the last President’s letter of my tenure

This is the last President’s letter of my tenure, although I will give a year-end report at the Annual meeting on the Association and I hope to see you there.  It is a wonderful evening, enjoyed by those who attend. 

I want to commend Drs. Carol and Tom Ritter and Jean-Max Hogarth, who traveled to Haiti to help following the earthquake.  I am sure that there are others in the BCMA who have helped following this tragedy, but Carol and Jean-Max are the only ones who have come to our attention.  Carol has blogged on the effort at Carol and Tom in Haiti.  Drs. Ginny Merryman and Pascale Duroseau also delivered Carol and Tom’s Haitian translator a healthy baby boy at GBMC. 

I am concentrating in this letter on our legislative efforts as we are about a third of the way through the session. We can see how the budget and the coming elections are weighing on the Legislature this year as we have not seen nearly as many health related bills introduced.  All of the MedChi bills have numbers now and have been assigned committees and are on the MedChi website. 

SB 279 and HB 525 are the Governor’s bills on False Claims.  As outlined in the last newsletter, this bill has two major changes in it for physicians: the Qui Tam provision in the bill, which  allows a whistle blower to benefit from reporting a case and to file an action on behalf of the State.   This person who is receiving the bounty very likely could be the biller in your office.   The bills also change the standard of intent to defraud.  The language the Governor and the Secretary want is knowingly and unknowingly intent, which means that if a mistake is made under this bill you would be charged with fraud even when you make every effort to follow the rules.  Every physician should be following this bill as it could have a detrimental effect on each us and it is extremely important to the Governor and to Secretary Colmers.  They expect it to bring in significant funds to the State. 

Lt. Governor Anthony Brown has been chairing a work group discussing the False Claims bills and trying to reach some compromise with the medical community over the bills. There may be room for compromise on the potential exposure to fines and the time frame, 30 to 60 days, for providers to produce information.  However, neither Secretary Colmers nor Governor O’Malley appear ready to compromise on the qui tam provision or the amount a court may assess for damages.  There have been several additional meetings with no compromise to date.   

Senator Lenett has introduced SB 187 and he too wants us to be charged with fraud even if it is a mistake.  All of these bills are before the House Judiciary and Senate Judicial Proceeding Committees.  These committees are not known to look particularly favorably on physician issues.  Senators Jim Brochin and Robert Zirkin are our representatives on the Senate Committee and Delegates Bill Frank and Todd Schuler are on the House Judiciary Committee.   Call or write them.

 There appears to be a significant battle heating up over the Assignment of Benefits bills.  There will be three or four bills introduced before the deadline, two of which are the crossfiled bills HB 147 and SB 314, in addition to HB 594.   HB 147 and SB 314 have been filed by Delegate Dan Morhaim and Senator Robert Garigiola.  They chaired the Joint Committee on Health Care Delivery and Financing which studied the issue this summer and developed what they consider a compromise on the issue.  Basically, this bill would mandate that the carriers send the check to non-participating physicians when patients assign their insurance benefits.  The compromise bill would designate the amount of the payments to these non-par physicians to 140 percent of Medicare or 140 percent of the average paid in the geographic area, whichever, is greater.  It is important for non-par physicians to understand that they may choose not to accept assignment of benefits.   HB 594 is a straight prohibition of the practice of sending the check to the patient when treated by a non-participating physician.  MedChi is strongly supporting HB 594.

 The carriers, particularly CareFirst, are opposed to these bills and have written to all of their brokers asking them to call their clients and to write to Senator Thomas “Mac” Middleton and Delegate Peter Hamman, chairmen of the committees hearing the bills. You should check with your broker to make sure they are not participating in this campaign against Assignment of Benefits or placing their business with a larger broker who is. We should not be financially supporting companies that are actively working against us.  I for one am letting the MedChi Agency take on more of my insurance business.

 There are two malpractice bills before the Legislature this year.  We must thank Senator James Brochin for his sponsorship with Senator Muse of the Apology bill, SB .   Dr. Richard Scholz is testifying on the bill.  In 2006 an Apology bill was passed, but it had a caveat that practically negated the bill.  The law allows an apology or expression of sympathy, unless it amounts to an “admission or a statement against interest” then it can be used in a court action.   SB 358 would negate this caveat.  If you see Senator Brochin or Senator Muse, please thank them personally.

 We hope there will be a bill to establish a Health Court in the circuit court system.  The Health Court would have judges who are trained to hear malpractice claims.  This is similar to the already established State’s business and technology management program and would fit into the tort reform demonstration projects in the Federal Health Care Reform bills.  Increased expertise in the judicial system cannot be a bad thing and speeding up the legal process for both the defense and the plaintiff would be beneficial for all.  These bills are also in the House and Senate judicial committees.

 The usual group of Delegates on the House Judiciary Committee is sponsoring HB 603 which would increase the cap on Non-economic damages.  Needless to say we are opposing this bill.

 The nurse practitioners are also planning an assault on the collaborative agreement.  They have been wooing the Women’s Caucus to support SB 484 and HB 319, which have been filed and which increase independent practice for the nurses.  They are asking to practice independently without a collaborative agreement with a physician.  The bills will be heard in House Health and Government Operations Committee (HGO), chaired by Delegate Hammen.

 I encourage you to take a moment to write your legislators.  They do count and pay attention to the letters and emails they receive.  Sometimes those letters make all the difference in the passage of a bill.