. Hamolsky led the new Charles L. Hill Award in recognition of American College of Surgeons. and mentor of residents, among were the subject of a front-page feature article the award, which is presented infre- board from then until his second his energetic and eloquent leadership Steven Migliori, MD, is Pres- other contributions. in the Providence Journal on July 5, 2010. quently to outstandingly meritorious retirement in 2001. in a time of particular challenge and ident-Elect. Jennifer Gass, MD, RIMS also introduced a bill to tax sugar-added individuals. The previous presenta- Dr. Aronson served on Rhode stress for the Rhode Island medical is Treasurer. Erik Enquist, MD, Steven R. DeToy, RIMS’ Director drinks. This bill attracted support from more than tions were made in 2002 and 2008. Island’s Board of Medical Licen- community. Dr. Ettensohn was is Secretary. Marlene Cutitar, of Government Relations and twenty organizations that share the Medical Soci- The Federation is the professional sure from 1992 to 2003. He is President of RIMS 2002–2003. MD, is Immediate Past President. Public Affairs, has been named ety’s concern about American dietary habits and association of state medical boards, the Founding Dean of Brown’s Dr. Carolyn Troise will be the third to the fifteen-member Federation the related epidemic of obesity. It also attracted Charles Pattavina, MD, will the authorities that license and medical school, now the Warren recipient of the Dr. Herbert Rakatansky Staff Advisory Steering Commit- vehement opposition from the beverage industry, receive the prestigious James D. discipline doctors in the various Alpert School of Medicine, and Award for Professionalism in Medicine. tee of the AMA Practice Manage- which launched a well-funded campaign of radio Mills Outstanding Contribution states. Dr. Aronson and Dr. Ham- served as Dean for 11 years. He Dr. Troise has served as the medical ment Center. The Center provides and print advertising and whipped up “anti-tax” to Emergency Medicine Award olsky received their awards at the is a former editor-in-chief of the director of the Rhode Island Free Clinic advocacy on payment issues, chatter on the radio talk show circuit. RIMS’ bill of the American College of Emer- federation’s 98th annual meeting Medical Society’s monthly journal, since its inception. v practical assistance to medical was given a lengthy hearing by the House Finance gency Physicians on Thursday, in Chicago in April. Medicine & Health Rhode Island. offices, and timely information to Committee. In the end, however, the opposition September 30, in the context Dr. Hamolsky had just retired in His popular, erudite commentaries Members should have received invita- medical society staff on medical succeeded in killing the bill. RIMS and a growing of the ACEP’s annual Scientific 1986 from a long and distinguished on medicine and medical history tions to the Annual Banquet by late practice issues. Mr. DeToy is also coalition will bring it back in 2011. Assembly in Las Vegas, Septem- career as a pioneering endocrinolo- appear regularly in that journal August. Questions can be directed to a founding member of the Exec- ber 28–October 1. The award gist, professor of medicine at Brown and on the editorial pages of Sarah Stevens at 401-331-3207. utive Committee of the AMA’s Professional liability is named for one of the founders and physician-in-chief at Rhode the Providence Journal every (See also p.2 of this newsletter.) Advocacy Resource Center. This year’s efforts on liability reform met with of the ACEP. disappointment as well. One might have hoped Island Hospital, when then-Director Monday morning. v Newell E. Warde, PhD, RIMS’ that RIMS’ legislation to protect open com- L. Anthony Cirillo, MD, will Executive Director, was elected by munication between doctors and patients when become Chair of the State Legis- his state medical society peers in outcomes disappoint (commonly known as the lative and Regulatory Commit- June to chair the Executive Com- “I’m sorry” bill) would have stood a good chance tee of the American College of Other health-related bills that did become law include • A bill to require school districts to work with the mittee of the Litigation Center. of passage this year in the wake of last summer’s Emergency Physicians when the the following: Rhode Island Interscholastic League (RIIL) to develop The Center, a joint undertaking of high-profile case involving the family of actor ACEP holds its annual Scientific guidelines for coaches and players of youth sports to the AMA and the medical societ- James Woods and Kent County Hospital. But • A bill to regulate “discount medical plans,” which Assembly in Las Vegas, September reduce risks associated with concussions. ies of every state and the District while the bill did receive a reasonable hearing are typically scams promoted by small signs nailed 28–October 1. of Columbia, was established in in House Judiciary Committee, the Senate did to utility poles. • A bill changing the name of the Department of Mental Philip R. Rizzuto, MD, will re- 1995 to advance physicians’ rights not deign to follow suit. Health, Retardation and Hospitals (MHRH) to Rhode • A bill adopting the AMA’s 6th edition Guides to the ceive the prestigious Secretariat through the judicial system. It The usurious prejudgment interest rate that Island Department of Healthcare, Developmental Evaluation of Permanent Impairment in workers’ Award of the American Academy has participated in more than Rhode Island law applies to medical liability Disabilities and Hospitals (DHDDH). compensation cases. This bill also clarifies the statu- of Ophthalmology in the context 200 legal cases. settlements and awards (12%) received diligent A more complete account of this year’s health legislation tory language pertaining to workers’ compensation and attention once again this year. Inappropriately is provided in the accompanying grid on pages 10–11. Preferred Provider Networks (PPNs). (See also a related frozen in law for decades now at an artificially The RIMS Public Laws Committee, chaired by article on workers’ compensation page 16.) Senator Sheldon high level, the prejudgment interest rate remains Michael E. Migliori, MD, is comprised of physicians Whitehouse with a significant driver of process delays and high • A bill to allow the Director of Health to grant privileges representing a full spectrum of medical specialties and RIMS President cost. Unfortunately, much like RIMS’ “I’m sorry” to health care professionals licensed in other states to subspecialties. Its meetings are open to RIMS members. Vera De Palo, MD, Physicians are encouraged to contact RIMS’ Director of at the Rhode Island legislation, this year’s interest bill received a practice in Rhode Island during a declared emergency. serious hearing on the House side but met a Government Relations, Steve DeToy, with questions Health Care Stake- • A bill to allow the health care provider of a child who holders meeting in firm stone wall in the Senate. regarding the legislative process or with suggestions for has been sexually assaulted to report that information Washington, DC, As always when liability reform bills are heard potential future legislation ([email protected]). As usual, to the appropriate regulatory agency. on July 14. in the General Assembly, it can be impressive the Public Laws Committee invites participation and to observe the intellectual creativity, rhetorical • A bill to expand the role of the medical examiner’s suggestions from members and specialty societies for its elegance and mulish intransigence of the plaintiff office to include making recommendations to decrease meeting in the autumn to formulate RIMS’ legislative bar as they fiercely defend their lush turf. the incidence of preventable child deaths. agenda for 2011. v

8 rhode island medical news • september 2010 september 2010 • rhode island medical news 9 Health-related bills that became law in the 2010 session of the Rhode Island General Assembly The complete text of the bills can be viewed at www.rilin.state.ri.us, search by bill number.

Bold and underlined indicates RIMS-Sponsored Bold and italicized indicates of particular RIMS interest

BILL HOUSE HOUSE SENATE SENATE BILL HOUSE HOUSE SENATE SENATE BILL NO. STATUS BILL NO. STATUS BILL NO. STATUS BILL NO. STATUS SPONSOR SPONSOR SPONSOR SPONSOR

RELATING TO EDUCATION H 7036 A aa PL 10-022 S 2034 A aa PL 10-021 RELATING TO HEALTH AND SAFETY – H 7654 A PL 10-154 S 2417 A PL 10-155 This act would require school districts to work with the Rhode Island Gallison Felag DISTRESSED ESSENTIAL COMMUNITY HOSPITALS Fierro Picard interscholastic league to develop guidelines for educating coaches and This act would allocate a quarter percent (.25%) of the taxes on players in youth sports about the risks associated with concussions. the premiums of health insurers to assisting a distressed essential This act would also limit the liability of school districts and others community hospital. This act would take effect upon passage. for such injuries, provided certain insurance coverage is provided. H 7711 A PL 10-065 S 2714 A PL 10-049 This act would take effect upon passage. RELATING TO INSURANCE This act would add a trend test to the risk based capital statutes Marcello Lynch RELATING TO BUSINESSES AND PROFESSIONS – H 7273 A aa PL 10-137 S 2130 A PL 10-139 governing insurers and health organizations, financial health RADIOLOGIC TECHNOLOGISTS LICENSING Pollard Gallo determinations. This act would take effect upon passage. This act would repeal the existing radiologic technology licensing act and adopt a revised radiologic technology licensing act. This revised act RELATING TO BUSINESSES AND PROFESSIONS – CONFIDENTIALITY H 7865 A PL 10-085 S 2220 Aaa PL 10-082 would allow the director of health to appropriately license radiologic OF HEALTH CARE COMMUNICATIONS AND INFORMATION ACT – McNamara Perry technologists in accordance with current standards of practice estab- HEALTH CARE COMMUNICATIONS AND INFORMATION lished by national professional associations which examine, register, This act would require the health care provider of a child who has been certify or approve individuals and education programs relating to opera- sexually abused to report the abuse to the appropriate law enforcement tors of sources of radiation. This act would take effect upon passage. entity. This act would take effect upon passage.

MAKING APPROPRIATIONS FOR THE SUPPORT OF THE STATE H 7397 A aa PL 10-023 RELATING TO HEALTH AND SAFETY – HEALTH CARE SERVICES – H 7907 A PL 10-190 Kilmartin FOR THE FISCAL YEAR ENDING JUNE 30, 2011 Watson UTILIZATION REVIEW ACT This act would repeal the sunset provision regarding the statutory RELATING TO HEALTH AND SAFETY – MEDICAL EXAMINERS H 7417 A PL 10-143 variances the department of health is allowed to issue. This act This act would increase the responsibilities of the medical examiner’s Naughton would take effect upon passage. office to make recommendations to decrease the prevalence of prevent- able child deaths, and to help establish community intervention strate- RELATING TO LABOR AND LABOR RELATIONS – WORKERS’ COMPENSATION H 8114 A PL 10-121 S 2083A PL 10-095 gies through the use of a child death review team. This act would take This act would make changes in the medical review procedure for Williams P Fogarty effect upon passage. claimants receiving workers’ compensation benefits. This act would take effect upon passage with paragraph 28-29-2(3)(ii) and section 28-33- 4 18 RELATING TO EDUCATION – HEALTH EDUCATION CURRICULUM H 7418 A PL 10-087 S 2265 B PL 10-081 applicable to all injuries sustained on or after January 1, 2011. This act would require that the department of elementary and Jackson DiPalma secondary education develop a Lyme disease awareness and pre- RELATING TO MOTOR AND OTHER VEHICLES – S 2440 Aaa PL 10-184 vention course for public school students and all health education THE DIESEL EMISSION REDUCTION ACT Miller classes include instruction on Lyme disease prevention and treatment. This act would add new provisions with respect to diesel emissions This act would take effect upon passage. control in public projects, and would exempt diesel emissions control technology from the sales tax. This act would take effect upon passage. RELATING TO HEALTH AND SAFETY – SEXUALLY TRANSMITTED DISEASES H 7450 A PL 10-175 S 2806 A PL 10-166 This act would permit physicians, physician assistants and nurse Ferri Perry RELATING TO INSURANCE – EXTENDED MEDICAL BENEFITS S 2629 PL 10-053 practitioners to prescribe prescription drugs to a patient’s sexual This act would provide that dental and vision benefits be included DeVall partner or partners for the treatment of sexually transmitted diseases. for individuals eligible for extended medical benefits. This act would take effect upon passage. RELATING TO INSURANCE - DISCOUNT MEDICAL PLANS H 7606 A PL 10-158 S 2632 A PL 10-156 This act would establish standards for discount medical plan Kennedy Sheehan RELATING TO HEALTH AND SAFETY S 2631 PL 10-051 organizations, protect consumers from unfair and deceptive marketing This act would give authority to the director of health to certify Tassoni practices and facilitate consumer understanding of discount medical out-of-state health care professionals in times of emergency. plan organizations. This act would take effect upon passage. This act would take effect upon passage.

10 rhode island medical news • september 2010 september 2010 • rhode island medical news 11 College Advisors Group, LLC “Solutions to make higher education a reality”

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Tar Wars® Rhode Island:  Society; Larry Lamothe, Director of Human Resources & 2010 Tar Wars® Presenters Mary Lyster, MD Compliance for the West Warwick Public Schools; and Nathan Beraha, MD Tim Manown, MD Annual Poster Contest Priya Gupta, MD, of the Rhode Island Academy of Family Jeffrey Borkan, MD, PhD Leslie Morris, MD Physicians. Maureen Bowman, MD Meg Murray, MD catherine Norton  Assistant Director of Professional  Special acknowledgement is also in order for this year’s Gillian Breslin, MD Brian Pickett, MD ® and Community Services for RIMS Tar Wars sponsors, whose support made the event pos- Stephanie Chow, MD Herb Rakatansky, MD sible: the Rhode Island Academy of Family Physicians, Robert Crausman, MD James Schwartz, MD While the heavy rain made the Rhode Island Chapter of the American Academy of Paul Del Guerico, MD Russell Settipane, MD for a soggy mess outside, it Pediatrics, the Rhode Island Medical Society Foundation, Suzanne DeLaMonte, MD Craig Woda, MD was quite a different story he explained to the audience as they anxiously waited and the West Warwick School Department. Kate Eldridge, MD Raymond Zarlengo, MD inside the school gymna- for the judges to emerge from their lengthy deliberation. Most of all, RIMS thanks the many volunteer present- Keivan Ettefagh, MD sium at Wakefield Hills Ele- First-place went to Alexandria Nogueras (left) from ers who gave their personal time to visit area schools Marissa Fast, MD Alpert Medical School mentary School on Saturday, Marieville Elementary School in North Providence, who and engage students in discussions about the dangers Roger Fazio, MD (Brown University)  May 8. A colorful array of received an all-expenses paid trip for her and her family to of tobacco use and teach them to think critically about Sarah Fessler, MD medical student  wonderful works of art were travel to the National Tar Wars® competition in Washington, tobacco advertising. Jacqueline Firth, MD Tar Wars® Presenters on display as 36 fifth-grade DC, in July. The second-place winner and recipient of a For more than 22 years, Tar Wars® has been the sole America Foster, MD Ross Beckman students and their families $75 American Express gift card was Maria Spagnolo from youth tobacco education program offered by a medical Arthur Frazzano, MD Eugene Cone gathered for the Rhode Island’s seventeenth annual state- George Peters School in Cranston; the third-place winner specialty organization in the United States. Tar Wars® is a Arnold Goldberg, MD Pamela Escobar wide Tar Wars® poster contest, the culmination of the and recipient of a $50 American Express gift card was Keia program of the American Academy of Family Physicians Donald Hebb, MD Richa Mishra Academy of Family Physicians and Academy of Pediatrics DePina from Kingston Hill Academy in Saunderstown. (AAFP) and reaches approximately 400,000 students an- Peter Hollmann, MD Alejandro Navarro yearly tobacco education program for middle schoolers. RIMS extends a hearty thanks to the 2010 Tar Wars® nually nationwide. In Rhode Island, the Tar Wars® program Yamini Howe, MD Reshma Ramachandran “The weather didn’t dampen our spirits. It was a great celebrity judges, who were presented with a very challeng- operates routinely in dozens of school districts across the Mae Igi, PA-C Arkady Rasin turnout,” noted Arthur Frazzano, MD, chairman of the ing task of picking a winner among this year’s 36 entries. state and involves more than 2800 students each year. Katja Karrento, MD Devin Smith Tar Wars® program and emcee for the day. “It was very tough choosing a winner this year,” explained To become a Tar Wars® presenter or receive more in- Martin Kerzer, DO Ina Soh Before announcing the winners of the 2010 contest, Dr. Channel 10 health reporter Barbara Morse Silva, who has formation about the program, contact Catherine Norton, Anita Kestin, MD Frazzano thanked all the students for their participation been judging Tar Wars® competitions for the past five years. 528-3286 or [email protected]. Volunteer presenters are Elizabeth Lange, MD in the 2010 Tar Wars® program, telling them they were Her sentiments were echoed by the four other judges, always needed and no experience is necessary. RIMS pro- Sheldon Lidofsky, MD all winners and congratulating them for a job well done. who were Gary Bubly, MD, President-Elect of the Medical vides all program materials, including “How To Present” Anthony Lombardi, Jr., MD “This was one of our most competitive contests to date,” Society; Nitin Damle, MD, Vice President of the Medical guidelines and PowerPoint presentation. v Patty Lynch-Gadaleta, MS, PA-C

2010 Bike helmet distribution to RIteCare kids Sadaf Ali, MD Jerry Fingerut, MD Thanks to the generosity of its physician members and to Rebecca H. Allen, MD David R. Gifford, MD, MPH the volunteer energy of several Brown University medi- Charles F. Allendorf, MD James F. Griffin, DO cal student members of RIMS, the Rhode Island Medical Cynthia M. Alves, MD Daniel S. Harrop, MD Society gave away about 225 new bike helmets and other Robert H. Andler, MD Melvin Hershkowitz, MD bike safety paraphernalia to children who are beneficia- Pamela M. Antoniuk, MD James K. Herstoff, MD ries of RIteCare. This year’s event took place Wakefield Stanley R. Balon, MD Peter A. Hollmann, MD Hills Elementary School in West Warwick on Saturday Peter E. Baziotis, MD Martin I. Holzman, MD morning, May 8. Linda J. Berman, MD Harold M. Horwitz, MD The Medical Society sincerely thanks medical students Jack R. Bevivino, MD Ian M. Jacobson, MD E. James Monti, MD and Rahul A. Somvanshi, MD Andrew Matson, Matthew Reilley, and Ina Soh for Jacques L. Bonnet-Eymard, MD Beth Lange, MD John F. Murphy, IV, MD Sonia Sprung, MD donating their time and talent, engaging the children Lawrence P. Bowen, MD and Raymond Zarlengo, MD Adelaide G. Nardone, MD Gregory J. Steinmetz, MD RIMS thanks the following individuals and medical practices for and individually fitting each helmet that day. Elizabeth A. Cadoret, PA-C David E. Leibowitz, DO Hung Nguyen, MD Elizabeth M. Sutton, MD their generous support of this year’s bike helmet give-away: Joseph F. Callaghan, MD Otto Liebmann, MD Patricia A. Nolan, MD Patrick J. Sweeney, MD, MPH American College of Emergency Physicians, Rhode Island Chapter Linda L. Carpenter, MD Mary D. Lekas, MD James A. O’Brien, MD Keiko M. Tarquinio, MD Consultants in Urology, Inc. David P. Carter, MD Patrick R. Levesque, MD Martin R. Papazian, MD John M. Tarro, MD East Bay Pediatrics and Adolescent Medicine Associates, Inc. Heather A. Chapman, MD Foong-Yi Lin, MD John J. Przygoda, MD Carole V. Toselli, MD East Greenwich Pediatrics and Andrew Sucov, MD Mary L. Lussier, MD Albert J. Puerini, Jr., MD Nancy Y. Tsai, MD ENT and Allergy, Inc. Nathan T. Connell, MD Terrie A. Mailhot, MD Diane Reali Marini, MD James J. Turanski, MD Medical Associates of Rhode Island, Inc. Michelle M. Daniel, MD Roland C. Merchant, MD Kenneth C. Rickler, MD Sui-Yen Wang, MD Orthopaedic Associates, Inc. Vincent A. DeConti, MD Frank Merlino, MD Norman E. Rudolph, MD Lewis R. Weiner, MD Orthopedic Group, Inc. Stuart V. Demirs, MD Joseph L. Migliori, MD Warren K. Russell, MD Elizabeth A. Welch, MD RI Colorectal Clinic, LLC Candace L. Dyer, MD Stephen J. Migliori, MD Virginia Schmidt Parker, MD and Stephen E. Glinick, MD RI Neurological Association, Inc. Frank J. Faltus, MD and Sidney P. Migliori, MD Nicole P. Somvanshi, MD Richard J. Zienowicz, MD

14 rhode island medical news • september 2010 september 2010 • rhode island medical news 15 practice management rims event

Workers’ Compensation Beacon Mutual’s divorce from Blue Cross generates confusion Rhode Island Medical Society at the Gamm! Late in 2009, Beacon Mutual Insur- to arise in May 2010, when many additional administrative requirements bearing in mind that the PPN becomes ance Company, Rhode Island’s largest Rhode Island physicians received of the workers’ comp system. relevant only when an injured worker A Night of Theater with RIMS writer of worker’s compensation in- correspondence from Prime that indi- RIMS immediately sought a meet- switches from his or her original You are invited to attend the Rhode Island premiere of “Mauritius” on surance, informed the Medical Society cated – misleadingly – that physicians ing with representatives of Beacon, the choice of physician. that Beacon wanted to have closer would have to join a Prime PPO Medical Advisory Board (MAB), and Thursday, November 4, 2010 at the Sandra Feinstein-Gamm Theatre. relationships with the physician in order to be included in Beacon’s the Worker’s Compensation Advisory Workers’ comp fee schedule COLA Pricing includes a ticket to the show and a pre-show cocktail hour with community and assume more direct Preferred Provider Network (PPN). Council (WCAC). Beacon subsequently In 1999 RIMS was successful in pro- hors d’oeuvres. The cost is $35 per person. Reservations need to be made management of workers’ compen- instructed Prime to rescind its all-pur- moting the addition of an annual cost sation cases. With those purposes PPN vs. PPO pose PPO provider agreement offer. In of living adjustment (COLA) to the by October 18, 2010 and will be made on a first-come, first-served basis. in mind, Beacon moved this year to PPN is a term of art that is unique addition, the Worker’s Compensation workers’ compensation fee schedule. Reception 6:30–7:30 pm terminate its long-standing arrange- to the language of Rhode Island’s Advisory Council drafted legislation to A COLA has been applied every year Performance 8:00 pm ment with Blue Cross & Blue Shield workers’ compensation law and is remove any possible ambiguity about since, with the sole exception of 2009; of Rhode Island for administrative and not interchangeable with the more the key provisions of the 1992 reforms, in that year the indices would have Gamm Theatre, 172 Exchange Street, Pawtucket, 401-723-4266 network services and to replace that familiar term PPO (Preferred Pro- including the subordinated function of provided a COLA of less than 1%. For Located in the historic Pawtucket Armory just 2 blocks from exit 29 off I-95 arrangement with a new, three-part vider Organization). Rhode Island law the PPN. This new statutory language 2010, a COLA of 2.8% should become (and 5 minutes from downtown Providence), The Gamm is easy to find and strategy: Beacon is now performing guarantees injured workers complete affirms that “any contract proffered or effective in October; however, the more care management in-house, freedom of choice in their initial maintained which restricts or limits Workers’ Compensation Division of offers plenty of free parking. contracting with Mitchell Health selection of a treating physician and the health care provider’s ability to the Department of Labor and Training The Rhode Island Medical Society gratefully acknowledges the support of RIMS Insurance Services for billing, and ceding to does not allow insurers to limit work- make referrals pursuant to the provi- informs RIMS that the 2010 COLA Brokerage Corporation Prime Health Care responsibility for ers’ initial choice to any particular sions of this section, restricts the in- may not be applied uniformly to all managing Beacon’s provider network. network. Moreover, if a treating phys- jured employee’s first choice of health services. This year’s COLA is more Unfortunately, some communi- ician refers the patient to a specialist care provider, substitutes or overrules likely to be applied to the fees that About “Mauritius” cation glitches with Beacon’s new for treatment or consultation, the the treatment protocols maintained by are close to Blue Cross payment levels Mom has died, leaving half-sisters Mary and Jackie with a rare partners marred the transition, and referring physician and injured worker the medical advisory board or attempts and less likely to be applied to fees stamp collection.Mary wants to keep it for its sentimental value. some confusion persists. retain the right of free choice for that to evade or limit the jurisdiction of that are already well in excess of Jackie wants to sell it for the fortune it might be worth. Enter three For physicians, the questions began initial referral. However, a subsequent the worker’s compensation court what Blue Cross has been paying foul-talking shady stamp dealers determined to get the sale, and an change in an injured worker’s treat- shall be void as against public policy” for a given service. elaborate con game over the dubious inheritance unfolds. At once ing physician or referrals must be (emphasis added). a gripping family drama and a delightfully sinister comedy, veteran made within the insurer’s approved The Medical Advisory Board has AMA 6th Edition now the law playwright Theresa Rebeck’s 2007 Broadway hit twists and turns AMA “Therapeutic Insights” Preferred Provider Network (PPN), also explicitly warned that “any effort The 2010 changes to the workers’ and takes you for a ride until its final shocking scene. series is: and that PPN must be on file with to amend the PPN because a caregiver compensation act also include the the Workers’ Compensation Medical has refused to participate in a PPO will adoption of the 6th Edition of the • free and online Advisory Board. be strenuously resisted by the Board.” American Medical Association’s • highlights one disease The participating agreement Prime Prime subsequently offered physi- Guides to the Evaluation of Perma- Reservation Form condition per issue offered to Rhode Island physicians for cians the opportunity to join a work- nent Impairment. This standard will Please respond by October 18, 2010. • features state and national its PPO raised concerns at RIMS, be- ers’ comp-specificPPO (again with a now be used to determine the earn- pre-scribing data from IMS cause the Prime PPO was all-purpose, discount of the workers’ compensation ings capacity of an injured worker as Name ______Health and evidence-based not limited to workers’ comp, and it fee schedule), which will presumably a percentage of an uninjured worker’s treatment guidelines included a substantial discount in re- become a basis for replacing Beacon’s capacity, based on the AMA Guides. Number of Tickets______• is written by top disease experts imbursement from the standard work- current PPN with a new Prime PPN The Workers’ Compensation Ad- Total Enclosed ______$35 per ticket in collaboration with the AMA ers’ compensation fee schedule. Such early next year. Beacon’s current ap- visory Council has invited the AMA • offers AMA PRA Category 1 discounting threatens a linchpin of proved PPN is valid through February and RIMS to make a presentation on Phone______CME Credit Rhode Island’s highly successful work- of 2011. the 6th Edition Guides on September Email ______Visit www.ama-assn.org/go/ ers’ compensation act, which has been Each individual medical practice 29th. In addition, RIMS and the AMA a national model since its passage in must make its own decision with will be available to offer training pro- therapeuticinsights to review the You may pay by check, payable to “Rhode Island Medical Society”, or by credit four newsletters currently available: 1992. Integral to Rhode Island’s suc- regard to participation or non-participa- grams on the 6th Edition, if there is cess is the mandate that physicians tion in Prime’s PPO and the possibility sufficient demand. card. Return this form with payment to the Rhode Island Medical Society, Treatment of Type 2 Diabetes and other health care professionals that it may evolve into the workers’ More information about the 6th 235 Promenade Street, Suite 500, Providence RI 02908. Managing Hypertension must be reimbursed at a rate that en- comp PPN next year. One factor for Edition Guides is available through If you have any questions, please contact Sarah at RIMS’ office, 401-528-3281. Management of Alzheimer’s Disease sures injured workers timely access to consideration would clearly be an as- RIMS’ Director of Government and Management of HIV in Primary Care care by the doctor of their choice and sessment of the value to the particular Public Affairs, Steve DeToy (sdetoy@ fairly compensates physicians for the practice of being a member of the PPN, rimed.org). v

16 rhode island medical news • september 2010 september 2010 • rhode island medical news 17 practice management

New “Regional Extension Center” (REC)  Useful links for practice management  offers doctors free, practical help with EHRs and health information technology

The federally funded Rhode Island Regional Extension From the AMA Center (RI REC), a new function of the Rhode Island www.ama-assn.org/go/pmalerts Physicians and their office Quality Institute, wants physicians to know that it is staff should sign up through this link for email alerts from open for business. That business is putting millions the Practice Management Center of the AMA, with timely of new federal dollars to work in Rhode Island to help information on unfair payer practices, tips on addressing “priority primary care physicians” achieve “meaning- them, and new practice management resources and tools. ful use” of electronic health records (EHRs). The RI www.ama-assn.org/go/pmsoftware The Medical Group REC is a vendor-neutral resource. Management Association (MGMA) collaborated to develop The REC’s definition of “priority primary care a new online toolkit, which is free to members. The toolkit, physician” includes solo physicians and small group “Selecting a Practice Management System,” helps you practices of ten or fewer primary care professionals, select and purchase the most appropriate software for community health centers, rural health clinics, public your practice. The toolkit resources include: and critical-access hospitals, and any other primary • A five-step guide to practice management system care settings that serve uninsured, underinsured or software selection. medically underserved populations. Those who meet the federal definition of • A comprehensive checklist that helps you determine “priority primary care physician” incur no cost which practice management system software features to enroll for REC services. and functionalities are essential to your practice and which will enhance your revenue cycle management. The Rhode Island REC provides the following services to medical practices: • A sample “request for proposal” that you can employ in your communications with practice management • Subsidies of up to $2,500 system software vendors. • Direct, individualized, on-site support www.ama-assn.org/go/ucrsettlement Last year’s massive • Access to a pre-screened marketplace UnitedHealthcare settlement made $350 million available of approved vendors to compensate physicians for underpayments received for out-of-network services provided between 1994 and 2009. • Pre-negotiated discounts from vendors This link is a key to submitting a claim, which physicians • Advice on best practices for efficient must do by October 5, 2010. (See related article on back page.) adoption and use of EHR technology for consistently optimal patient care From the Rhode Island Quality Institute The RI REC portal is DocEHRtalk.org. The REC is www.docEHRtalk.org is the portal for Rhode Island’s new ready to provide interested medical practices with federally funded Regional Extension Center (REC), a func- a Process Manager who can offer unbiased, indivi- tion of the Rhode Island Quality Institute and a resource dualized support in moving the practice toward for primary care physicians in achieving “meaningful use” “meaningful use.” DocEHRtalk.org provides a list of health information technology. (See related article on of REC-approved, pre-qualified vendors as well as the new Rhode Island REC in the column to the left.) updates on relevant state and federal initiatives. The REC’s services include helping practices measure and document their progress toward From the U.S. government “meaningful use” to help them qualify for federal, www.cms.gov/EHRIncentivePrograms/ This is the official state, and payer incentives. CMS website for the Medicare & Medicaid EHR (Electronic The Centers for Medicare and Medicaid Services Health Records) Incentive Programs – who is eligible for the (CMS) define “meaningful use” of health information programs, how to register, “meaningful use,” upcoming EHR technology (HIT) as capturing health information in training and events, etc. a standardized, coded format; using that information www.hhs.gov/news/press/2010pres/06/20100618d.html to track and manage key clinical conditions; coordi- provides information on the recently issued “final rule” on nating care by communicating that information; and temporary certification forEHR (Electronic Health Record) reporting clinical quality measures and public health technology from the Office of the National Coordinator for information electronically. v Health Information Technology (ONC). v

september 2010 • rhode island medical news 19 professional liability

AMA’s new liability survey: While physicians are likely to be served with a lawsuit to be sued as women. The report author suggests that the likely to be sued than doctors who work in hospitals and at some point in their careers, only about 5% of physicians difference might be in part because male physicians are multispecialty group practices, largely because they work Eye-popping, but not surprising are sued in any given year, the report found. concentrated in the specialties with the highest numbers in liability claims-heavy specialities. Ob/Gyns are a special More than 60% of doctors over the age of 55 have been Certain specialities – including general surgeons and of claims. In addition, women physicians are generally case, however: they do tend to practice in solo or single- sued at least once, according to a survey released by the obstetricians/gynecologists – were more than five times younger than male physicians, and older doctors are more specialty practices, but unlike other specialties who get American Medical Association (AMA) in August. as likely to be sued as pediatricians and psychiatrists, likely to have been sued at some point in their careers, sued the most often, the work Ob/Gyns usually are sued Although most of those claims are dropped or dismissed, according to the report. About half of Ob/Gyns under the simply because they’ve been working longer. for – childbirth – is done in the hospital. the survey indicates that most physicians will be sued for age of 40 have already been sued, and 90% of surgeons Also, the survey found that practice owners and those The survey was funded by the AMA and more than malpractice at some point in their careers, and while some ages 55 and older have been sued. who work in single-specialty group practices were more 40 national medical specialty associations. v physicians will experience a greater frequency of litigation In contrast, less than 30% of pediatricians and psychia- than others, the overall trend is for a total of 95 medical trists surveyed had been sued, and almost no one in either malpractice lawsuits to be filed for every 100 physicians speciality had had an adverse claim filed in the previous Managing Professional Risk now in practice, according to AMA. 12 months. Tips for Steering Clear of Problems with Pain-Med Prescribing “This litigious climate hurts patients’ access to physi- The report goes on to say that while 65% of claims cian care at a time when the nation is working to reduce are dropped or dismissed, all claims are costly. Even Mary-Lynn Ryan patient. It discourages patients from seeking an unlimited unnecessary healthcare costs,” said AMA immediate past dropped or dismissed claims on average incur defense Risk Management, NORCAL Mutual Insurance Company  supply of medication and helps staff members verify the president J. James Rohack, MD, in a prepared statement. costs between $22,000 for cases dropped early to more and the NORCAL Group legitimacy of refill requests. For the report, AMA surveyed 5,825 physicians from than $100,000 for cases that go to trial before being Monitor patients over time on their needs for and use of pain the 2007–2008 Physician Practice Information (PPI) survey, dropped or dismissed, according to data in the report The following tips are intended to help physicians prescribe medication. Richeimer observes that patient trustworthiness which is used to update the practice cost data to develop from the Physician Insurers Association of America. narcotics/opioids appropriately to patients in chronic pain. “can only be assessed by monitoring the patient over time.”2 practice expense relative value units (RVUs) for the Medi- “Even though the vast majority of claims are dropped Obtain a thorough history and determine the specific cause  Cole suggests talking with patients periodically to reduce care Physician Fee Schedule. The measure of malpractice or decided in favor of physicians, the understandable fear of pain. In an article on treating patients’ pain, Eliot Cole, dosage appropriately, as well as periodically ordering “urine claims was determined by survey questions that asked of meritless lawsuits can influence what specialty of MD, a physician associated with the American Academy drug screens for…patients of concern to document that you doctors about the number of claims filed against them in medicine physicians practice, where they practice, and of Pain Management, advises, “Do not call [a patient’s] pain are able to recover their prescribed medications.”1 their career and over the previous year; the survey did not when they retire,” Rohack said. a headache or backache but try to find a specific pathologi- If you keep controlled substances in your office, establish  ask about the outcome of those claims. The report also found that men were twice as likely cal process to explain why your patients hurt.”1 Stephen a reliable process for safeguarding and reconciling such Richeimer, MD, Chief of Pain Medicine at the University of medications and for tracking their distribution. The federal Southern California, says, “Assessment is a key issue. The Drug Enforcement Administration (DEA) requires physicians history and physical examination provides the information who administer or dispense controlled substances from their that allows the physician to judge if the patient is legitimately offices to have effective controls to guard against theft and in pain or if the patient is improperly seeking drugs.”2 diversion. Controlled substances must be stored in a securely Document well. Cole advises, “Chart everything you see, locked, substantially constructed cabinet. Using a controlled think, feel, and hear about your patients. Leave nothing to substances inventory log can help you account for each and the imagination of the future reader… Explain what you are every dose of medication that goes through your office. doing, why you believe opioid analgesics will be helpful or These strategies are aimed at fostering appropriate pain continue to be helpful, what alternatives have been consid- management within the limits of professional practice. ered, that your patient agrees to the treatment, and how you Furthermore, they can help physicians and staff consistently intend to follow your patient over time.”1 Richeimer agrees: meet regulatory requirements on the management of “Good record keeping is part of good medicine, and it is also pain medications. your best protection from frivolous lawsuits,” he says.2 Ask chronic-pain patients to agree to use a single pharmacy. References Discussing pain treatment with the patient and getting the 1. Cole E. Prescribing opioids, relieving patient suffering, and stay- patient to agree to certain parameters associated with long- ing out of personal trouble with regulators. The Pain Practitioner. term pain management are mutually beneficial strategies: 2002;12(3):5-8. Available at: http://www.aapainmanage.org/literature/ PainPrac/V12N3_Cole_PrescribingOpioids.pdf. Accessed June 3, 2009. they help you avoid inadvertently supplying medication that 2. Richeimer S. Opioids for pain: risk management. California Society might be diverted for street sale, and they reassure the patient of Anesthesiologists Online CME Program. Available at: http://www. in pain that he or she can count on obtaining needed medica- csahq.org/cme2/course.module.php?course=3&module=12. Accessed tion. An especially useful rule is that the patient will use a June 3, 2009. single pharmacy for all pain medications. Managing Professional Risk is offered by the NORCAL Make use of a written pain medication agreement with Mutual Insurance Company and the NORCAL Group. More chronic-pain patients. A signed agreement by the patient information on this topic, with continuing medical education that he or she will follow rules for obtaining pain medication (CME) credit, is available to NORCAL policyholders. To learn will improve the likelihood of appropriate behavior by the more, visit www.norcalmutual.com/cme. v

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October 5 is deadline for physicians to claim their share of UnitedHealthcare’s  $350 million settlement for past underpayment of out-of-network services Thousands of physicians across the country who cared may be based on 50%, 70% or 90% of the difference for subscribers of UnitedHealthcare (or for subscribers between what the physician billed and what was paid. of some twenty-one affiliates and subsidiaries of United) on an out-of-network basis during the more than 15-year Background: The $350 million dollars now available to period from March 15, 1994, to November 18, 2009, may compensate physicians and patients is one part of the qualify to be compensated for underpayments from United. historic class action settlement that took final form last Most physicians who qualify for compensation under year – after ten years of litigation by the AMA Litigation the class action, including many doctors in Rhode Island, Center and the Medical Societies of New York State received a Settlement Notice and claim form by U.S. mail and Missouri. in early summer. The deadline for returning the claim This is the same settlement that New York State form is Tuesday, October 5, 2010. Attorney General Andrew Cuomo helped consummate Additional copies of claim forms can be downloaded during 2008–2009. from the special AMA link, www.ama-assn.org/go/ A second major piece of the settlement agreement ucrsettlement. This AMA site provides a wealth of eliminates United’s systematically skewed database, in-formation and resources to help physicians claim Ingenix, as the health insurance industry’s leading source what is rightfully theirs. of physician payment data. Most payers had used Ingenix’ The claim and recovery process is not as simple or data for years to calculate “usual, customary and reason- quick as it might be. Physicians will find the above-cited able” (“UCR”) payments for physician services provided AMA website indispensable. In addition, AMA members out-of-network. United, Aetna and Cigna have provided can receive hands-on, individualized help directly from an additional $90 million to replace Ingenix with a new, AMA in filing their claim for compensation. independent, transparent, non-proprietary database, Depending upon the level of documentation a physician which is currently being constructed under the aegis is able to assemble, his or her recovery of underpayments of Syracuse University. v