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My most important update concerns a meeting between Fraser Cobbe, Dr. Michael Webb
(FMA W/C advisor), Jerry Fogel (3rd party insurer, and consultant to Health South),
Dr. James Dolan (FLAMPAC), and others. Mr. Fogel
has created a think tank to re-design the worker’s compensation delivery system. This would abandon the current system (no 3 member panel, no Florida Impairment Guides) and instead become physician driven. Physicians would receive increased reimbursement of 150% of current Medicare (possibly 200% for surgeries) with future rates increased based on 2001 Medicare plus increases for inflation. Insurers would be required to answer authorization questions immediately, and be held accountable for these decisions. Physicians would follow clinical pathways. Authorizations would be automatic along these pathways but require justification for any deviations. Disability would be determined by function and not diagnosis or arbitrary impairment or pain. Appeals would be referred to a physician panel that would also refer to the pathways. Employers would be held accountable to determine if they have employment for a given level of function. Cost savings would be through diminishing the role for attorneys (nothing ever goes through the judicial system), reducing paperwork (a single form for diagnosis, treatment, work status), and forcing hospitals to accept the same reimbursement physicians receive. This would be presented as a legislative package which specifies the key points of structure and reimbursement, but with broad packages of rules to be developed in the future. This package is more likely to pass than simply legislating physician fees, since it would not result in any increase in premiums (and thus would have good support from both the insurance and the employer industries).
From our specialty, this presents several good things along with some bad. On the good side, permanently guaranteed improved reimbursement for many without any negotiation. (However, if you currently receive these rates or better through effective contracting, this is not a current advantage, but rather might be realized in the future if your contracts fall through because of the increasing cost of the current system). This should reduce our overhead with a single standard form, easier authorizations, and markedly diminished time spent communicating with patients’ attorneys, and simplified treatment through clinical pathways. Basically, we should get paid more for doing less.
On the down side, there could be increased physician liability for making functional determinations and creating pathways and serving on physician panels. Additionally, if there are any problems with the proposed future system, it might be difficult to change it since most of the system would be administered through rules and not legislation.
FMA Resolutions that affect orthopedists include making worker’s compensation and tort reform the FMA’s top priorities, seeking legislation to provide bone density testing as a covered benefit for women over 45 and men at risk, seeking repeal of NICA, and pursuing at the AMA level making un-reimbursed care a federal income tax deduction.
I am also happy to report that I was elected to the presidency of the Young Physician’s Section, and re-elected as a YPS AMA Delegate, and re-elected to the FLAMPAC Board.
Lastly, I would encourage all of us to become more effective legislatively by joining both the FMA and FLAMPAC. Your FMA is the advocate of physicians in Tallahassee, and has done several things you might not be aware of. We passed all-products clause, which means that AETNA and others are prohibited from making physicians sign up for “all products“, such as PPO and HMO and PSO. Instead, all products have to be offered separately. We stopped the Board of Medicine from doubling our licensure fee (the savings of which would more than pay for your FMA dues each year). We eliminated the 5 hour worker’s compensation course. We passed Adverse Determinations, which requires that a Florida licensed physician sign off on all managed care adverse determinations (denials/modifications of necessary treatment). This feet alone now means that we can remove them of their license and their job for wrongful denials of care.
FLAMPAC is how the FMA finances legislation, and very effectively helped in the last election cycle to remove pro-insurance legislators in favor of pro-medicine candidates.
If you have any questions about legislation, the FMA, the AMA, or FLAMPAC, please do not hesitate to contact me.
Sincerely,
Adam S. Bright, M.D., F.A.A.O.S., F.A.C.S.
941-342-6404
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