North Dakota Medical Association CONTENTS J UNE 2009 Checkup The mission of the North Dakota Medical Association is to promote the health and well- feature articles being of the citizens of North Dakota and to provide leadership to the medical community. 61st ND Legislative Assembly 5 The NDMA Checkup is published quarterly by Medicaid Rebase a Reality the North Dakota Medical Association, 1622 E. Interstate Avenue, P.O. Box 1198, Bismarck, ND 58502-1198, (701) 223-9475, Fax (701) 223-9476, Just What the Doctor Didn’t Order: e-mail: [email protected] 11 Why Wills Alone Won’t Work For Most Physicians Robert A Thompson MD, President Kimberly T Krohn MD, Vice President A. Michael Booth MD, Secretary Treasurer ND Legislative Assembly Enacts Steven P Strinden MD, Speaker of the House 16 Shari L Orser MD, Immediate Past President Health Information Technology Bill Gaylord J Kavlie MD, AMA Delegate Robert W Beattie MD, AMA Alternate Delegate Understanding the Health Care Councillors: 17 Provisions of the Stimulus Joseph E Adducci MD Thomas F Arnold MD Package Steven D Berndt MD William D Canham MD Debra A Geier MD Will You Be Ready For Linda L Getz Kleiman MD 19 Yvonne L Gomez MD HITECH Health Care? Catherine E Houle MD Steven R Mattson MD Rupkumar Nagala MD Minor Consent for Prenatal Care Fadel Nammour MD 27 and SB 2394 Jeremiah J Penn MD Shelly A Seifert MD Rory D Trottier MD The Recovery Audit Contractor Derek C Wayman MD 29 (RAC) is Here Rosemarie Kuntz, MBA, CMPE, NDMGMA President Staff MMIC Risk Management Bruce Levi, Executive Director 34 Managing Medication Risks Dean Haas, General Counsel Leann Tschider, Director of Membership & Office Manager Annette Weigel, Secretary Shelly Duppong, Designer & Production Manager departments with Clearwater Communications SUBMISSIONS: The NDMA Checkup welcomes manuscript, photog- President’s Message 3 raphy and art submissions. However, the right to edit or deny publishing submissions is reserved. Submissions are returned only upon request. Letters to the Editor with name, address and phone number of the author Organized Medicine – 22 are welcome. All letters are subject to editing. What Has It Done For You Lately? ADVERTISING: NDMA accepts one-quarter, half page and full NDMGMA 23 page ads. Contact our office for advertising rates. Copyright 2009 North Dakota Medical Association. All rights reserved. Briefings 24 NDMA Checkup is printed on recycled paper. NDMA Alliance News 33 2 NDMA CHECKUP CHECKUP PRESIDENT’SMessage Robert Thompson, MD, MBA The Telltale Signs of Health Care Reform... Finally on the Horizon? he planets are aligning for health care reform. “build momentum behind a comprehensive overhaul TAs described in my prior editorials, the so-called this year.” President Obama has described this volun- American health care system, which is really more of a tary effort as an “unprecedented commitment” by the patchwork than a true system, is unsustainable. The telltale organizations to “put aside their differences and work signs of true reform are finally appearing and the country toward fixing the healthcare system.” The letter draft- is ready for change. During the early 1990’s, similar things ed by the health industry attendees stated, “We, as were said. So, why do I think that this time it is inevitable? stakeholder representatives, are committed to doing Let me list these telltale signs and you can make up your our part to make reform a reality in order to make the own mind. system more affordable and effective for patients and The first sign of change was the economic collapse, purchasers...” These are very powerful words. which became plainly evident last fall. Economists say The fourth sign of the potential for real change that the weakening started in 2007 and that the economy is the willingness of key congressional members to simply ran out of steam. The collapse of the housing begin to engage in a meaningful dialogue regarding market, the rising numbers of unemployed, the increase sweeping reform. Their goal is in alignment with in bankruptcies, and the collapse of signature American the White House, which aims to produce meaning- icon businesses have all led to a citizenry that is frankly ful health care legislation by fall for consideration spooked. Did you know that health care expenses account and passage. On April 29, 2009, the Senate Finance for roughly 50% of personal bankruptcies? Frankly, the Committee released a report for public comment American public wants health care reform and they want it called Transforming the American Health Care to be sweeping and meaningful. Delivery System: Proposals to Improve Patient Care The second sign of change was the election in and Reduce Health Care Costs. On May 11, a sec- November and the collapse of an effective political oppo- ond options paper was released on expanding health sition to the President and his party during this legislative care coverage: Expanding Health Care Coverage: cycle. The ability to drive through change and create leg- Proposals to Provide Affordable Coverage to All islation has never been more probable, especially with a Americans. On May 18, the final of three papers charismatic president with high approval ratings. was released relating to the financing of health The third sign is the recent summit at the Obama care reform: Financing Comprehensive Health White House of the major health care players – the Care Reform: Proposed Health System Savings and American Medical Association, the American Hospital Revenue Options. If you are at all interested in health Association, the American Health Insurance Plans, the care policy and reform, I would strongly recommend Pharmaceutical Manufacturer’s Association, the Advanced looking through these documents, which will give Medical Technology Association, the Service Employees you an idea what some of the legislation might look International Union, and others – all vowing to work like. (See http://finance.senate.gov/sitepages/baucus. towards solutions that will save 2 trillion dollars over ten htm). years! As opposed to the early 1990’s and the efforts by The Obama administration, in their words, is trying to the Clinton administration to overhaul the health JUNE 2009 3 care system, I do not foresee that the entrenched vested are projected to be grossly under-funded, and the longer interests will be able to derail the momentum that is build- the tough decisions are delayed, the worse the prob- ing. Remember the Harry and Louise ads on television? I lem becomes. Kathryn Sebelius, the Health and Human doubt you will see something as effective this time. Services Secretary, makes the point that we can’t fix The fifth sign relates to the competitiveness of American Medicare without fixing the whole health care system. business. Many corporations and small businesses are say- This process will be interesting to watch. Since we are ing that they cannot compete against their counterparts talking about reforming approximately one seventh of this in Europe and Canada. Many businesses hope that health country’s economy, the public needs to be brought along. care reform, especially in these difficult times, will allow Mike Murphy, a Republican political consultant and advi- them to regain a competitive edge. sor, talks about the “sacrifice gap” in American politics. The sixth sign is the statement by Medicare Board of His point is that while politicians talk about solutions, they Trustees (May 12, 2009) that Medicare Part A will run out do not spell out what sacrifices need to be made. If true of money two years earlier than predicted (2017 instead health care reform is to occur, there will be sacrifice from of 2019). For that matter, all of the entitlement programs everyone involved, including the public. Will there be sweeping reform this year? I think so. I believe the signs are there. David Brooks, writing in the New York Times in May, thinks there will only be a medium-sized bill. His point is that there will be extended coverage, but very little to trim costs. He states, “there are deep structural forces … that have driven the explosion in health care costs.” In days past, I would have agreed with him; however, this is a unique legislative cycle and President Obama’s only real chance to “double down” on a massive effort. We shall see. At this point in our history, we stand on the precipice of uncertainty. The theme of my presidency has been leadership and I still believe that for physicians to play a meaningful role in shaping the destiny of our profession, it is a crucial time to become involved. These are indeed interesting times. Above: Dr. Thompson and Dr. Biron Baker participate in a Healthcare Reform Roundtable held by Sen. Kent Conrad and Rep. Earl Pomeroy. Left: NDMA Vice President Dr. Kimberly Krohn and Dr. Thompson pause on the steps of the U.S. Capitol between meetings with our Congressional Delegation. 4 NDMA CHECKUP 61ST NORTH DAKOTA LEGISLATIVE ASSEMBLY New legislation includes rebase of Medicaid physician payments he 2009 North Dakota Legislative Assembly met NDMA Priorities Addressed Tfor 79 legislative days, adjourning sine die during the late hours of May 4. The session was punctuated by NDMA came to the 2009 session with a member- stops and starts caused by statewide flooding and will be ship-driven agenda developed by the Commission on remembered for heated debate complicated by the need Legislation, chaired by Dale Klein of Mandan, approved to allocate federal stimulus dollars and strong views on by the NDMA House of Delegates led by House Speaker both sides relating to the implementation of Measure 3. Steve Strinden of Fargo in September 2008, and refined Legislative highlights include the funding of many priori- by both the Council chaired by NDMA Vice President ties articulated at the start of the session by Governor John Kimberly Krohn and the Commission on Legislation prior Hoeven and legislative leaders on both sides of the aisle, to the start of the session.