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New Law Changes (SB 50A) 2003

Highpoints of Medical Features

Michael J. Webb, MD

Florida Workers’ Compensation Institute

August 18, 2003 

I.      Improvement of employer/employee access to quality care: increase in physician participation.  Many physicians had left the Workers’ Compensation system because of the low fee schedule (the lowest of the 50 states) and because of administrative demands which accompanied work injury treatment (“hassle factors”). 

New Fee Scheduled Effective January 1, 2004: 110% of Medicare for non-surgical CPT codes; 140% of Medicare for surgical CPT codes (or present fee schedule, whichever is higher).

 Negotiation of fees: Physicians and carriers can negotiate contracts which pay above the fee schedule (reason must be stated in the contract). 

II.      Reduction in hassle factors: The Division of Workers’ Compensation will standardize physician reports to employers and carriers, thereby reducing the number and variety of forms which challenge the physician.  Effective January 1, 2004, the Department of Financial Services shall require that all medical bills properly submitted by the provider be paid within 45 calendar days.

 III.      Enhancement of quality, reduction in variation of medical services and improvement in resource utilization: Requirement of clinical practice guidelines adopted by United States Agency for Healthcare Research and Quality (AHRQ).  Independent Medical Examinations. 

Intended results: put physicians and carriers on “same page” regarding acceptable guidelines for quality care; speed authorization of requested diagnostic studies and treatment; reduce the number of unnecessary tests and treatments.

 Reality:  AHRQ maintains a library of clinician guidelines but does not endorse or update specific state regulatory process to remedy this shortcoming is expected (e.g., establishment of a Clinical Care Guidelines Committee which will review AHRQ and offer resources and produce edited versions of existing guidelines).

 Independent Medical Examinations: In cases involving dispute, effective October, 2003, the employer and employee are entitled to only one IME per injury (rather than per specialty).  If the employee wins the dispute, the employer will reimburse the cost.

 If care is being provided under a managed care arrangement, the carrier will pay the costs of the IME if a network physician is used.  The parties may mutually agree to a “consensus IME”, when the conclusions shall be finding to both parties.

 Reasonable necessary medical care of injured workers shall in all situations: 

1. Utilize a high intensity, short duration treatment approach that focuses on early activation and restoration of function whenever possible.

2. Include reassessment of the treatment plans, regimes, therapies, prescriptions and functional limitations or restrictions presented by the provider every 30 days.

3. Be focused on treatment of the individual employee’s specific clinical dysfunction or status and shall not be based upon non-descript diagnostic labels.

IV.      Establishment of a compensable work injury condition: A greater focus on reasonable medical care benefits: Effective October 2003, the establishment of a bona fide work injury or medical disorder must be based on objective relevant medical findings.  Pain alone, or other physical complaints, in the absence of objective relevant medical findings, will not be compensable. 

Causation:  To be compensable, the work injury must be the major contributing cause (greater than 50%) for the condition which is under treatment (compare to “old law”: major contributing cause is defined as being greater than any other contributing cause).

FAOEM Broadcast August 16, 2004

FAOEM's Next Meeting:  Will be with the FL Workers' Compensation Educational Conference, Tuesday, August 24, 2004, 12 - 3 pm, The Orlando World Marriott, in the Crystal Ballroom, Rooms E & F.  Please RSVP to Lorry Davis, Lorry4@earthlink.net, or 904 270 8886, so we'll have a lunch for you!

RSVP'd so far:  Drs Stuart Brooks, Jim McCluskey, Mike Webb, Tom Dukowitz, Monica Grinberg, Seth Feldman, Richard Dolsey, Karen Carlson, Ken Phillips, Mario Medero, Jeanne McGregor, Stanley Haimes, Kathleen Jenkins, Robert Chapa, Cynthia Lewis-Younger, Gary Newcomer, Gary Clonts, Michael Hankins, Michael Band, Jock Sneddon, Joseph Mignogna, Charles Grant, Richard Johnson, Albert Lojko, Marlene Lambiaso, Hal Haase, Toni Belisle, Joan Watkins, Mark Glencross, Sanford Silverman, Gary Jay, Norm Hogar (represented by Barb Maxwell).  Also, Lorry Davis, Kimberly Fink, Diana McCluskey, Fred Whitson, Naaman Clonch.

While you enjoy lunch, you will benefit from the Sponsorship Presentation of 4Physicians.net/Practice Management and Recruiting.  This outfit has coding, billing, and collection products that will be of interest to many of you.  They also offer expertise in financial and human resources management, operations, and compliance.

Part of the Business Meeting Agenda:

1.       2004 Florida Work Comp Legislation - Report from Dr Michael Webb, Chair of the FMA's Workers' Compensation Advisory Committee, and Fred Whitson, Attorney and FMA Director of Medical Economics (where work comp lies within the FMA)

2.  DWC 25 Forum - Making short presentations and fielding questions/comments:

a.      Dr Michael Webb

b.  Mr Whitson

c.  Sissy Kemmer of Nogar & Associates (formerly Sissy Nogar - with the Div of Work Comp for many years, now out on her own consulting)

d.  Sandra Seay (invited) - representing a TPA, Choice Medical Network.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net
 

FLORIDA ASSOCIATION OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE

Atlanta Marriott Marquis

May 7, 2003

MINUTES

Present in order of sign-in:  Drs Karen Carlson, Ken Phillips, Gary Newcomer, Michael MacDonald, Rich Johnson, Jorge Trujillo, Emmett B (Bud) Ferguson, Kathleen T Jenkins, Stan Haimes, Joan Watkins, Tom Dukowitz, Michael Webb, Hal Haase, Robert Gordon, Gwyn Crump, Robert Haight, Steven Taubkin, Jeanne M McGregor,  and Homi S Cooper; Lorry Davis (Executive Director)

Presiding:  Homi Cooper, MD – President 

1. Self-introductions were made all around.
2. Minutes of the August 20, 2002, Orlando World Center Marriott meeting were approved.
3. Membership and Treasury Reports were given.*

*Details of the Membership and Treasury Reports can be obtained by members from Lorry S. Davis, M.Ed., Executive Director, at Lorry4@earthlink.net.

 A motion was made and carried to cancel the hospitality suite at the work comp conference if no sponsors could be found within a week.  It annually costs us $2000+, even when FSPMR pays 1/3.  It has been increasingly difficult to get sponsors to commit to the approximate $4000.00 cost, and attendance has not been good over the last 3 years to justify such an expense.  We will focus on our luncheon meeting and the healthcare provider breakout as the physician focal point at the comp conference – both have been tremendously successful the last few years.

 A motion was made and carried to reimburse Delegates to ACOEM’s House $500.00 rather than $1000.00.  When a treasury surplus is available again, the amount can be moved back up.

 A motion was made and carried to allow any oc med resident in Florida to join FAOEM for free.

4. ACOEM Report – Drs Cooper, McGregor, and Newcomer attended and reported.  ACOEM has an internal and external ID problem.  Money has been budgeted by the private practice section to do public relations for oc med.

Dr McGregor discussed the model bylaws being developed by ACOEM.

5. FMA Report – Dr Webb gave a thorough report as to the status of work comp reform: 

Workers' compensation reform died when the legislature adjourned Friday, May 2nd, without successfully passing House Bill 1837.  The Senate added six amendments to the bill, the House then refused to consider these changes, and the bill was never readdressed in the Senate.  Although not a perfect bill, HB 1837 did increase reimbursement fees for physicians to 110% of Medicare for non-surgical codes and 140% for surgical procedures or the current fee if higher (decreasing fees for certain hospital services and care), allowed providers to negotiate with insurers, streamlined some reporting, stated that pain and suffering alone without objective finding would not be compensated, limited IMEs to one except in certain situations, overhauled the dispute resolution process, and added increased efforts to identify and punish fraud.  The bill did this with an overall workers' comp system savings of 14%.

The Governor will be bringing the legislators back for a Special Session to consider this issue.  This week the legislators are back home in their district offices.  It is very important they hear from their physician constituents who accept workers' comp patients.

Dr Webb provided a summary of the proposed FairCare plan.

Dr Ken Phillips stated that he advises the insurance company for which he works to pay more for good treatment.  Physician win, patients win, employer/carriers win, and lawyers lose when this is done.  Dr Phillips said that a business perspective needs to be maintained to get industry to come and stay in Florida.

Dr and Mrs Cooper, and Lorry Davis attended the Tallahassee Rally for tort reform.  All were urged to continue communicating with their legislators, specifically the Senate, re this matter.

Re PIP, Lorry Davis reported that the FMA was successful in killing unfavorable changes in this law including a fee schedule that would have drastically reduced physician reimbursement (tying it to the work comp fee schedule).

Re Scope of Practice, Davis reported that the FMA helped to kill bill that would have expanded the scope of practice for ARNPs, Pas, Psychologists, Optometrists (they wanted prescribing privileges), and pharmacists who wanted privileges to administer immunizations.

6. University of South Florida ERC Report – concern was brought up that a non-physician had been appointed to the State of Florida’s Advisory Committee on Bioterrorism.  ACOEM had wanted each state to advocate for an ACOEM member to sit on these committees.  Dr Joan Watkins had expressed interest in this committee, but we found out that the position had already been filled.  A decision was made to contact Dr Steven Field to discuss this matter and Dr Ferguson will talk to FL’s College of Emergency Medicine to get their take on it.

7. Other New Business:  Dr Jorge Trujillo discussed some NIOSH tapes that disturbed him because he felt they were saying there was no more need for occupational and environmental medicine.  He requested that FAOEM write a letter of protest.  Dr Bud Ferguson agreed to review the tapes before FAOEM takes any action.  One of the USF Residents had a different slant:  OEM does need to be more socially active given their population based training.

8. Our next meeting is August 19, in conjunction with the FL Work Comp Conference (Aug 17 – 20), and this meeting will again be with the FL Society of Physical Medicine and Rehabilitation.  We are still seeking at least a $5000 sponsorship for this event.

Respectfully submitted,

Lorry S Davis, MEd

FAOEM Executive Director

DWC e-Alert Notification System:  Go to the division's homepage at www.fldfs.com/wc/ and click on the DWC e-Alert icon that is in the top right hand corner.  You will be asked to input your e-mail address and some other general information.  Once you have signed up, the Division will automatically send e-mails to you that provide information about our activities such as rule hearings, informational memorandum, bulletins, press releases, legislation, publications, etc.

Dr Jeanne McGregor, FAOEM President, represented us at the Jan 31 FMA Specialty Section meeting in Tampa.  There was much discussion about the FMA's initiative to gather enough petitions and enough money to have a constitutional amendment to limit attorneys' contingency fees, put on the next ballot. 

Rally at the Capitol:  Our Executive Director, Lorry Davis, will represent us at the FMA's Rally, Thursday, March 25.  The focus will be the medical liability insurance crisis.

Other Action During this Florida Legislative Session:  Session began March 2.  As usual, there are the scope of practice issues.  ARNP prescribing (controlled substances) is a big one (SB 2072).  This past Tuesday, in Senate Health Care, the nurses did not have enough votes to pass the bill.  The FMA asks that you let Senator Saunders, Chair, (saunders.burt.web@flsenate.gov) know that you are disappointed he did not support physicians and ask him to NOT agenda this bill again.  Also not supporting physicians:  Sen Dockery (dockery.paula.web@flsenate.gov) and Sen Wasserman-Schulz (schulz.Debbie.web@flsenate.gov).  Thank the following for supporting physicians:  Sen Carlton (carlton.lisa.web@flsenate.gov), Sen Fasano (fasano.mike.web@flsenate.gov), Sen Peaden (peaden.durell.web@flsenate.gov), Sen Villalobos (villalobos.alex.web@flsenate.gov), Sen Aronberg (aronberg.dave.web@flsenate.gov), Sen Dawson (dawson.mandy.web@flsentae.gov), Sen Wilson (Wilson.Frederica.web@flsenate.gov).

Controlled Substance Database:  The FMA supports these House and Senate bills, while working hard to ensure that the new law does not negatively affect physicians who are practicing appropriately.

Naturopaths:  Sen Diaz de la Portilla, SB 2604, Rep Bowen, HB 1375.  The FMA is strongly opposed to naturopaths once again being licensed by the State of Florida as health care providers.  Under these bills, a person who attends a school of naturopathy would be allowed to diagnose, treat, operate and prescribe for disease, pain, injury or other physical or mental condition.  This is the definition of the practice of medicine.

ACOEM:  Lorry Davis participated in the late January State Legislative Contact Conference Call.  FL, NJ, NY, WOMA, CA, and WI were represented.  Each state's rep gave a brief report, and Davis reported much of what is reported in this broadcast.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net
 

FAOEM Broadcast January 8, 2004:

FAOEM's Next Meeting; Workers' Compensation New Fee Schedule; FMA Work Comp Lobbyist for 2004 Legislative Session; Division of Workers' Compensation Asks for Physician Input; Editor

FAOEM's Next Meeting:  In conjunction with AOHC, April 30 - May 6, 2004, Kansas City, Missouri.  Stay tuned for details.

Workers' Compensation New Fee Schedule:  The 2003 Reimbursement Manual went into effect on 12/04/03, the 2004 RM went into effect on 01/01/04.  Under the 2004 schedule (according to the law, effective 01/01/04), you are to be paid the greater of either the 2003 WC MRA or the Medicare allowances increased to either 110% or 140%.   That is the reason that we had to publish both the 2003 MRAs and the Medicare percentage increases in the 2004 manual.

If your concern is how the Medicare increases were calculated for the 2004 RM - you would be paid from one of the locality columns depending on where you performed the service.  AHCA's Work Comp Medical Services Unit rounded all of increases of 110% and 140% for each of the localities according to whether the procedure was performed (in or out of facility).  The 2nd edition of the 2004 RM is being prepared and will incorporate the 2004 M'care payments.

FMA Work Comp Lobbyist for 2004 Legislative Session:  In late November, President of FAOEM, Dr Jeanne McGregor, sent out a communication to all members, asking for contributions to the FMA's Contract Lobbyist Fund.  FAOEM's Executive Committee voted to fund this lobbyist again this year, through individual contributions.  Last year, FAOEM contributed over $2000.00 to this effort, and we have pledged $2000.00 again.  Hopefully, most of you were waiting until after the first of the year to make this contribution.  Please mail your check, written to "FMA Contract Lobbyist Fund" to Lorry Davis at the address below.  On the memo section of your check write "FAOEM:  work comp."  Suggested contribution:  $100.00.  Thanks go to Dr Victor Krestow, to date our sole contributor.            

Division of Workers' Compensation Asks for Physician Input:  On the
appropriateness of continuing to use a "workers' compensation unique code" 97752 (Muscle testing, manual or by automated equipment with written report) in addition to the valid CPT code series of 95831 - 95834 (muscle testing, manual, with report [with specified body area corresponding to each code]).  In particular, the Division would like to hear from a PMR.physician.  The Division has also made this inquiry to the AMA (about the rationale for the CPT change in 1995 in which they deleted a specific code for "muscle testing, electrical").  Please send your responses to Anna L Ohlson, RN Consultant, AHCA WC Medical Services Unit, ohlsona@fdhc.state.fl.us, ph 850 410 1093, fax 850 414 6912.    
 

FAOEM Broadcast November 24, 2003

FAOEM's Next Meeting, SOTAC 2003, Organized Medicine in FL, Workers' Compensation, FAOEM Member Awarded First Annual FL Choice Award, Job Opportunity Paid Ad, Editor

HAPPY THANKSGIVING!

FAOEM's Next Meeting:  In conjunction with AOHC, Spring, 2004.  Stay tuned for details.

SOTAC 2003:  Jeanne McGregor MD, Joan Watkins, DO, and Phyllis Gerber MD attended SOTAC and represented FL in the ACOEM House of Delegates.  Per Dr Watkins, there was not a quorum, therefore no business accomplished.  There was talk of merging with the American Academy of Preventive Medicine.

Organized Medicine in FL:  Are You Collecting Signatures?.for the constitutional amendment to limit attorneys' contingency fees?  Have you contributed to Citizens for a Fair Share, the group that is organizing this effort?  If not, call 800 762 0233 (FMA).  FAOEM has contributed $500.00, and thank our members, Homi Cooper MD - $1000, Terence McCoy MD - $1000, and Patrick Hutton MD - $1000  for contributing to this cause.

Workers' Compensation:  Michael Webb MD is Chairing the FMA's Advisory Committee to the Three Member Panel.  Congratulations to Dr Webb who is now also the Chair of the FMA's Medical Economics Committee - where work comp issues are heard.  Jeanne McGregor, MD, FAOEM President, has replaced Homi Cooper MD, Immediate Past President, on the FMA Committee.  Per Fred Whitson, Atty, the FMA Director of Medical Economics, and the FMA staff person assigned to the Advisory Committee, "The majority of the 2003 legislative changes to Florida Workers' Compensation Law, Chapter 440, Florida Statutes, went into effect Oct. 1, 2003. Since significant revisions were made last session, with some not effective until Jan. 1, 2004, the legislature will probably only address "glitches or problems" in the workers' comp law during the 2004 Session. As physicians using this law, we need your assistance in identifying the specific areas that either are incorrect or are creating more problems than they resolve. Please email any comments to Fred Whitson, at fwhitson@medone.org."  Please cc Dr McGregor (pewterpalace@juno.com) and Lorry Davis (lorry4@earthlink.net) with any communications to Whitson re work comp.

Also per Whitson, "legal advised that the 2003 Health Care Provider Reimbursement Manual will be official adopted 12/4/03."  The manual is now on the Division of Work Comp's website at this address: http://www.fldfs.com/WC/pdf/2003HCPRM.pdf.  It is 135 pages long.

Congratulations to Dan Gerstenblitt  MD, FAOEM Member, and one of five physicians awarded at the First Annual Florida Choice Awards for Workers' Compensation, during the annual work comp conference in Orlando.

Job Opportunity Paid Advertisement:

        Lead Occupational Medicine Physician
                        Discover Florida's best kept secret..North Central Florida
                        Low Cost of Living.High Quality of Life !

        The successful candidate will provide professional and clinical leadership to a fully comprehensive Occupational Medicine / Urgent Care clinic and will evaluate and treat in an expeditious manner all patients who present to the facility and will address disability management and administrative issues related to work injury cases.  Additionally this individual will provide supervision and mentoring to clinical staff and provide input to management regarding clinical issues.

Ideally, this successful candidate will possess the following qualifications:
-       Board certified in Occupational & Environmental Medicine or Emergency Medicine
-       Experience in Urgent care and Worker's compensation injury treatment and disability management
-       Experience in Industrial Medicine treatment, preventative care, post-offer/pre-employment testing, work-site ergonomic assessments and patient evaluation procedures
-       Excellent interpersonal skills
-       Possess the knowledge and demonstrate an understanding to consumer (patient-company-carrier) satisfaction
-       Collaborative approach to decision making
-       Computer capabilities
Lucrative equity sharing arrangement, attractive salary, comprehensive benefits package and relocation assistance

CONTACT:                If interested please forward CV/resume in confidence to:
                        Andrew Morris, VPHR
                        All In One.Compcare
                        Email resume: amorris8@mindspring.com
                        Fax resume: 352-382-0212      
                      

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, lorry4@earthlink.net 

FAOEM Broadcast August 6, 2003

Contents:
1. FAOEM's Next Meeting
2.  News from Organized Medicine - Tort Reform
3.      New FAOEM Contact Info!

FAOEM'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center, Crystal Ballrooms E and F.  We will again meet with the FL Society of Physical Medicine and Rehabilitation.  Many thanks to Allergan who is sponsoring this meeting.  Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above.   So far, we've heard from Drs Gary Newcomer, Jim McCluskey, Jock Sneddon, Richard Dolsey, Bud Ferguson, Michael Band, Thomas Dukowitz, Michael Hankins, Bhupendra Gupta, Stan Haimes, Seth Feldman, Gary Clonts, Jenne McGregor, and Homi Cooper.  Fred Whitson from the FMA will be joining us as will Diane McCluskey, MPH, Director of USFs ERC Center, and Bob Griffin, Director of PrimeComp Network out of Jacksonville.  Let's hear from the rest of you!
Minutes from our May meeting are attached.

NEWS from ORGANIZED MEDICINE:  Re Tort Reform, Dr Eli Lerner, Chair of the FMA's Specialty Section, urges all oc med docs to join with their county medical societies in picketing Senators who are not supportive of the $250,000 cap.  The pickets will be on Monday, Aug 11, 11:30 am - 1:30 pm.  Contact your own county society to get details.  Dr Homi Cooper, FAOEM President, will be participating with his county society and urges all FAOEM to do the same with theirs.

NEW FAOEM CONTACT INFO!  FAOEM, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net

FAOEM Broadcast July 21 2003

Contents:
1.  New FAOEM Contact Info!
2.  FAOEM's Next Meeting
3.  News from Organized Medicine - Tort Reform, Work Comp
4.  Editor

NEW FAOEM CONTACT INFO!  FAOEM, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net

FAOEM'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center.  We will again meet with the FL Society of Physical Medicine and Rehabilitation.  Many thanks to Allergan who is sponsoring this meeting.  Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above.   So far, we've heard from Drs Gary Newcomer, Jim McCluskey, Jock Sneddon, Richard Dolsey.  Fred Whitson from the FMA will be joining us as will Diane McCluskey, MPH, Director of USFs ERC Center.  Let's hear from the rest of you!
FAOEM members who will be presenters at the comp conference:  Dr James McCluskey will present "Agents of Bioterrorism," 11:15 am - 12:15 pm, Tues, Aug. 19; Dr Oregon Hunter will moderate a panel on FCEs, Mon, Aug 18, 1:30 - 3 pm, and he will speak on "A Little Medical Knowledge is NOT a Dangerous Thing!" Wed, Aug 20, 8:45 - 9:45 am; Dr Stuart Brooks will present "Health Effects of Molds in the Indoor Environment," Tues, 9 - 10 am.  Are there more of you?

NEWS from ORGANIZED MEDICINE:  Thank you to Kathleen Jenkins MD who took time to go to the capitol and talk to legislators re tort reform during their last special session.  As most of you are aware, there is yet another special session scheduled to address tort reform.
On July 15, Gov Bush signed Senate Bill 50A enacting major workers compensation reform.  Per Fred Whitson of the FMA, Dan Sumner, Deputy Division of Workers Compensation Director, stated that a new FL Work Comp Health Provider Reimbursement Manual must be developed.  Sumner assured Whitson that by Jan 1, 2004, the changes required by SB 50A will be incorporated into the Manual.  In response to a physician's concern about portions of the new law, particularly the "threat of fines" for not adhering to practice parameters, Atty Whitson provided this information:
Two of the difficult issues that will be addressed over the next several months, by the Division of WC and AHCA, will be, (1) development of a reimbursement fee schedule that includes SB 50A (referenced above) and (2) the use of practice parameters.   

New section 440.13(15) says:    PRACTICE PARAMETERS.-The practice parameters and protocols mandated under this chapter shall be the practice parameters and protocols adopted by the United States Agency for Healthcare Research and Quality in effect on January 1, 2003.

The fact is that the USAHR&Q does not adopt practice parameters, they screen guidelines, etc.  and if they pass scrutiny, make them available on a web site.  The language in the statute was a last minute compromise of three different inputs and ended up being incorrect.  Both the Division of WC and AHCA are aware of the problem and are having internal discussions on the issue.  I guarantee you that many meetings will occur before final decisions are made. Until then, there are no practice parameters to follow. 

Re the "threat of fines"  for not adhering to practice parameters.  The language in section 440.13(8) is (new language in bold): 

(8)     PATTERN OR PRACTICE OF OVERUTILIZATION.-
(a)     Carriers must report to the agency all instances of overutilization including, but not limited to, all instances in which the carrier disallows or adjusts payment or a determination has been made that the provided or recommended treatment is in excess of the practice parameters and protocols of treatment established in this chapter. The agency shall determine whether a pattern or practice of overutilization exists.
(b)     If the agency determines that a health care provider has engaged in a pattern or practice of overutilization or a violation of this chapter or rules adopted by the agency, including a pattern or practice of providing treatment in excess of the practice parameters or protocols of treatment, it may impose one or more of the following penalties:
1.      An order of the agency barring the provider from payment under this chapter;
2.      Deauthorization of care under review;
3.      Denial of payment for care rendered in the future;
4.      Decertification of a health care provider certified as an expert medical advisor under subsection (9) or of a rehabilitation provider certified under s. 440.49;
5.      An administrative fine assessed by the agency in an amount not to exceed $5,000 per instance of overutilization or violation; and
6.      Notification of and review by the appropriate licensing authority pursuant to s. 440.106(3).

As you can see, the agency (AHCA) has always had the ability to impose a fine for overutilization, what is new is that practice parameters can now be used to assist in that proof.  Also note that the agency must prove a "pattern of practice" before any penalty can be assessed.  A pattern of practice proof requires a significant, reliable sample size.

Re justification needed to contractually go above the fee schedule.  This issue is addressed in four different paragraphs, sections 440.12(a) and (d), and  440.14(a) and (b) [underlining by me]:  

(12)    CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM REIMBURSEMENT ALLOWANCES.-
(a)     .. Annually, the three-member panel shall adopt schedules of maximum reimbursement allowances for physicians, hospital inpatient care, hospital outpatient care, ambulatory surgical centers, work-hardening programs, and pain programs. An individual physician, hospital, ambulatory surgical center, pain program, or work-hardening program shall be reimbursed either the agreed-upon contract price or the maximum reimbursement allowance in the appropriate schedule.
       ..

 (d)    Reimbursement for all fees and other charges for such treatment, care, and attendance, including treatment, care, and attendance provided by any hospital or other health care provider, ambulatory surgical center, work-hardening program, or pain program, must not exceed the amounts provided by the uniform schedule of maximum reimbursement allowances as determined by the panel or as otherwise provided in this section. This subsection also applies to independent medical examinations performed by health care providers under this chapter.                  ..

(14)    PAYMENT OF MEDICAL FEES.-
(a)     .. Payment to health care providers or physicians shall be subject to the medical fee schedule and applicable practice parameters and protocols, regardless of whether the health care provider or claimant is asserting that the payment should be made.
(b)     Fees charged for remedial treatment, care, and attendance, except for independent medical examinations and consensus independent medical examinations, may not exceed the applicable fee schedules adopted under this chapter and department rule. Notwithstanding any other provision in this chapter, if a physician or health care provider specifically agrees in writing to follow identified procedures aimed at providing quality medical care to injured workers at reasonable costs, deviations from established fee schedules shall be permitted. Written agreements warranting deviations may include, but are not limited to, the timely scheduling of appointments for injured workers, participating in return-to-work programs with injured workers' employers, expediting the reporting of treatments provided to injured workers, and agreeing to continuing education, utilization review, quality assurance, precertification, and case management systems that are designed to provide needed treatment for injured workers.

This incomplete list gives you some idea of language you can put in your contracts/agreements to justify getting more than the reimbursement fee schedule amounts.

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Email:  Lorry4@earthlink.net

FAOEM Broadcast July 3 2003

Contents:
1.  New FAOEM Contact Info!
2.  FAOEM's Next Meeting
3.  News from Organized Medicine - Physicians Called Back to Capitol for Special Session
4.  Written Prescription Law Change
5.  Work Comp Law Change
6.  Editor

NEW FAOEM CONTACT INFO!  FAOEM, Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Fax 904 246 9233, Email:  Lorry4@earthlink.net 

FAOEM'S NEXT MEETING: Tuesday, August 19, 2003, 12 - 3 pm, in conjunction with the annual FL Workers' Compensation Educational Conference, Orlando World Marriott Center.  We will again meet with the FL Society of Physical Medicine and Rehabilitation.  Many thanks to Allergan who is sponsoring this meeting.  Please RSVP to Lorry Davis for the luncheon meeting.  Contact information above. 

NEWS from ORGANIZED MEDICINE:  Attention All Physicians: Your Attendance is Required At The Capitol - SEIZE THE MOMENT!!! TAKE A STAND FOR YOUR PATIENTS!!! SPEND THREE DAYS WITH YOUR SENATE AND HOUSE MEMBERS!!! The time to act is now. The Florida Medical Association is continuing to drive toward reform. We need to stand shoulder to shoulder and make a presence at the next special session scheduled Wednesday, July 9 through July 15. We are committed to reform. We have cancelled the July board meeting to focus our efforts on this next special session. The Governor is also committed to seeking a resolution. He will continue to bring the legislators back until a comprehensive fix is achieved. Florida's health care is at stake! 

Check with your county medical society to see if they have transportation arranged for arrival on Wednesday morning the 9th, leaving Friday afternoon, the 11th. For your convenience, we have put together a list of local hotels with their proximity to the capitol. We have arranged for discounted rates at several of these hotels. We are awaiting word from the Capitol Police on the possibility of a "camp out" on the Capitol grounds for those wishing to do so. 

We will schedule speakers each day around noon on the steps of the Old Capitol. The Foundation will also have boxed lunches for sale each day. We encourage you to invite your House Representatives to dinner to thank them for their support.

Visit http://www.fmaonline.org/members/authorized/full_packet.pdf for hotel and restaurant information. 

Written Prescription Law Change:  On July 1, 2003, Senate Bill 2084 went into effect. The bill provides that all written prescriptions must be legibly printed or typed.  The new law also reiterates current law, stating that the prescription must contain:

1. the name of the prescribing practitioner;

2. the name and strength of the drug prescribed;

3. the quantity of the drug prescribed;

4. the directions for use of the drug;

5. the date of the prescription;

6. In addition the prescription must be signed by the prescribing practitioner on the day when issued.

The only major provisions of the law that are new are that now the quantity must be in both textual and numerical formats (100/one hundred) and the month must be written in textual letters (July 2 instead of 7/2).

Work Comp Law Change: The Governor has not signed this bill yet, but is expected to do so:  Changes pertinent to physicians:  

- Reimbursement fees.  Effective January 1, 2004, workers' compensation reimbursement fees for physicians licensed under chapters 458 or 459 are increased to a maximum of 110 percent of Medicare for non-surgical and 140 percent of Medicare for surgical procedures, or the current fee schedule, whichever is greater.  A system increase of 4.8 percent or $144 million will be going to physicians with 3.4 percent being offset by hospital cuts.  

- Ability to negotiate fees.  An individual physician shall be reimbursed either the agreed upon contract price or the maximum reimbursement allowance outlined above.

- Practice parameters.  The bill mandates the use of the practice parameters and protocols adopted by the United States Agency for Healthcare Research and Quality.  

- Independent Medical Examinations (IME).  The employer and employee are now entitled to only one IME per accident.  The IM Examiner may not provide the recommended, medically necessary follow-up care.  If the employee wins the dispute, the carrier will reimburse his/her costs.  If a managed care arrangement exists, the carrier will pay the costs of the IME if the physician used is in the provider network.  The parties may mutually agree to a "consensus IME," where the findings and conclusions shall be binding to both parties. 

- Maximum medical improvement (MMI).  The carrier must report the MMI date to the Department of Financial Services (Department) within 14 days after each MMI is determined, or at 98 weeks, after temporary disability benefits begin to accrue, if MMI has not been reached.

- Injury.  The injury must be based on objective relevant medical findings. 

- Mental injury.  Benefits for a compensable mental or nervous injury are limited to six months following the date of MMI of the injured employee's physical injury.

- Reports.  The Department will standardize physician reports to employers and carriers.

- Payments.  After January 1, 2004, the Department shall require that all medical bills properly submitted by the provider (and not denied by the carrier), be timely paid within 45 calendar days.

- Chiropractors.  The number of Chiropractic services allowed was changed from 18 within 8 weeks to 24 within 12 weeks.  Chiropractic and podiatric physicians can to be used as Medical Care Coordinators to manage care of same specialty physicians. 

The FMA has been trying to talk to AHCA re the practice parameters.  AHCA is unwilling to communicate until the Gov signs the bill into law.  The new law says FL's work comp system will be using the parameters and protocols adopted by the US Agency for Healthcare Research and Quality.  Fred Whitson, Atty with the FMA, spoke with AHRQ and they do not adopt parameters, rather they screen them and make them available on the web.  Common sense says that the law's intent would then mean that FL will follow parameters screened and made available by AHRQ, right?  We'll see....

Editor:  Lorry S. Davis, M.Ed., Executive Director, PO Box 330298, Atlantic Beach, FL  32233-0298, Phone 904 270 8886, Email:  Lorry4@earthlink.net

FAOEM Broadcast April 9 2003

Contents:

1.  FAOEM's Next Meeting

2.  Work Comp Reform Legislative Update

3.  Scope of Practice Expansion Legislative Update

4.  Editor 

FAOEM'S NEXT MEETING: Will be a dinner meeting, 6 - 9 pm, Wednesday May 7, 2003 in conjunction with AOHC, Atlanta Marriott Marquis, 265 Peachtree Center Ave, Madrid Room, Convention Level.  Spouses/significant others are invited.  Please RSVP to Lorry Davis, 352 372 9360 - ph, 352 373 8034 - fax, Lorry4@earthlink.net. 

RSVPs received so far:  Drs Thomas Dukowitz, Richard Johnson, Joan Watkins, Steve Taubkin/Mrs Taubkin, Homi Cooper/Mrs Cooper, Michael MacDonald, Gary Newcomer, Kathleen Jenkins/Guest, Kenneth Phillips, Karen Carlson, Harold Haase, and Jeanne McGregor.  Let us hear from you so we'll know how many dinners to order!

ORGANIZED MEDICINE:  WORK COMP REFORM:  On April 7, Dr Michael Webb and FAOEM Exec Dir Lorry Davis participated in a phone conference with the FMA's Advisory Committee to the Three Member Panel and Rep Dennis Ross, Chair of the House Select Committee on Workers' Comp.  Ross is a defense attorney well-schooled in comp.  He states FL has the highest medical expenses and the lowest paid doctors, and he is committed to raising physician reimbursements while still trying to bring overall costs down.  The Governor and Speaker of the House want to reduce work comp rates for employers.  Per Ross' report we are currently at 83% of Medicare for nonsurgical and 120% for surgical.  To get us to 125% nonsurgical, 150-200% surgical, Ross offers these incremental steps:  17%/yr increase nonsurgical, 5%/yr increase surgical, for 5 years.  He says the shift has to be revenue neutral. 

Ross supports maintaining physicians' ability to negotiate (above the fee schedule, in and out of managed care arrangements) as the "ultimate safety net."  Dr Webb, Chair of the FMA Committee, responded that even though quality physicians can negotiate, they are still not participating in the work comp system in Florida.

Dr Webb stated that testimony given during the Gov's Work Comp Commission revealed that FL's hospital profits in comp were 3 - 4 times the national average.  Ross acknowledged this by stating that although litigation was also a significant cost driver, hospitals accounted for over 60% of comp costs.  Ross stated that his tactic has been to continue negotiations with hospitals to "wean 'em off," as opposed to having them go "cold turkey" with diminishing profits.

Dr Troy Tippett, a neurosurgeon from the panhandle, inquired about proposed legislation to have a state run insurance program.  Ross said that the Governor does not want the state competing with private entities.

Dr Webb reminded us that the Gov's Work Comp Commission, to which Ross was present, determined that FL's comp system is broken.  Dr Webb asked if the budget neutral requirement could be bendable because the time to treat the system with bandaids is over, major reform is required.  Ross agreed that some movement needed to be made to see that employer rates go down.

Ross ended with stating that there will be an increase in physician reimbursement, although not the increase physicians want.  It won't be what will bring quality providers "back in droves."  The improvement will be piecemeal.  FL's work comp system is "very frustrating" for Ross.  It is an ongoing battle for him.  And he states he has an ongoing commitment, as long as he's in the legislature, to eventually completely fix the system, but it won't be this year.

On June 4, in Orlando, a one day seminar sponsored by the FL Work Comp Institute will be held to unveil and explain whatever work comp reform has been legislated.  You will be receiving a registration flyer in the mail.

Scope of Practice:  The FMA is working diligently in OPPOSITION to:

ARNP's, HB 341 Rep Carole Green, SB 1736 Sen Gwen Margolia

PA's, HB 1311 Rep Dennis Baxley, SB 2022 Sen Charlie Clary

Optometrists, HB 699 Rep Joe Pickens, SB 1714 Sen Dennis

Pharmacy/Immunizations, HB 1519 Rep Phillip Brutus

Naturopaths, HB 1615 Rep Carole Green, SB 2014 Sen Skip Campbell

Psychologists, HB 1583 Rep Phillip Brutus, SB 1820 Sen Gwen

Alternative Health Care, HB 1301 Rep Rene Garcia

SB 2738, Dept of Health Bill, provides in Section 34 that Chiropractors and Podiatrists shall be paid the same as a physician for any given procedure.  Please contact your Senators in opposition to this Bill.

Editor:  Lorry S. Davis, M.Ed., Executive Director, 7008 SW 30th Way, Gainesville, FL  32608, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net 

FAOEM Broadcast March 20, 2003

Contents:

1. FAOEM's Next Meeting

2. Tort Reform

3. Work Comp Reform

4. PIP Reform

5. Scope of Practice Bills

6. Editor

FAOEM'S NEXT MEETING: Will be a dinner meeting, 6 - 9 pm, Wednesday May 7, 2003 in conjunction with AOHC, Atlanta Marriott Marquis, 265 Peachtree Center Ave, Madrid Room, Convention Level. Spouses/significant others are invited. Please RSVP to Lorry Davis, 352 372 9360 - ph, 352 373 8034 - fax, Lorry4@earthlink.net.

RSVPs received so far: Drs Thomas Dukowitz, Richard Johnson, Joan Watkins, Steve Taubkin/Mrs Taubkin, Homi Cooper/Mrs Cooper, Michael MacDonald, Gary Newcomer, Kathleen Jenkins/Guest. Let us hear from you so we'll know how many dinners to order!

ORGANIZED MEDICINE:

Tort Reform: On Wed, Mar 12, the House Health Care Committee heard PCB 03-03. The Committee voted 15-6 in favor of the bill that contains a cap of $250,000. (Thank Reps Benson, Bilirakis, Farkas, Rene Garcia, Green, Harrell, Homan, Mayfield, Murzin, Negron, Poppell, Prieguez, Robaina, Sansom and Sobel.)The bill as capped is $250,000 per defendant, but the amendment by Rep Homan changed it to $250,000 per incident, which is what the FMA has been seeking. The FMA is drafting amendments and lobbying further changes. Please contact your State Rep and ask them to support the amendment deleting the wrongful death language, support the amendment adding subsequent treater/expert witness to the bill, support the amendment deleting the language which changes the makeup of the Board of Medicine, vote no on any amendment changing the cap, vote no on any amendment on mandatory insurance

Frank Farkas, St Petersburg: farkas.frank@myfloridahouse.com, 850 488 5719

Edward Homan, Tampa: homan.ed@myfloridahouse.com, 850 488 3087

Anna Benson, Pensacola: benson.holly@myfloridahouse.com, 850 488 0895

Gus Bilirakis, Palm Harbor: bilirakis.gus@myfloridahouse.com, 850 488 5580

Rene Garcia, Hialeah: garcia.rene@myfloridahouse.com, 850 487 2197

Carole Green, Ft Myers: green.carole@myfloridahouse.com, 850 488 2047

Gayle Harrell, Pt St Lucie: harrell.gayle@myfloridahouse.com, 850 488 8749

Stan Mayfield, Vero Beach: mayfield.stan@myfloridahouse.com, 850 488 0952

Dave Murzin, Pensacola: murzin.dave@myfloridahouse.com, 850 488 8278

Joe Negron, Stuart: Negron.joe@myfloridahouse.com, 850 488 8832

Ralph Poppell, Titusville: poppell.ralph@myfloridahouse.com, 850 488 3006

Manuel Prieguez, Miami: prieguez.manuel@myfloridahouse.com, 850 488 4202

Julio Robaina, Miami: robaina.julio@myfloridahouse.com, 850 488 6506

Ray Sansom, Ft Walton Beach: sansom.ray@myfloridahouse.com, 850 488 1170

Eleanor Sobel, Hollywood: sobel.eleanor@myfloridahouse.com, 850 488 0465

Work Comp: Dr Michael Webb, Chair, and Lorry Davis continue to participate in phone conferences with the FMA's Advisory Committee to the Three Member Panel. There are numerous work comp bills being filed. The FMA's work comp lobbyist, which FAOEM helped fund, Hayden Dempsey, was formerly on staff with the Governor's Office and then served on the Governor's Work Comp Reform Committee. He states the Governor wants reform.

Dennis Ross, R-Lakeland, Chair of the House Select Committee on Workers' Comp says that this Committee will issue a report with recommendations, not a bill. Rep Ross is drafting a bill that he will sponsor that will go to the House Insurance Committee as a PCB and is expected to pass through that Committee as early as next week. Dr Webb testified before this Committee this week. Ross' bill is expected to call for the establishment of practice parameters, overutilization measures, and is expected to contain some of FairCare's principles. Sen Clary, the Senate's designated work comp person, has filed SB 1946 and this is expected to be the companion bill to Rep Ross'.

Dr Webb's Committee is working ardently with lobbyists Dempsey and FMA's Fred Whitson to monitor all the work comp bills filed and respond immediately with amendments where needed. It is felt that 150% - 200% of Medicare for the fee schedule is not likely to fly because at this point, NCCI states that this would increase total expenditure by 12%. NCCI will be asked to run the numbers for 150% across the board, or perhaps 130% - 180%. The Governor wants the reform to be budget neutral. Dr Webb's committee agreed that the absolute bottom line would be to retain the right to negotiate.

On June 4, in Orlando, a one day seminar sponsored by the FL Work Comp Institute will be held to unveil and explain whatever work comp reform has been legislated. You will be receiving a registration flyer in the mail.

PIP: Please contact members of the House insurance Committee and tell them to defeat the amendment pertaining to the fee schedule, tying it to Medicare, PCB 03-HIN-01. Regarding the one way attorney fee, Jeff Scott of the FMA said this is "what guarantees that you will get paid, and not suffer the same nickel and dime antics that HMOs engage in. If a PIP insurer does not pay your bill, you can sue and if you win, recover all of your attorney fees. If you lose, you simply pay costs (not including attorney fees). Thus if you submit a bill for $100 that the insurer cuts to $80, you can sue to recover the $20 because you will get all of your expenses back. In the HMO context, if they cut your bill by $20, you are stuck because if you sue and win, the attorneys' fees you will pay will exceed the $20 you obtain. For names and email addresses of this Committee, contact Lorry Davis.

Scope of Practice: The FMA is working diligently to prevent passage of:

ARNP's, HB 342 Rep Carole Green, SB 1736 Sen Gwen Margolia

PA's, HB 1311 Rep Dennis Baxley, SB 2022 Sen Charlie Clary

Optometrists, HB 699 Rep Joe Pickens, SB 1714 Sen Dennis Jones

Pharmacy/Immunizations, HB 1519 Rep Phillip Brutus, no Senate Bill yet

Naturopaths, HB 1615 Rep Carole Green, SB 2014 Sen Skip Campbell

Psychologists, HB 1583 Rep Phillip Brutus, SB 1820 Sen Gwen Margolis

Alternative Health Care, HB 1301 Rep Rene Garcia, no Senate Bill yet

Editor: Lorry S. Davis, M.Ed., Executive Director, 7008 SW 30th Way, Gainesville, FL 32608, Ph 352 372 9360, Fax 352 373 8034, Email: Lorry4@earthlink.net

FAOEM Broadcast Feb 28 2003

Table of Contents:  FAOEM's Next Meeting, Tort Reform & Rally, Work Comp Reform, Days at the Capitol, Doctor of the Day, FAOEM Member Appointed to FL Board of Medicine, Nurses Should Not Be Authorized to Prescribe Controlled Substances, Editor

FAOEM'S NEXT MEETING: Will be a dinner meeting, 6 - 9 pm, Wednesday May 7, in conjunction with AOHC, Atlanta, 2003.  Spouses/significant others are invited.  Please RSVP to Lorry Davis, 352 372 9360 - ph, 352 373 8034 - fax, Lorry4@earthlink.net

ORGANIZED MEDICINE:
Tort Reform:  Dr Homi Cooper, President, has been asked by Dr Robert Cline, President of the FMA, to ask FAOEM members to contribute $100.00 each to People for a Better Florida.  Checks should be mailed to Lorry Davis, 7008 SW 30th Way, Gainesville FL  32608, and she will forward them on to the appropriate person. 

Days at the Capitol March 27's Tort Reform Rally at the Capitol, 2 pm, front steps of the Old Capitol Building in Tallahassee.  Dr Cooper and FAOEM Executive Director Davis will participate.  Dr Cooper urges as many oc med docs as possible to give up a day in clinic, not only to march for tort reform for your own practice, but for the future of the next generation of physicians.  If you are interested in participating, and have not been receiving information from the FMA about this, please contact Lorry Davis, contact information above.

Days at the Capitol also consists of organized legislative visits.  If anyone else wants to participate, let us know.  You are urged to contact your Florida legislators now regarding tort reform.  If you don't know who your legislator is, click on http://capwiz.com/law/officials/state/&state=FL&lvl+L.  The FMA needs to know when you make these contacts, if you have a good relationship with a legislator, and what your legislators are saying to you.  You can call Sarah Jennings at 800 762 0233, or email her at sjennings@medone.org.  

Work Comp Reform:  FAOEM pledged $2000.00 to the FMA for its work comp reform lobbyist effort.  We are almost there!  If just 25 more of you would contribute $40.00 each, it would make up the difference!  Please write a check to the FMA, notate on it "FAOEM comp lobby" and mail it to me:  Lorry Davis, FAOEM Exec Dir, 7008 SW 30 Way, Gainesville, FL  32608. Thank you to the following FAOEM members who have contributed to date:  Drs Homi Cooper, Gary Newcomer, Michael MacDonald, Stephen MacDonald, Richard Dolsey, Michael Webb, Marlene Lambiaso, Victor Krestow, Thomas Richards, Howard Eskildsen, Emmett Ferguson, Eve Hanna, James McCluskey, Jeffrey Williams, Timothy McCormick, Jorge Trujillo, Kathleen Jenkins, Eniola Owi, Howard Weiner, and Jeanne McGregor.

Dr Webb is the Chair of the FMA's Advisory Committee to the Three Member Panel, and he and FAOEM Executive Director Davis have been participating in this committee's teleconferences.  Dr Webb continues to work very intensely with the FMA on this issue.

FAOEM Member Appointed to Florida's Board of Medicine:  Congratulations to Dr Terence McCoy, Tallahassee, also former President of the FMA.

Scope of Practice:  Communicate with your legislators about HB 341, by Rep Green, and SB 548, by Sen Margolis, Nurses Should Not Be Authorized to Prescribe Controlled Substances.

The FMA is again calling for Doctors of the Day for the 2003 FL Legislative Session.  If you are willing to spend a day in Tallahassee during the Session, March 4 - May 2, providing health care for members of the legislature and its employees, improving and strengthening physician-legislator relations, contact Michell Jacquis at the FMA, mjacquis@medone.org, or call her at 800 762 0233.

Editor:  Lorry S. Davis, M.Ed., Executive Director, 7008 SW 30th Way, Gainesville, FL  32608, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FAOEM Broadcast, January 30, 2003 

FAOEM'S NEXT MEETING: Will be in conjunction with AOHC, Atlanta, 2003……stay tuned 

Tort Reform:  Dr Homi Cooper, President, represented FAOEM at the FMA’s January Council Days in Orlando, attending both the Board of Governors meeting as well as the Specialty Society Section.  Primary agenda item was the Days at the Capitol March 27’s Tort Reform Rally at the Capitol, 2 pm, front steps of the Old Capitol Building in Tallahassee.  Dr Cooper and FAOEM Executive Director Davis will participate.  Dr Cooper urges as many oc med docs as possible to give up a day in clinic, not only to march for tort reform for your own practice, but for the future of the next generation of physicians.  Many of us who watched the State of the Union address know that President Bush put tort reform and medical liability malpractice issues in his speech.  The public and political climate for this reform has never been better.  If you are interested in participating, and have not been receiving information from the FMA about this, please contact Lorry Davis, information at the end of this broadcast.

 Days at the Capitol also consists of organized legislative visits.  If anyone else wants to participate, let us know.  You are urged to contact your Florida legislators now regarding tort reform.  If you don’t know who your legislator is, click on http://capwiz.com/law/officials/state/&state=FL&lvl+L.  The FMA needs to know when you make these contacts, if you have a good relationship with a legislator, and what your legislators are saying to you.  You can call Sarah Jennings at 800 762 0233, or email her at sjennings@medone.org.  

 The FMA is again calling for Doctors of the Day for the 2003 FL Legislative Session.  If you are willing to spend a day in Tallahassee during the Session, March 4 – May 2, providing health care for members of the legislature and its employees, improving and strengthening physician-legislator relations, contact Michell Jacquis at the FMA, mjacquis@medone.org, or call her at 800 762 0233.

 FAOEM is a member of the Coalition to Heal Healthcare in Florida, an organization with a comprehensive plan to fix Florida’s broken medical liability system.  Log on to www.healFLhealthcare.org.

 Work Comp Reform:  FAOEM pledged $2000.00 to the FMA for its work comp reform lobbyist effort.  We are halfway there!  If just 25 more of you would contribute $40.00 each, it would make up the other half!  Please write a check to the FMA, notate on it “FAOEM comp lobby” and mail it to me:  Lorry Davis, FAOEM Exec Dir, 7008 SW 30 Way, Gainesville, FL  32608.  

FAOEM Broadcast January 30 2003, page 2 

Along with his contribution, Dr Michael Webb wrote, “…FAOEM consists of physician members who specialize in the primary care of the work-injured patient.  As a specialty organization, for many years we have sought reform for the Workers’ Compensation System that would improve the accessibility of quality healthcare for injured workers.  It is certainly hoped that major reform is accomplished in the 2003 Legislative Session which will benefit the patient first and foremost; and will make it feasible for physicians to treat these worthy patients in a fashion which is appropriate and mutually beneficial to the employer.” 

Dr Webb is the Chair of the FMA’s Advisory Committee to the Three Member Panel, and he and FAOEM Executive Director Davis have been participating in this committee’s teleconferences.  Dr Webb has been working very intensely with the FMA on this issue.

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Editor:  Lorry S. Davis, M.Ed., Executive Director, 7008 SW 30^th Way, Gainesville, FL  32608, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FAOEM Broadcast, December 20, 2002

Contents:  Next Meeting, Work Comp Reform, ACOEM MRO Fast Track Course, Editor

FAOEM'S NEXT MEETING: Will be in conjunction with AOHC, Atlanta, 2003......stay tuned

Work Comp Reform:  FAOEM is pledging $2000.00 to the FMA for its work comp reform lobbyist effort.  After you review the rest of this broadcast, please take the time to write a check to the FMA, notate on it "FAOEM comp lobby" and mail it to me:  Lorry Davis, FAOEM Exec Dir, 7008 SW 30 Way, Gainesville, FL  32608.

The FMA is using its resources this year to deal with tort reform, and it does seem likely that there will be some sort of reform this legislative session.  The Governor's Commission on Work Comp Reform will next meet in January and reportedly will begin drafting language for a bill.  Dr Michael Webb has been chairing the FMA's Advisory Committee to the Three Member Panel, and President Dr Homi Cooper has been serving on that committee as well.  FAOEM Exec Dir Lorry Davis attended the 3MP meeting Oct 28 in Tallahassee, where the 3MP approved the FairCare Plan.  This is the Fogels/Revel plan that we heard about at our last meeting.  The FMA's Advisory Committee's position supports some of the FairCare plan, for example better medical reimbursements, but not all of it.  The FMA has been vocal at the Gov's Commission meetings.  This Commission had a teleconference on Dec 18 with these pertinent outcomes  (information from Fred Whitson, FMA Atty): 

1. Re the medical delivery system:  Recommend that provider reimbursement fees be increased to be in line with other states, that authorization guarantees payment, standardization so fees paid are the same regardless of location/venue.  And the reduction in fees for hospital outpatient services and for free standing facilities. (The Commission voted unanimously to accept this position.)

2. Medical dispute resolution process:  Should expedite the dispute process and include the establishment of a claims operations unit tasked to triage the work comp disputes, with those determined to be medical and ripe being sent to an out-of-state peer review panel.  (The Commission voted 9 - 2 to accept this.)

3. Indemnity benefit:  Concept is to shift from an impairment model to a functional loss model.  Vote postponed until January meeting due to lack of data.

4. Attorney fees:  Discussion included attorneys must be part of the work comp system to aid aggrieved employees; hourly fees vs contingency model. (Discussion to continue at January meeting).

News from ACOEM:

ACOEM in Florida!
January 11-12, 2003 MRO Fast Track Course in Tampa Offers Last Chance to Meet DOT's January 31, 2003 Certification Deadline
Now is the time to register for this exceptional ACOEM educational offering in Tampa! The timing of this course provides an excellent opportunity for MROs who have not yet met federal requirements that MROs handling DOT drug testing be trained and certified by January 31, 2003.
Saturday & Sunday, January 11-12, 2003
Medical Review Officer (MRO) Fast Track Course
The MRO Fast Track course fully meets the DOT MRO Qualification Training requirements and is designed for physicians and other collection and health care professionals who are familiar with basic substance abuse testing procedures. Appropriate for experienced MROs who seek the required CME hours for initial certification or recertification opportunities.
For course and hotel details and a registration form, click here:
http://www.acoem.org/education/course.asp?EVENT_ID=336
To view ACOEM's entire 2003 course schedule (mark your calendar!), click here:
http://www.acoem.org/education/courses.asp
Tuition includes the course materials, a light continental breakfast, and beverage breaks - lunch on your own.
The course registration deadline is December 27, 2002, so take advantage of this outstanding educational offering and register today!
Please also note that the Medical Review Officer Certification Council (MROCC) will offer a certification exam on Sunday, January 12, from 2:00-5:00 pm at the course location. For exam information and registration, call the MROCC at 847-303-7210.

HAPPY HOLIDAYS!

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FAOEM Broadcast, October 21, 2002

FAOEM'S NEXT MEETING: Will be in conjunction with AOHC, Atlanta, 2003……stay tuned

 The “Revels/Fogel” Plan:  Work Comp Reform:  We heard Jerry Fogel talk about this plan at our meeting in August, and Claude Revels introduced himself to us.  According to the Sept issue of The Florida Workers’ Comp Reporter, “the Revels/Fogel plan would allow doctors to make medical decisions while leaving employers the right to address return-to-work issues.”  The plan is formally titled “A Principle-Based Integrated-System Model:  A Self-Executing System” and more about this will be included in the August meeting minutes, to be distributed in the near future.  This plan is also mentioned in the October issue of The Florida Workers’ Comp Reporter.  A story which appeared in the Ocala Star Banner, to which Dr Michael Webb, FAOEM, contributed can be found at http://www.starbanner.com/articles/business/796.shtml.

 Question from Dr Gary Newcomer, FAOEM VP, RE Collection of Drug Screen Specimens:  “All facilities that collect urine drug screen specimens must get a special training certification for all employees who do that procedure by Jan, 03.   It is a federal DOT requirement, but they don't tell you how to get that training.   I've only found a couple overpriced lab company offers

to provide training courses on video (about $1000 for our office).  Since this requirement affects all occ med clinics, I am curious how others have dealt with it…have others encountered

difficulty in obtaining drug screen collector certification as mandated by DOT with a 1/03 deadline.  And from whom did that certification come from?”  Please email your response to Dr Newcomer, GNGator@aol.com, and please cc Lorry Davis, Lorry4@earthlink.net.  Thanks!

 Comment from Dr Greg White, Past FAOEM President:  Sorry he missed our August meeting, he had an urgent conflict…regards to all…Mike Webb keep up the battle with W/C…please pass on to the members that one of the things they can do speaking as an MCC is to always assign sedentary or LD!!!…am amputee can be accommodated…It continues to amaze him how many docs STILL ASSIGN 000!  Dr White can be contacted at GRWHITEMD@aol.com.

 Governor Bush Creates Task Force to Address Healthcare Liability Insurance Crisis:  FL’s Dept of Health, Sec John Agwunobi MD MBA, will be responsible for providing logistical and staff support for the task force, which will consist of Chair John Hitt PhD, President, University of Central FL; Marshall Criser Jr, President Emeritus, UF; Richard Beard, Trustee, University of So FL; Donna Shalala, President of the University of Miami,; Fred Gainous, President FL A&M.  According to statistics from the Dept of Health & Human Services, insurance rates increased an average of 30% in the past 2 yrs with further increases expected.  The task force will submit its recommendations and/or proposed legislation by Jan 31, 2003; the task force shall continue in existence until no later than June 30, 2003.

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FAOEM Broadcast, August 12, 2002

 Last Chance to RSVP!

 FAOEM'S NEXT MEETING: Tues, Aug 20, 2002, 12 - 3 pm, Aruba & Bahamas rooms, w/ the FL Workers’ Compensation Educational Conference, Aug 18 – 21, Orlando World Center Marriott.  We will again meet with the FL Society of Physical Medicine & Rehabilitation, and after lunch, split into two groups. 

 RSVP to Lorry Davis, Exec Dir, 352 372 9360, fax 352 373 8034, Lorry4@earthlink.net, to make sure there is a lunch for you. 

 Thank you to Elan Pharmaceuticals for sponsoring this luncheon meeting. 

 Signed up so far:  Drs Eve Hanna, Mike Webb, Homi Cooper, Jairo Parada, John Muenz, Rob Dehgan, Matt Imfeld, Dave Haddock, Alan Doyle, Michael McDonald, Stephen McDonald, Jim ZeBranek, Richard Dolsey, Nick Potochny, Gary Newcomer, Richard Johnson, Mitch Freed, Mark Rubenstein, Venerando Batas, Greg White, Mark Rubenstein, Gary Clonts, Steven Field, Seth Feldman, Colleen Zittel, Jock Sneddon, Mike Hankins, Pedro Oliveros, Michael Band, Bob Fleigelman, Craig Lichtblau, Michelle Eaton, Toni Belisle, Joan Watkins, Phyllis Gerber, and Kathy Jenkins.  We know more of you plan to attend, so be sure to RSVP to Lorry, so you’ll have lunch!  RSVPs will be taken through noon on Thursday, Aug 15.  Final orders have to be given to the hotel at that point.

 Our hospitality suite will be # 20968, same as last year.  Last year, Dr Michael Webb had a mail label (standard Avery 5160 or other brand, same size) placed on the back of his business cards.  Great idea!  Please have someone in your office do the same for you.  It’s a great way to hand out your business card and invite someone to our suite at the same time.  The label should say “You and your associates are my guests at the FAOEM Hospitality Suite.  Beverages, snacks, relaxation.  East Tower.  Floor 9 Rm 20968.  Hours:  5 – 8, Sun – Tues (8/18 – 8/20)  See you there!”  Of course, the writing will need to be reduced so that it all fits on the mailing label.  Great idea!

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FAOEM Broadcast, July 30, 2002

FAOEM'S NEXT MEETING: Tues, Aug 20, 2002, 12 - 3 pm, Aruba & Bahamas rooms, w/ the FL Workers’ Compensation Educational Conference, Aug 18 – 21, Orlando World Center Marriott.  We will again meet with the FL Society of Physical Medicine & Rehabilitation, and after lunch, split into two groups.  RSVP to Lorry Davis, Exec Dir, 352 372 9360, fax 352 373 8034, Lorry4@earthlink.net, to make sure there is a lunch for you.  Thank you to Elan Pharmaceuticals for sponsoring this luncheon meeting.  Signed up so far:  Drs Eve Hanna, Mike Webb, Homi Cooper, Jairo Parada, John Muenz, Rob Dehgan, Matt Imfeld, Dave Haddock, Alan Doyle, Michael McDonald, Stephen McDonald, Jim ZeBranek, Richard Dolsey, Nick Potochny, Gary Newcomer, Richard Johnson, Mitch Freed, Mark Rubenstein, Venerando Batas, Greg White, Mark Rubenstein, Gary Clonts, Steven Field, Seth Feldman, Colleen Zittel, and Jock Sneddon.  We know more of you plan to attend, so be sure to RSVP to Lorry, so you’ll have lunch!

 Our hospitality suite will be # 20968, same as last year.  Last year, Dr Michael Webb had a mail label (standard Avery 5160 or other brand, same size) placed on the back of his business cards.  Great idea!  Please have someone in your office do the same for you.  It’s a great way to hand out your business card and invite someone to our suite at the same time.  The label should say “You and your associates are my guests at the FAOEM Hospitality Suite.  Beverages, snacks, relaxation.  East Tower.  Floor 9 Rm 20968.  Hours:  5 – 8, Sun – Tues (8/18 – 8/20)  See you there!”  Of course, the writing will need to be reduced so that it all fits on the mailing label.  Great idea!

 Congratulations to Dr Hal Haase:  now the Medical Director of Lockheed Martin Missles and Firecontrol in Orlando.

 News from Organized Medicine:  FMA President Frank Farmer, MD, met with President Bush and others recently in a discussion on liability reform and patient access, and he had the opportunity to cite the situation as it exists here in Florida.  The US Senate has introduced tort reform legislation, S 2793, companion bill to HR 4600.  This legislation places a $250,000 cap on non-economic damages and places a reasonable limit on punitive damages without preempting existing state law.  The FMA is urging FL Senators Nelson (202 224 5274) and Graham (202 224 3041) to co-sponsor S 2793.

 Upcoming fundraisers:  Aug 2, 7 pm, The Ocean Reef Club, Key Largo, for FL House Speaker-Designate Johnnie Byrd.  Info:  Sarah Jennings, 800 762 0233; Aug 20, 6 – 8 pm, home of Dr Alan and Caryl Mendelsohn, Hollywood, for FL Senators Ron Klein, Debbie Wasserman Schultz, Steve Geller.  Info:  954 962 0505; Aug 31, 11 am, The Wyndham Palace Resort, Lake Buena Vista, for FL Senate President-Designate Jim King.  Info:  Sarah Jennings, 800 762 0233.

 New Director for DWC: The FL Dept Of Ins has named Tanner Holloman as the new Director of the Division of Workers’ Compensation, and Dan Sumner as Assistant Director, effective 7/1.

 *******PAID ADVERTISEMENT**Looking for South Florida Oc Med Position:    

Dale Dacus, MD, 10 years experience in the field.  Please call me at 954 426 4821 or email me at dacus739@msn.com if looking to fill position. 

Editor:  Lorry S. Davis, M.Ed., Executive Director, Ph 352 372 9360, Fax 352 373 8034, Email:  Lorry4@earthlink.net

FCSO Medicare Provider Web Site: www.FloridaMedicare.com
WEB SITE UPDATES: Detailed information on the following can be found on the web site.

MARCH 8, 2002 CONVERSION TO MEDICARE'S MULTI-CARRIER SYSTEM (MCS)

• MCS Post Transition Issues <Revised 04-30-02>

> To assist providers who are experiencing issues related to MCS, First Coast Service Options, Inc. (FCSO) has developed this MCS Post Transition Issues communication, which will provide a status of the most commonly reported issues. This communication will be updated regularly as new information becomes available. Estimated completion dates (ECDs) are subject to change based on new issues and corresponding impacts. Please continue to check the web site for updates.

• MCS Post Transition FAQs <Revised 04-30-02>

• FCSO CONTINUES TO PERFORM MASS ADJUSTMENTS <Revised 04-30-02>

> FCSO continues to assess the volumes associated with issues inappropriately resulting in denials. As noted in the current MCS Post Conversion Issues Matrix, several mass adjustments have been completed and the next planned adjustments include the following:

PROCEDURE CODE(S): Procedure to diagnosis denials

Q0091 denied with diagnosis code V762
G0105 denied with diagnosis V160
76075 denied with diagnosis 7330 and 73301
84436 denied with diagnosis 24290
85013 denied with diagnosis 2859
93320 and 93325 when billed with diagnosis 78609

PROCEDURE CODE(S): Procedures denied in error as invalid procedure, denial message 160.

All 93XXX codes
G0121
36820

PROCEDURE CODE(S): 77333 and 77334 denied due to MAX SERVICES

PROCEDURE CODE(S): Services denied incorrectly by a specialty 48.

97001 and 97002
11001
93923 and 93925

PROCEDURE CODES(S): 65855 denied with message 839.

PROCEDURE CODE(S): 98940-98943 incorrectly denying for UPIN when billed by a Chiropractor.

PROCEDURE CODE(S): 68761 by specialty 41.

Note: Please see the MCS Post Transition Issues matrix for the specific dates. Mass adjustments may be subject to change. Please continue to check the web site for the most current information.

• FCSO TO PUBLISH SUMMARY OF MEETINGS WITH HEALTHCARE LEADERS

  > FCSO met with key healthcare leaders from throughout Florida on April 25th and 26th. In three separate sessions, FCSO met with the highest Medicare billers in Florida; members from various medical specialties, county medical societies, and consultants; physicians and other partners on the Carrier Advisory Committee (CAC). The purpose of the meetings was to provide information on FCSO’s performance after the conversion to the Multi-Carrier System (MCS), learn about issues not yet identified, and solicit input from healthcare leaders on how to improve service. FCSO plans to post a special summary of these sessions to the web site on Thursday, May 2, 2002.

CPT codes, descriptors and other data are copyright 2001 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

FACTS:  WORKERS’ COMPENSATION REIMBURSEMENT SCHEDULE

 Chair

Members William J. Bryant, DDS , Alan W. Christensen, MD , Michael Hankins, MD , David R. Johnson, MD , G. Grady McBride, MD , William Nevius, DC , Rigoberto Puente-Guzman, MD , Jerry A. Rubin, MD , Diane B. Tellier, DC , Brian D. Wolff, MD

  Division Representatives Reginald Watkins, Chief, BRMS , Cathyann Dufford, BRMS , Barbara M. Moody, BRMS , Nancy Rice, BRMS , Anna Ohlson, RN

Ø      Facts about Workers’ Compensation in Florida

• Litigation is the primary cost-driver of workers’ compensation costs in Florida, not medical treatment.
• The majority of litigated cases involve, directly or indirectly, issues related to access to patient or physician requested diagnostic evaluation, specialty consultation or treatment. 
• Physician reimbursement levels have not changed since 1997.
• Workers’ Compensation Managed Care Arrangements base most contracts on the reimbursement schedule but are not required to do so.
• It is the consensus of the Workers’ Compensation Oversight Board and the Physician Advisory Committee to the Division of Workers’ Compensation that Florida’s reimbursement schedule is inadequate and outdated.
• There is a distinct difference between workers’ compensation and non-workers’ compensation medical care.
• The National State Median Workers’ Compensation Fee Schedule is 150% of Medicare1
• The current Workers’ Compensation Fee Schedule is the lowest in the country.
• The average Workers’ Compensation premium rate is the 2^nd highest in the country

Ø      Concerns of Florida Physicians and the Florida Medical Association

• Patients have inadequate access to quality medical care due to low reimbursement levels and resulting inadequate physician participation.   
• Work injured patients have become a second-class citizen with regard to medical care.
• Physician groups have left and are leaving the workers’ compensation arena.
• There have been recent reports of occupational medicine clinics leaving the state due to the inadequate fee schedule.
• Specialists are unavailable to treat injured employees in many areas of the state.

Ø      Proposed Solutions:

• Physicians need a fair fee schedule reference to serve as a baseline for negotiations under Workers’ Compensation Managed Care Arrangement contracts and to serve as a fair reimbursement for treatment outside of WC managed care.
• Physicians recommend a Workers’ Compensation reimbursement schedule set at 150% of Medicare for non-surgical codes and 200% of Medicare for surgical codes.
• Legislation is needed to allow for:

1.         Adequate physician representation on the Three Member Panel.

2.         Mandatory meeting time frames to follow annual Medicare changes.

3.         An automatic increase to be applied reflecting the Consumer Price Index if Medicare changes are not implemented during a given calendar year. 

• This is simply the right thing to do.  Insurance carriers should expect, at least initially, an increase in total costs but anticipate long term savings through improved access to quality care and reduced litigation.

Ø      Facts about Workers’ Compensation in Florida

• Treatment provided outside a Workers’ Compensation Managed Care Arrangement must be reimbursed according to the Division’s schedule and guidelines.
• The Three Member Panel is authorized to establish reimbursement levels for Workers’ Compensation treatment, but they have not addressed this issue since 1996. 
• The 1996 Reimbursement Schedule decision, implemented in 1997, was based upon a budget-neutral approach; i.e., that total expenditures would not increase beyond what would be expected under the 1995 Fee Schedule.  The 1995 Fee Schedule had not reflected any increases since 1986 (which was based upon 1984 data).
• Workers’ Compensation Managed Care Arrangements base most contracts on the reimbursement schedule even though it is clear that the schedule is only required for non-managed care treatment.  (Because WCMCAs became optional in 1994 and mandatory 1/1/97, the vast majority of Workers’ Compensation care is provided through a Managed Care Arrangement)
• Contracts based on the reimbursement manual allow an additional level of appeal and review when a reimbursement request is denied by the WCMCA.  (Providing that the contract specifies that the reimbursement manual rules, in addition to the reimbursement manual fee schedule, will be adhered to).
• In 1996, the Three Member Panel approved an incremental implementation of reimbursements generally based on Medicare that would be completed in 2000.  However, the graduated steps required annual approval by the panel and have not been executed. 
• There is a distinct difference between workers’ compensation and non-workers’ compensation medical care.  Variables include physician and staff time, disability expertise and teamwork emphasizing return to work.  One occupational physician estimates that office visits by workers’ compensation patients results in an average loss of$17.00 per visit.  

Ø         Concerns of Florida Physicians and the Florida Medical Association

• Lack of treatment delays return to work and increases employee dissatisfaction.
• Carriers representing employers or large self-insured employers and physicians are the critical parties to contracts with WCMCA’s.  DWC, DOI and AHCA play supportive roles and should not be allowed veto power over or micromanagement of these relationships.

Ø         Proposed Solution

·         Physicians need a fair fee schedule reference to serve as a baseline for negotiations under WCMCA contracts and to serve as a fair reimbursement for treatment outside of WC managed care.  This will result in a “win-win-win” arrangement for injured workers, employer/carriers and physicians – with a reduction in litigation and total Workers’ Compensation costs.

·         Physicians throughout the State of Florida presented testimony to the Workers’ Compensation Oversight Board in June, 2000 as well as to the Three Member Panel October 18, 2000 regarding a Fair Reimbursement Schedule, referencing the different dimensions of Workers’ Compensation care, including medico-administrative activities and disability management and team efforts to return the patient to work.   Their recommendation was:  150% of Medicare for non-surgical codes and 200% of Medicare for surgical codes.  

• At the 11/29/00 meeting, the Three Member Panel should, at a minimum, implement the installment changes agreed upon in 1996, with the exception of eliminating any reduction in fees should result from that application of the formula.

Prepared by Linda Knopf, Consultant / former Assistant Director of Division of Workers’ Compensation and modified by Michael J. Webb, MD 11/20/00 

Tuesday, August 20, 2002, 12 – 3 pm
Aruba and Bahamas Rooms
Orlando World Center Marriott

 MINUTES 

Many thanks to Elan Pharmaceuticals for sponsoring this luncheon and to Dr David Hocker for presenting “How to Prevent Lost Time for your Occupational Medicine Clients with Skelaxin and Sonata

Present:  (in order of sign-in) Bob Chapa MD, Homi S Cooper MD, Jairo Parada MD, Michael Macdonald DO, Joan Watkins DO, Venerando Batas MD, Toni Belisle MD, Leon Behar MD, Seth Feldman DO, Stephen MacDonald DO, William J Bryant DDS, Michelle Eaton MD, Eve Hanna MD, Jolen Keller MD, Robert Dehgan MD, Guy N Crump MD, Mark Rubenstein MD, Tom Quinn DO, Rich Johnson MD, Nick Potochny DO, Alan Doyle DO, Colleen Zittel MD, Enrique Monasterio MD, Michael Hankins MD, Gary Clonts MD, Stan Haimes MD, Erick Grana MD, Robert Fleigelman MD, Richard Dolsey MD, Mitchell Freed MD, David Haddock MD, Jock Sneddon MD, Victoria Rabe-Tagala MD, Kathleen Jenkins MD, Jeanne McGregor MD, Mike Band DO, Matt Imfeld MD.

 Presiding:  Homi Cooper MD, FAOEM President & Jairo Parada MD, FSPMR President

 Self-introductions all around. 

1. Update on What’s Happening with Work Comp Legislation –

1.  Michael Webb MD, FAOEM FMA Liaison, Co-Chair FMA Medical Economics Committee.  Please see the attached “Medical Service Features of 2002 Workers’ Compensation Legislation.”

2. Jerry Fogel, Study Director for mandated Three Member Panel Study (Health Care Provider Survey) – discussed comprehensive work comp reform for the 2003 legislative session that is supported by the Florida Medical Association.  Mr Fogel works on this project with Dr Webb and Claude Revels, an employer representative with JM Family Enterprises, who stepped into the meeting momentarily to introduce himself.  Dr Webb will keep us as informed as possible regarding this developing reform.  Please see the attached “The Expected Outcomes.” 

2. Review of FMA’s Board of Governors Summary of Major Actions, July 20 – 21, including 2003 Legislative Agenda (note work comp is a priority) – Dr Cooper, Enrique Monasterio MD, FSPMR Treasurer – please see attached “FMA Summary of Major Actions.”

3. Tort Reform – Mark Rubenstein MD, FSPMR, Treasurer Palm Beach Co Medical Society, discussed “Facts About the Medical Malpractice Claims Crisis in Florida,” (attached) and gave us a “Medical Malpractice Insurance Evaluation Checklist.” (attached).  Dr Rubenstein suggests contacting Matthew Gracey, Malpractice Insurance Specialist, for guidance (Gracey-Danna Inc, 62 SE 6^th Ave, Delray Beach FL  33483, ph 561 276 3553, fax 276 6545, gracey@graceydanna.com).  Dr Rubenstein is well aware of the crisis, especially since he is from So FL and they have been the hardest hit.  He serves on the Tort Reform Committee for the Palm Beach Co Medical Society and several months ago flew with a contingent of over 100 to Tallahassee for a march on the capitol, and more recently participated with 400 other physicians and health care professionals who marched on the courthouse in West Palm Beach.

FAOEM and FSPMR then broke into separate groups.

Meeting of FAOEM members:

1. The minutes of the April 16, 2002, Chicago meeting were approved by Dr. Chapa and seconded by Dr. Joan Watkins as well as the attending members at 2:15 pm.
2. The treasury report was presented by Dr. S. MacDonald, Secretary/Treasurer and received by FAOEM.  Specific information on the Treasury Report can be obtained by members from Lorry S. Davis, Executive Director, PO Box 330298, Atlantic Beach FL  32233-0298, Ph 904 270 8886, Fax 904 246 9233, Lorry4@earthlink.net
3. Dr. Watkins discussed with the members that presently nurse practioners and physician assistants may become members of ACOEM and encouraged the present FAOEM members to attempt to encourage physician extenders to join the organization as a method to increase membership.  Dr. Cooper also encouraged all members present to recruit one additional member to the organization over the next year.
4. The current Residents in Occupational and Environmental Medicine at the University of South Florida discussed the status of their residency program.  Currently there are four Residents in Occupational and Environmental Medicine at USF.  Three Residents were in attendance at this meeting.
5. Dr. M. MacDonald, Director, presented the membership report.  Currently there are 193 members of FAOEM of which 128 are due payers and 65 are non-due payers.  Dr. Cooper and Lorry Davis have communicated to many of these members to encourage their participation. 
6. The ACOEM Report was presented.   
   1. Dr. McGregor discussed their activities at the AOHC Delegates

Meeting.  They stated that they had a worthwhile time while there and
encouraged other members to attend the next SOTAC meeting if
possible.

2. Dr. Cooper also discussed their activities as AOHC Delegates this

past year.  He encouraged the present members to attend the next
Florida Medical Association (FMA) meeting scheduled for August 29
through September 1, 2002.  He also encouraged the present members
to attend the next AOHC meeting scheduled for May 2 through May 9,
2003 in Atlanta, Georgia. 

7.    It was discussed that FAOEM is looking to obtain a new Webmaster to assist
with Dr. Oregon Hunters’ newsletter.  Anyone who could provide assistance was
encouraged to contact Lorry Davis.  It was discussed that maybe Lorry Davis’
husband could provide assistance with this or perhaps a pharmaceutical sponsor
could be obtained.  The possibility of making this a USF OEM Residency project
was also discussed.

8.    Dr. McGregor discussed the thirteen milestones that occurred over the past
one year regarding ACOEM.  She mentioned that JOEM now provides CME credits. 
She additionally discussed that she plans to attend the next SOTAC meeting in
Baltimore, Maryland and would present any issues that any members may have at
that time.

      9. Dr. Stan Haimes discussed with the present members the ability to assist with
the Federal Transportation Security Administration (TSA) and encouraged individuals
to contact him if they were interested.

10. Dr. Michael Webb, the FMA Liaison encouraged all members to become active
 in the FMA. 

      11. The meeting was adjourned at 3:10 p.m. 

Respectfully submitted,

Stephen H. MacDonald, DO, MPH, MBA, Secretary/Treasurer   

October 20, 2002      

faoem minutes aug 02

iii. Survey carriers to determine the estimated impact on carrier costs and Workers’ Compensation premium rates by implementing changes to the carrier reimbursement schedule or implementing alternative reimbursement methods.

 iv. Submit recommendations on or before January 1, 2003, and biennially thereafter, to the President of the Senate and the Speaker of the House of Representatives on methods to improve the Workers’ Compensation health care delivery system.

 v.  The division shall provide data to the panel, including but not limited to utilization trends in the Workers’ Compensation health care delivery system. The division shall provide the panel with an annual report regarding the resolution of medical reimbursement disputes and any actions pursuant to s.440.13(8)

 c.   PAYMENT OF MEDICAL FEES. -

 Fees charged for remedial treatment, care, and attendance, except for independent medical examinations, may not exceed the applicable fee schedules adopted under this chapter.

 d.  For any self-insured employer or carrier who elects to deliver the medical benefits required by this chapter through a method other than a Workers’ Compensation Managed Care Arrangement, the discontinuance of the use of the Workers’ Compensation Managed Care Arrangement shall be without regard to the date of the accident, notwithstanding any other provision of law or rule.

 2.  New Health Care Provider Fee for Service Reimbursement Manual, 2002 (Medical Fee Schedule) (effective July 8, 2002)    In Adobe Acrobat format, 1.2 mb. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.
 

Presented by Michael J. Webb, MD
Medical Director, U.S. HealthWorks - Ocala
Florida Workers’ Compensation Institute Conference
Wednesday 8/21/02

The Expected Outcomes
In Adobe Acrobat format. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.

Florida Medical Association, Inc.
Summary of Major Actions
Board of Governors
July 20-21, 2002
Westin Diplomat Resort  
Hollywood, Florida  

• Council on Ethical and Judicial Affairs

• ·         Approved that a charter be issued establishing the Franklin County Medical Society.

• ·         Reaffirmed and sunsetted FMA policies under the ten-year old review policy.

• ·         Recommend to House of Delegates that Gonzolo Huaman, M.D. and Charles Mutter, M.D. be reelected to the Council and the seat being vacated by Dr. Charles Eytel be submitted at a later date.

 Council on Legislation 

• Approved that the FMA seek legislation that will provide for a cause of action in prompt pay cases, the disclosure of fee schedules by managed care companies; and legislation prohibiting hold harmless clauses in contracts.
• Support legislation prohibiting retaliatory action against a provider.
• Support legislation creating a licensure category for “Anesthesiology Assistants” under the supervision of a licensed physician.
• Approved that the FMA proceed with passing a tort reform bill with some or all of the following provisions: issues relating to expert witness; subsequent treater, collateral sources, periodic payment, offer of judgment, medical review panels, bifurcation of trials, standard of proof, jury pool composition, control over settlements, joint and several liability, no mandatory insurance, and sliding scale for attorney contingency fees.
• Approved workers’ compensation as a legislative priority for 2002-03.
• Approved continued opposition for the following:

Oppose legislation allowing bare bones health insurance policies, but look toward insuring more patients and use of medical savings accounts.

Oppose licensure of hospital administrators.
Oppose scope of practice expansion issues for non-M.D.s and non-D.O.s.

• Approved reaffirmation or sunsetting of ten-year old policies, except the PMATF policy not be sunsetted.

Council on Medical Economics

• Approved recommending to the House of Delegates that Resolution 01-48, Hospital Self-Designation for Specialty Care, not be adopted.
• Approved recommending to the House of Delegates that Resolution 01-61, Medicaid Hospital Services Physicians’ Certification, be adopted.
• Reaffirmed and sunsetted FMA policies under the ten-year old policy.

Council on Medical Education and Science

• Recognized the need to review and update the FMA courses on HIV and AIDS and direct staff to explore available sources for development and funding of this project including coordination with resources in Florida and assist the CME Committee with course development.
• Approved recommending to the House of Delegates reaffirmation of ten-year old FMA policies.

Council on Public Health

• Approved that the FMA and the CMSs have a defined role in state, regional and local disaster     training, planning and funding; and are an integral part of the planning process with the Department of Health and the Florida Department of Law Enforcement.
• Approved that the FMA create an FMA Environment and Health Section under the Council on Public Health that advises the Board on issues of the natural environment as these issues may affect the public health.

Approved recommending to the House of Delegates that Resolution 01-10, Global Warming Response Plan, be adopted as amended.

• Approved that the FMA write a letter to the Department of Health (DOH) voicing support for the Community Environmental Health Advisory Board and encouraging the DOH to resume regular meetings of this Board.
• Approved supporting the concept of a nationwide health tracking network that monitors chronic diseases and environmental factors that may be related to them and that the FMA be an advocate for this network.
• Approved the creation of a Minority Health Care Section under the Council on Public Health for the FMA to take a lead role in addressing minority health care issues and public health care disparities in Florida.
• Approved recommending to the House of Delegates FMA policies to be reaffirmed or sunsetted.

Committee on Managed Care 

• Approved recommending to the House of Delegates that FMA policies be reaffirmed or sunsetted in accordance with FMA sunset policies.

Specialty Society Section

• Approved that the FMA give the Florida Academy of HIV Medicine initial recognition as a recognized specialty society of the FMA.

Medical Student Section Governing Council

• Approved amending the FMA Bylaws to increase the number of medical students in the FMA House of Delegates from three to four delegates and alternate delegates.
• Approved that the Medical Student Section Bylaws be amended reflecting changes in duties of its officers, to increase MSS delegates in the FMA House of Delegates and make editorial changes updating the bylaws.
• Approved that a new award category of “Advocate for Medical Students” be created and that the first recipient be awarded to Madelyn E. Butler, M.D.

Task Force on Tort Reform

• The Board received a comprehensive report from the Task Force on Tort Reform, chaired by Dr. Dennis Agliano. 

Task Force on Membership

• Approved changing the FMA Charter and Bylaws to allow direct membership in the FMA and to allow county medical societies and other association memberships independent of the FMA; and that this provision be reviewed in two years and modified as necessary.
• Approved that the delegates to the FMA House of Delegates be allocated proportionately by representative groups; that each physician member of the FMA shall be allowed to designate not more than two of the following representative groups to represent him/her in the FMA House of Delegates:  County medical societies, FMA recognized specialty societies and FMA recognized societies organized by physicians sharing and wishing to advance a common interest; and that the provision for representation in the House of Delegates be reviewed in two years and modified as necessary.

Committee on Bylaws

• The Board approved bylaws changes implementing the membership changes and representation in the House of Delegates; approved changing the bylaws to allow a seat on the Board for the FLAMPAC President, Chair of the Specialty Society Section, and the Chair of the Conference of Medical Society Executives; approved other changes and revisions to bylaws for recommendation to the House of Delegates.

Report of the Executive Committee

• Approved the sale of the FMA building at 100 E. College Avenue, relocate to the Adams Street building, relocate some staff outside downtown area, pay off existing loan and invest proceeds.
• Approved nominations for FMA Awards to be presented at the Annual Meeting.
• Support continued fund for a public relations campaign next year focusing on physicians’ issues.
• Support a statewide demonstration to publicize the issue of professional liability insurance.

Other Actions

·         Approved that the President and Executive Committee be authorized to appoint task forces and advisors to hire consultants as necessary for tort reform.

·         Approved sending RFPs for a public relations firm to focus on constitutional amendment activities in 2004 and report back with recommendations at the November Board meeting.

·         Approved $800 to Tim Bullard, M.D. to continue efforts on expert witness database.

·         Approved in-kind contributions from the FMA to the Citizens for Tort Reform

Facts About the Medical Malpractice Claims Crisis in Florida
Matt Gracey, Malpractice Insurance Specialist

ü     We are now in an unfolding malpractice insurance crisis because claims against doctors have skyrocketed.  Malpractice insurers did not collect enough premiums in the last five years to cover these claims and have either left Florida’s market or are severely restricting their underwriting requirements.  Only a handful of companies are still offering coverage in South Florida, whereas almost forty companies vied for the doctors’ coverage only three years ago.     

 ü     Between 1980-1999 there was a 995% increase in indemnity and legal expenses in Florida for paid medical malpractice cases.  That is a huge increase per year on average and is the real cause of the malpractice claims crisis.

 ü     The average legal expense in these cases in 1980 was $5,208.  In 1999 it went up to $39,747.

 ü     Many plaintiff attorneys say that the malpractice insurance crisis is just another insurance company problem.  They blame the high rates on 9/11 and insurance companies’ lowered investment returns with the downturn in the financial markets.  Both of these situations certainly have caused rates to increase by some percentage points, but are not the real cause of the tremendous increases in rates that we have seen.   

 ü     Nuisance Cases:  The above claims numbers are for paid cases only, and do not take into account the incredible expense, aggravation, loss of time, and stress caused by the majority of claims filed against doctors that are groundless and are stopped without any indemnity payments.    Nationally malpractice insurers close 70% of cases against doctors without any payment made.  The dominant company in Florida closed 82% of their cases in 2000 without payment. 

ü     74% of the total indemnity payments made in Florida in 1999 were for non-economic damages.  Many states, including California, have reformed their tort laws to place a cap on these non-economic damage awards.  In virtually every state that has done so, malpractice insurance claims and rates have stabilized. 

ü     If the insurance companies were making exorbitant profits we would have many offering coverage today in Florida.  In fact we have gone from 40+ companies offering malpractice insurance coverage in Florida three years ago to less than six viable companies today.  The second largest malpractice insurer in the country, St. Paul Company, recently announced that they lost almost $1 billion last year and that they will no longer be renewing the policies for 42,000 doctors nationwide.   

ü     Often we are seeing in article headlines now associated with anti-tort reform efforts that medical errors account for 98,000 deaths each year.  While obviously successful in generating massive amounts of media attention, the study that produced this number was very flawed.  The data was from a State of New York 1984 study and then was repeated using 1992 data from Colorado and Utah.  The 98,000 deaths was a number the study authors extrapolated from the 1984 controversial analysis of 180 actual deaths out of 30,000 acutely ill, hospitalized patients. In the 1992 data analysis, again very flawed data was extrapolated and 44,000 deaths from medical errors were reported.  Even the incredibly high spread between 44,000 and 98,000 should be a warning that the results are flawed but the headlines and plaintiff attorneys, of course, always use the 98,000 number.     

Know the facts behind the current malpractice crisis that is threatening the practices of many Florida doctors.  Unless we get meaningful tort reform the claims against doctors will continue to increase, and the malpractice insurance prices will follow.   

For more information on facts, figures, tort reform efforts, and information on malpractice insurance, contact: 

Matt Gracey
Malpractice Insurance Specialist
Gracey - Danna, Inc.

(800) 966-2120 / (561) 276-3553

Medical Malpractice Insurance Evaluation Checklist

 You are encouraged to use this checklist every year to ask important questions about your current policy and company or one that you might be considering.

q       What is the company's A.M. Best rating?  You should not settle for any insurer rated less than an “A-“ unless there are mitigating factors that make good business sense.

q       How long has the company insured physicians in your state?

q       What is the history of their rate charges in your state and elsewhere? Ask about the number of rate increases or decreases the carrier has had in the past several years.

q       Is a large concentration of the company's policyholders in a higher risk territory or specialty? If the carrier has a larger insured exposure in higher rated territories like Dade, Broward, and Palm Beach counties or in higher risk medical specialties it could cause claims to soar and the carrier could incur a larger loss impact. As a result of this exposure, the carrier could impose severe rate changes or worse, leave the state. This creates many concerns including policyholder non-renewals, lost vesting of tails, and could jeopardize the quality of defense for open claims.

q       What is the company's policyholder surplus?

q       What is the company's overall medical professional liability premium volume in your state?

q       Are the exclusions outlined and clearly defined?

q       Are the policy definitions clear and straightforward?

q       Does the information on the application become part of the insurance agreement?

q       What are the "tail" provisions upon termination of the policy? Does the "tail" coverage offer unlimited duration or is it limited to a certain number of years? What are the retirement requirements for "tail" coverage? The policy should have provisions for vested tails upon retirement, disability and death.

q       Is defense coverage offered outside or inside the limits of liability?  (It should always be outside.)

q       What is the claims coverage "trigger?" A "demand trigger" is so unfavorable that you should always insist on a trigger that recognizes an “incident report.”

If you accept a demand trigger (and you often aren't asked) the company will not defend any incidents you might report until the incident turns into a written demand or claim against you. This can cause serious problems when changing carriers. The new company, and your previous company, will exclude the incident from coverage because you had prior knowledge of and reported the incident to your previous insurer.

q       How is your corporation, professional association or other entity covered? Can you endorse the policy to properly cover a corporation for free on a shared limits basis or can you purchase separate, affordable corporate coverage?  Is vicarious liability coverage included in the separate corporate policy? (It should be.)  Even if you are a solo practitioner and have formed a closely held professional association, it should be named on the policy.  

q       How are your employees covered?  What about coverage for any skilled ancillary personnel like physician assistants or surgical assistants who are often excluded from coverage under the standard policy forms? 

q       Who are the company’s defense lawyers? Are they local attorneys and do they have experience in defending medical professionals?  If you are sued, will your case be handled by a senior member of the legal firm or assigned to a less experienced associate?  

q       Is legal defense coverage offered for investigations by the Agency for Healthcare Administration (AHCA)?  Are there different policy limits for this coverage?

q       Is coverage offered for defense of regulatory investigations of Medicare / Medicaid usage and billing practices? Are there different policy limits for this coverage?

q       Is the "Retroactive Date," sometimes called a prior-acts date, the same as your previous policy? Your retroactive date is critical. You should personally check the date on your policy each year. Remember that when switching companies, it is usually better to keep the same retroactive date with your new company rather than purchasing a "tail" and going onto a first year claims-made policy.

q       Is your policy effective date the same as your previous policy? (It must be the same to avoid gaps in retroactive coverage.)

Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Gracey - Danna, Inc.  He has created successful and stable malpractice insurance programs for numerous south Florida and statewide medical organizations, including the Palm Beach County Medical Society.  He continues to lecture and author educational material to help doctors understand their insurance issues.

Sheraton Chicago Hotel and Towers

Tuesday, April 16, 2002
Missouri Room, Level 2, 12 – 3 pm

Luncheon & Business Meeting

 MINUTES

 Presiding:  Homi Cooper, MD, President

 Present:  (in order of sign-in)  Homi S Cooper, MD, Steve Schumann, MD, Michael Rappa, DO, Stan Haimes, MD, EB (Bud) Ferguson, MD, John Darwood, MD, Stephen MacDonald, DO, MPH, Michael Macdonald, DO, MPH, Steven Taubkin, MD, Kathleen T Jenkins, MD, Jeanne M McGregor, MD, MPH, Dan Gerstenblitt, MD, Robert Fleigelman, MD, Yemi Owi, MD, Joan Watkins, DO, MPH, Michael Webb, MD, Kenneth G Phillips, MD, Karen Carlson, MD, Richard Johnson, MD, Steven Field, MD.

1. The minutes of the August 21, 2001, Orlando meeting were approved and seconded by the attending members at 12:15 pm

2. The treasury report was presented by Dr. S. MacDonald, Secretary/Treasurer and received by FAOEM.  Dr. MacDonald stated that currently there is $8,082.54 in the treasury.  He listed the additional anticipated expenses throughout the upcoming year, which total approximately $14,000.  With an anticipated payment from at least 33 additional FAOEM members, the predicted treasury total is $12,867.54 resulting in a shortfall of approximately $1,150.00.

3. Dr. M. MacDonald, Director, presented the membership report.  Currently there are 212 members of FAOEM of which 145 are dues payers and 67 are non-dues payers.  Dr. Cooper and Lorry Davis have communicated to many of these members to encourage their participation.  Currently there are 46 delinquent members.

4. The ACOEM Report was presented. 
   1. The state of the college was discussed by Bud Ferguson, MD, Past Treasurer, ACOEM, who discussed the current welfare of the college. 
   2. Drs Cooper and McGregor discussed their activities at the SOTAC Delegates

Meeting.  They stated that they had a worthwhile time while there and
encouraged other members to attend the next SOTAC meeting if possible.

FAOEM Minutes, April 16, 2002, page 2

3. Drs Cooper and McGregor also discussed their activities as AOHC Delegates this

past year.

5. The 2002 Legislative Report was presented by Michael Webb, MD, FMA Liaison, who

discussed the various bills that had been presented at the Florida Legislative Sessions
this past year.  He also discussed which bills had passed as well as those that had
failed to pass and why. 

Dr. Cooper encouraged the members to attend the Days at the Capitol as well as
serve as the Doctor of the Day at the Capitol, if available.  He felt that his
experiences there were worthwhile and that additional members would enjoy the
same experience. 

6. Steven Field, MD, Director, presented the University of South Florida ERC Report.  He
   also discussed The Florida Partnership for Safety and Health as well as upcoming
   programs and workshops through the USF ERC.

7. Dr. Joan Watkins, Immediate Past President, discussed the possibility of FAOEM
   providing  

a $500 donation to support the Duke List.  The members elected to provide this $500
donation if it is determined that there are sufficient funds in the treasury in the
future.

8. Other additional items of business were discussed including the decision to entertain
   the possibility of obtaining pre-printed FAOEM business cards stating an invitation for
   selected individuals to attend the Hospitality Suite at the next FWCI Conference in
   Orlando, Florida in August, 2002.  Lorry Davis, Executive Director, was unable to
   attend the meeting and all attending members wished her their support. 

9. The meeting was adjourned at 2:45 pm.

 Respectfully submitted,

 Stephen H. MacDonald, DO, MPH, Secretary/Treasurer    

April 16, 2002               

Legislative Regulatory Update article on "Fair Care"
(In Adobe Acrobat format. Click on hyperlink. If nothing happens or you know you do not have Acrobat, click here.)

TASK FORCE ON WORKERS’ COMPENSATION ADMINISTRATION

Recommendations and Answers to Questions Presented in the Enabling Legislation 4

Funding the Administration of the Workers’Compensation System and Operations of the Division of Workers’ Compensation 6

Eliminate Interest On Medical Bills and Jurisdiction of JCC to Hear Medical Bill Payment Disputes 17

Partial Dismissal of a Petition for Benefits 20  

Eliminate Docketing Orders 20  

Setting Definite dates for Mediation, Pretrial and Final Hearings 21  

Workers’ Compensation Oversight Board Judges of Compensation Claims 21

ENABLING LEGISLATION:

5. What cost savings could be achieved in the administration of the workers’ compensation system, including the operations of the Division of Workers’ Compensation.  

6. What organizational changes affecting the administration of the workers’ compensation system, if any, should be made to make it more efficient. To assist the Task Force in its work, the Executive Office of the Governor contracted for the completion of a budgetary and operational analysis of the Division of Workers’ Compensation, detailing the staffing of the division, receipt and expenditure of revenues, reliability of financial records and reports, and the efficiency of internal controls and procedures.

PRELIMINARY STATEMENT:

WORKING PHILOSOPHY OF TASK FORCE:

Recommendation: Continue to fund the administration of the workers’ compensation system, including the judges of compensation claims and the operation of the Division through an assessment on the premiums that employers pay for their workers’ compensation insurance. No funds should be allocated from general revenue. Try to decrease the assessment rate for carriers that are doing an excellent job providing accurate benefits in a timely fashion.

Recommendations: A complete audit of the Division’s operating budget and cash reserves should be conducted, with a view toward using cash reserves to lower the assessment rate, while still maintaining the fiscal soundness of the Division. In addition, eliminate the mechanism that requires the Division to use the Treasury to invest the Division’s cash reserves.

Recommendations : Staff at the Division need to be adequately equipped to carry out the core functions. There should also be a determination of whether certain functions of the Division should be outsourced. Several suggestions for outsourcing include the educational functions of the Division and functions such as the early dispute resolution, if a version of this is determined to be within the core functions of the Division. Another area for outsourcing appears to be the mediation function of the state mediators. The testimony presented to the Task Force was that private mediators have been more effective in resolving cases.

Recommendation: Transfer the Division’s Bureaus to the Department of Insurance (DOI), with the exception of the judges of compensation claims, which should be transferred to the Division of Administrative Hearings under the Department of Management Services. Prior to a transfer, a determination should be made of whether certain functions of the division might better be outsourced. With regards to the self-insurance section, the non-regulatory functions should be transferred to Florida Self-Insurance Guaranty Association (FSIGA) and the regulatory functions to the Department of Revenue.

Recommendations : This bureau should develop and implement dynamic field and paper audits that are triggered by complaints or by prior untimely claim handling practices. When identified, the Division should aggressively impose appropriate penalties to discourage untimely claims handling. Stronger compliance and monitoring enforcement is essential.

BUREAU OF OPERATIONS SUPPORT:

Recommendation: The bureau would continue administer the PT supplemental benefits, the SDTF, and the WCATF. It may be most cost effective to limit the bureau’s involvement with solvency petitions of claimants, since these are basically never denied. It may be more cost effective to settle claims for PT supplemental benefits instead of continuing to administer this program. Leave the administration and reimbursement from the SDTF in its current form.

Recommendations : Eliminate all exemptions in the construction industry and require that all persons engaged in the construction industry be covered by Workers’ Compensation insurance. The proof of coverage (POC) function of this bureau should be outsourced to a private entity such as the National Council on Compensation Insurance (NCCI), while the enforcement power to correct coverage fraud should be retained. Experience has demonstrated that verifying certificates of insurance on sub-contractors is not practical. This transfer would create greater accuracy, faster response, be less burdensome to

BUREAU OF RESEARCH AND EDUCATION:

Recommendations: The educational material distributed should be coordinated for accuracy, and a determination of whether the production of these materials could be effectively outsourced is needed. Education of stakeholders, even prior to an injury, has been an effective component of reducing costs in other states. All written and educational material should be simplified and centralized under one roof. The Bureau of Research and Education has a Project Data Management Team section referred to as the Data Quality Audit Consulting Team (DQACT) with 5 FTE’s. The salaries and related benefits for operating the DQACT are approximately $360,000. The Division should assess the value added benefits that DQACT brings to the Division.

Recommendations : Eliminate the requirement to file an RFA, since all parties agree that it is not helping to timely resolve claims. Instead, only require the filing of a petition for benefits which must be served on the employer/carrier, the JCC having jurisdiction over the claim, and the Division. Require that documentation be submitted with the Petition for Benefits supporting each request for benefits. Once a petition for benefits has be filed, the employer/carrier should have thirty days to either pay or deny the requested benefits before attorneys’ fees apply. Repeal all portions of section 440.191, Florida Statutes, except subsection 440.191(1)(b). A determination of whether the new early intervention program is working should be made, but a more foundational question of whether the Division should be the one doing early intervention, or whether the carriers or employers need to do be incentivized to do a better job needs to be addressed. Any early intervention program should also be approached from the perspective of outsourcing.

Recommendation: Repealing the mandatory managed care provision contained in section 440, Florida Statutes. Employers may still have in place a managed care system, but only if they determine that is the most effective system for them. Need a specific statement in the legislation that the elimination of the mandatory managed care provisions would be procedural and therefore could be applied retroactively.

Recommendation: Limit independent medical exams to only one (1) per date of accident and allow insurance carriers to charge these expenses as medical benefits.

ELIMINATE INTEREST ON MEDICAL BILLS AND JURISDICTION OF THE JUDGE OF COMPENSATION CLAIMS TO HEAR MEDICAL BILL PAYMENT DISPUTES

Recommendation: Eliminate the judicially created payment of interest on unpaid medical bills. Eliminate the jurisdiction of the judges of compensation claims to resolve disputes regarding unpaid medical bills.

Recommendation: Similar to what other states have done, the amount an attorney may receive in fees should be limited to a contingency amount, as currently set out in the statute, with the claimant being responsible for paying 20% of any contingency amount awarded. One exception would be in a case in which three requirements were met. First, the claim was for medical benefits only. Second, said claim for medical benefits only must have been formally denied by the carrier. Finally, no request must have ever been made for indemnity benefits and no claim for indemnity benefits should be ripe. In such a case where those three requirements are met, the fee awarded may be a reasonable hourly rate, but may not exceed twice the value of the medical benefits obtained up to $5,000.00. Attendant care shall not be considered a medical benefit for purposes of this fee calculation.  The only other exception would be with regards to appellate attorney’s fees. It is recommended that the hourly rate for appellate attorney’s fees should be limited to $125 per hour up to a maximum of $5,000.00.

The statutes provide that attorneys’ fees do not attach until 30 days after the filing of a Request for Assistance and 14 days after a Petition for Benefits has been filed. The First District, however, created as exception to this provision in its ruling in Allen v. Tyrone Square 6 AMC Theaters. In this case, the appeals court held that the request for assistance and a petition for benefits need not be filed for attorneys’ fees to attach if the issue in question involves medical benefits only. In this case, what constitutes notice to the carrier is subjective. Case law also has not clarified what constitutes a reasonable time to respond to one of these subjective "requests" prior to incurring attorneys’ fees.

Recommendation: In the interest of the timely provision of benefits, and in light of the removal of the RFA process, provide that entitlement to an attorneys’ fee attaches when either a medical or indemnity benefit is not provided within 30 days after the Petition for Benefits has been filed.

Recommendation: Allow for partial dismissal of a petition for benefits, so that only claims that are ripe, due and owing can be addressed.

Recommendation: Eliminate the review and docketing process, which will reduce attorneys’ fees, unnecessary paperwork and administrative costs.

Currently, dates for mediation, pretrial and final hearings are tentatively scheduled and then often canceled and rescheduled. These delays drive up the costs for the administration of the system and delay the delivery of benefits to the injured workers.

Recommendation: Once the petition becomes final, mediation must be scheduled within 60 days; a pretrial conference must be scheduled within 90 days; and a final hearing must be scheduled within six months. If any of these dates need to be rescheduled, a new date should be set and put in the order continuing the event being reset.

Recommendation: Eliminate the Workers’ Compensation Oversight Board

Recommendation: Since the DLES will be eliminated this year, it is recommended that the JCCs should be moved to the Division of Administrative Hearings (DOAH), which can improve the existing capacity to control scheduling, case load, time off, and other administrative functions of the JCCs. The hearing process would be exempt from the Administrative Procedures Act (APA). Eliminate jurisdiction of JCCs to hear issues regarding medical and other provider bill payment disputes.

Workers Compensation Reform Proposal

 “FairCare”

  A Self-Executing, Principle-Based, Integrated-System Model
(This model was developed by Jerry N.Fogel with collaboration from Michael J. Webb, MD, and Claude Revels, J.M. Family Enterprises. It is a work in progress and will be presented again Nov. 12, 2002, in Miami at the Workers' Compensation Reform Commission.)

(Workers Compensation Reform Proposal
“FairCare” 
If you prefer to view in Adobe Acrobat format, click on hyperlink above.
 If nothing happens or you know you do not have Acrobat, click here.)

 Mission:

To establish a consensus of operational understanding and practice for clinicians, consumers, and regulators, that is inherently logical, practical, and fair, in order to facilitate optimal access, utilization, and benefit of clinical services, achieve optimal return to work outcomes, minimize cause for disputes resulting in decreased frequency, establish mechanism for dispute resolution that is efficient, consistent, criteria-based and fair, and reduce overall Workers Compensation System bureaucracy, thereby resulting in enhanced clinical and functional outcomes (efficacy), and appropriate use of financial and human resources (efficiency).

As a result, overall system costs should be substantially lower (while providing optimal benefits to the injured worker and reimbursement to the clinicians), as a result of a “comprehensive, integrated system, based on principled fundamentals, and faithfully executed by all major stakeholders.”  There is no question that services and benefits can be provided achieving substantially superior results at significantly lower overall system costs. 

Categorical Summary:

1. Operationally defines key medically related terms, services, criteria, expectations, as well as roles & responsibilities, and is the centerpiece for the system as a whole. 
2. Establishes a fair and stable medical reimbursement system for both health care providers and hospitals, is the same for comparable services regardless of venue, and is adjusted using the MPI.
3. Establishes an expedited, empowered dispute resolution system that tightens the definition of a dispute, requires evidentiary pleading, establishes a unified operation for claims management, and separates medical from administrative-legal issues.
4. Regarding work status and indemnity benefit, system shifts from an impairment (illness) based model to a disability (function and vocational/economic impact) model, thereby enhancing decisions and outcomes by utilizing more relevant factors.

v     In general, streamlined processes and single, uniformed, documentation (forms) replace (throughout system) antiquated, redundant and/or excessively divergent regulatory or industry efforts.

v     In addition, well-defined, relevant process data and outcome statistics will be collected and maintained to properly assess and continually, but thoughtfully, enhance the system over time.

Key Features

Medical:

All medical and related indemnity benefits eligibility will be subject to compliance with the following definition, principles, and parameters of work-related illness, functional disturbance, clinical management, and duty status:

• All medical and related decisions (diagnosis, treatment recommendations, consults & referrals, authorization for clinical services, medical dispute resolution) shall be based on evidence-based criteria:
  1. Research support (published scientific studies).
  2. Professional consensus (AAOS, NASS, AHCPR, ACOEM, etc).
  3. Principle-based (anatomy, physiology, pathology, clinical principles).
• System elements:
  1. Identifies a continuum of four (4) distinct elements;

                                                               i.      Accident/occurrence: an unusual or unexpected work related event or stimulus that potentially, but not necessarily, results in an injury (i.e., slip and fall, direct trauma, excessive exertion, contact or ingestion of a toxic substance, etc). 

                                                             ii.      Injury/illness: an objectively determined medical/clinical disturbance (see injury/illness criteria below).

                                                            iii.      Functional disturbance/loss: a defined and substantive loss in gross capability or tolerance to performing fundamental movements or tasks (as defined in the Dictionary of Occupational Titles (DOT) i.e. sitting, standing, bending, lifting, handling, etc).

1.      Vocational/economic impact: a partial or complete loss of ability to work and generate income at pre-injury levels (see indemnity criteria below).

2. Each element above is distinct, requiring actual confirmation of their presence or absence, their nature, and their relationship (if any) to each other. In other words, the presence or absence of one or more does not necessarily indicate the presence, absence, or relatedness of the others.

                                                               i.      In general, to be eligible for various Workers Compensation benefits, it must be determined that:

1.      There was an accident/incident that arises out of, and is in the course and scope of, one’s employment (reporting).

2.      That results in an objectively confirmed, relevant injury/illness (potential medical benefits).

3.      That results in a confirmed, relevant functional loss (potential work/duty status modifications).

4.      That results in a confirmed, relevant vocational/economic impact (potential indemnity benefits).

                                                               i.      All work-related accidents and incidents shall be reported to the employer within 3-7 days from the occurrence.

1.      It will be up to the employee whether to seek medical care; however, the employee must report the incident/accident to the employer and a Notice of Injury must be completed by the employer. The employer, at his discretion, may do whatever investigation (accident, drug testing, etc) is appropriate and consistent with the policies of that employer (and consistent with statutory rights and responsibilities).

2.      In cases where the work related injury or illness is alleged to be the result of an accident or incident (vs. prolonged exposure), and it is has not been reported in the 3-7 day required time frame, the burden of proof, by clear and convincing evidence, regarding causal relationship shifts to the employee.

                                                             ii.      An employee has no more than 30 days from the date of a physical accident/incident (trauma, exertion, positional, or movement related), to file a workers compensation claim. Other than insidious exposure cases, claims may not be filed beyond that time frame.

1.      Rationale: Where a specific incident or occurrence has been reported to be at fault, time frames beyond 30 days create inherent conflict due to the inability to assess causality with any reasonable degree of clinical certainty. 

                                                            iii.      Issues involving environmental exposure, inhalation, or ingestion of a substance shall be assessed forensically on a case-by-case basis, requiring specific clinical confirmation to establish causality.

2. From a medical/clinical standpoint, causality;

                                                               i.      Shall be afforded a “deference”

1.      Acknowledging the difficulty in many cases to definitively determine or confirm the exact cause of an illness or injury in the absence of overt, direct trauma, and in an effort to facilitate the self-executing forward progression of the case, causality should presumed as long as there is basic clinical indication supporting a connection.

                                                             ii.      To refute causality;

1.      There should be case specific clinical indication that the injury / illness is not work-related, or,

2.      The clinical condition is one of the scheduled list of conditions requiring specific confirmation indications (which will be detailed via rule).

a.       i.e. carpal tunnel, RSD, myofascial pain syndromes, spondylolisthesis, sexual dysfunction, emotional / psychological dysfunction, headache, fibromyalgia.

3. From a non-medical/clinical perspective, causality and the determination of compensability is still the domain of the employer/carrier, who may investigate the accident, coverage, previous history, or other exploration as appropriate.
4. If it is determined that pre-existing clinical conditions are a substantive part of the current work related condition, all reasonable effort should be made at determining the clinical significance of the pre-existing factors.  Goals for treatment should aim at restoring pre-injury levels of health and function, and not necessarily complete resolution of the illness (e.g., if it is determined that a lifting injury irritated an existing low back condition, treatment responsibility, from a workers compensation perspective, would be limited to managing the irritation). This distinction would factor in as well at MMI regarding any residual determinations.
• Regarding intention and competency, there should be deference on behalf of the treating practitioners. Therefore recommendations and requests for evaluation, diagnostic testing, and/or treatment should be routinely approved unless there are specific, relevant, merit-based reasons to question or deny authorization (i.e. requested service is clearly not necessary or appropriate, additional information or clarification is required). This same deference should be applied in dispute resolution (see dispute resolution section) in that, given essentially equal levels of documentation and support for either side of a dispute between the treating clinician and a consulting clinician, the treating clinician would be given deference.
• Documentation:
  1. All providers will be required to complete the official DWC clinical summary form (see attached), in addition to their written or dictated reports or office notes.
  2. Summary form will be transmitted to the employer/carrier within 24 hours of the service or visit.
• Clinical management should:
  1. Be progressive in practice, acknowledging that research clearly demonstrates that case outcomes worsen as case duration increases.

                                                               i.      In general, clinical management should be based on a “sports medicine” approach, utilizing high intensity, short duration treatment approaches that focus on early activation and a restoration of function.

                                                             ii.      Treatment plans, regimes, therapies, prescriptions, and functional limitations/restrictions must all be reassessed regularly, and never longer than 30 days without review of the progress, order, plan, or status.

2. Be problem-based (i.e. tissue inflammation, abnormal spinal biomechanics, neurological deficit), rather than treating diagnostic labels (i.e. herniated lumbar disc, degenerative joint disease) which does not reflect an individual’s specific clinical dysfunction or status.

                                                               i.      Problem list orientation ensures enhanced clinical accuracy and relevancy, rather than generic diagnostic labels which routinely allow for wide ranges of clinical presentation.

                                                             ii.      Therefore, clinical management must be inherently logical, matching the documented physiologic and clinical problem to the associated evaluation or treatment procedure.

1.      i.e. inflammation, strength, biomechanical correction, tissue healing, etc, should match type, intensity, and duration of service. 

3. Be consistent with the macro framework of patient classification:

                                                               i.      Level I:  Patient has a well-defined, work-related clinical condition associated with specific physiologic dysfunction(s); there are no significant psychological or vocational factors; there is no discordance between physical findings and the reported complaints. Typically, this status is identified in the time period that is days to weeks following the reported work-related injury/exposure.

                                                             ii.      Level II:  Patient is defined by the presence of systemic abnormalities such as deficits in strength, flexibility, endurance, motor control (coordination); the patient may or may not have a well-defined, specific physiologic dysfunction(s); there are no significant psychological or vocational factors. Typically, this status is identified 30-90 days (or more) following the report of work-related injury/exposure.

                                                            iii.      Level III:  Patient is defined by the presence of significant, associated psychological or vocational issues; typically, the patient does have systemic deficits (see above); the patient may or may not have specific physiologic dysfunctions. Typically, status is identified 3 – 6 months (or more) following the reported work-related injury/exposure.

4. Utilize specific criteria promulgated as rules as they are developed;

                                                               i.      The clinical principles outlined in this document are fundamental and should be included in statute as they are not expected to change over time, however;

                                                             ii.      There are, and will continue to be, additional content specific guidelines and indications available that are clear and widely acknowledged enough to be used to enhance quality and optimal  utilization management. Examples include;

1.      procedures such as x-rays and other imaging technologies, surgery, therapy, medication, injections, etc.

2.      clinical conditions such as low back or neck dysfunction and other musculoskeletal injuries.

                                                            iii.      these specific guideline criteria or recommendations should be developed in conjunction with the Medical Oversight Board (see below).

• Outcomes: By having well-defined definitions of injury/illness and functional loss, improved criteria for causality, facilitated access to quality clinicians, and a structured, progressive, clinical problem-based approach to management, it is expected that case durations, disputes, lost time, and overall utilization of services will decrease, while clinical case outcomes and functional restoration will improve.
• Return to work, duty status, and work modifications are the sole domain of the employer and employee.  Medical providers (and other relevant clinicians and health care practitioners) role is limited to providing, as applicable, information regarding clinically relevant functional restrictions or limitations, including time frames and prognostic expectations.
  1. Limitations are functional deficits that are actually measured (e.g. lifting capacity, sitting tolerance, hearing).
  2. Restrictions are functional parameters that are prescribed based on clinical protocol (e.g. non-weight bearing post fracture, exposure of a wound to environmental factors).
• Indemnity benefits will be based on the impact of functional status in relation to the employee’s ability to be gainfully employed (disability), as opposed to an illness based model (impairments), as in the current system. Even in the presence of “confirmed abnormal relevant physiology” there would have to be an associated substantive functional loss to be eligible for indemnity benefits (unless the condition was on the list for scheduled benefits – see indemnity section).
• Behavioral dysfunction:
  1. Psycho-social factors are acknowledged to be an important component of clinical management of a work related injury / illness (commensurate with the specifics of each case), and therefore may benefit (at the discretion of the treating physicians / providers) from psychological support services or management.
  2. However, these issues should not be factored into the determination of disability, or eligibility for indemnity benefits.  This disconnect between clinical care / support on one hand, and functional loss, duty status, and indemnity on the other, should remove any disincentive for employer/carriers to approve these services (if and when appropriately), and minimize inappropriate requests for consultations and services.
  3. Support services should be of short duration, be in conjunction with (not substituted for) the primary management for the principle injury, and focused on, and limited to, the specific psychological/behavioral aspects of the work related injury/illness.

• A Medical Oversight Board should be established:

a.       Assist with development, maintenance, and updating of clinical and functional criteria.

b.      Review new technologies, procedures, and protocols for recommendations for utilization by health care providers and consumers.

c.       Participate in quality assurance oversight of the Peer Review Organazation (PRO), as well as medically related disputes handled by the Workers Compensation Appeals Board (program evaluation methodology, including management report statistics, pattern & trend analysis, and select case reviews).

d.      Composition should reflect an in- state panel made up of qualified, relevant health care providers representing an appropriate diversification of disciplines and specialties. Oversight Board should routinely utilize input from relevant researchers, academics, and constituencies of the system including injured worker and employer/carrier representatives.

Health Care Providers:

• All health care providers will be required to be Workers Compensation Certified, which will be satisfied by signed consent by the provider to the DWC generated provider roles & responsibilities document & agreement, which will outline in detail the clinical, administrative, and procedural rules, terms and conditions of providing services within the Florida Workers Compensation System.
• Employers shall be responsible for providing injured workers with prompt, reasonable access to quality medical care and related health care services.

4. A principle treating provider model (PTP) shall be utilized. The PTP will be responsible for referrals, consultations, coordinating care and status determinations, medications, and other clinically or functionally related matters.

                                                               i.      The PTP model differs from the typical “gatekeeper” model in that:

1.       It is exclusively a clinical distinction, and there will be no financial, administrative, or overall case management responsibilities.

2.      The PTP may change several times during the duration of a case, depending on which provider (by specialty or area of practice) is most appropriate to the main clinical issues at that point in the continuum of the case.

5. Referrals, consultations & transfers of care:

                                                               i.      The PTP determines the need for clinical services and / or other health care providers and will document the relevant clinical indications. Of course, all consults and/or referrals for service will still require authorization from the employer/carrier.

                                                             ii.      In cases where additional care or consultation that is not recommended by the PTP is requested by either the injured worker or the employer/carrier, the following rules will apply:

1.      There are no IME’s allowed by either side.

2.      Confirmatory consultations (issue-focused second opinions) may be used to clarify clinical and related issues

a.       One (1) discretionary confirmatory consultation is available per case to both the injured worker and the employer/carrier.

b.      By either side following an affirmative surgical recommendation.

c.       By either side if there is a dispute regarding functional determination at MMI.

d.      By mutual agreement of the injured worker and employer/carrier.

e.       A confirmatory consultation may only be used by the disputing party. Once there are two defined sides to a clinical or functional dispute, the providers and/or parties may confer to resolve the issue. If still at impasse, the issue may be referred to the COU for Dispute Resolution (see Dispute Resolution section).  Neither side may use the consultations to “pile on” or reinforce already documented positions.

                                                            iii.      The injured worker is allowed a discretionary change of provider one time per case (accident)

1.      A PTP may transfer the care of an injured worker to a more appropriate specialist or provider at the PTP’s professional discretion at any time during the case as clinically appropriate (through the appropriate employer/carrier authorization process).

2.      If a treating provider who is not the PTP on a given case requests a transfer of their own care to a different provider (same or different discipline), it would need to be coordinated through the PTP and the employer/carrier.

                                                           iv.      If an injured worker requests either a transfer of care, or a confirmatory consultation, the employer/carrier must provide the injured worker with three choices within the appropriate specialty and appropriate geographical consideration.

                                                             v.      Neither the change of provider nor the confirmatory consultation option may be used to circumvent the result of a completed dispute resolution process.

a.       i.e. an injured worker may not use either discretionary provider option to attempt to get a particular treatment, or referral to a different specialist, if the issue has already been appropriately addressed through the dispute resolution process.

Medical Reimbursement:

• Authorization for services guarantees payment in accordance with reimbursement system (unless service not delivered or other obvious substantive discrepancy).

• Standardization of reimbursement system (for all non in-patient services) through the establishment of a Medicare-based fee schedule, tied to annual increases in the MPI:

• Thereby stabilizing the increases in a controlled, gradual manner that matches the economy and market conditions.
• Suggest 150% of Medicare for all currently existing codes (national average).
• Will require a select number of additional codes for services that are WC specific, but not typically relevant for Medicare (i.e. FCE, work hardening, etc), and suggest utilizing national standards for establishing the initial fee values, and again tie the annual levels to the MPI.

• The combination of the above two provisions is expected to significantly decrease the frequency of medical fee disputes (a very high volume dispute issue in the current system).
• Regarding out-patient services, comparable services shall be reimbursed at the same level (see above) regardless of venue (i.e. out-patient P.T in a private practice vs. out-patient P.T in a hospital, etc).
• Absolute per-service fee schedule established (no paying above or below fee-for-service), set at rates that encourage quality care, uninhibited access, and system compliance.  Service is either of acceptable quality or it isn’t.

• Case rates and other global-type pricing may be utilized if mutually agreed to by the responsible parties (provider and payor), as long as the service is consistent with all relevant system requirements, facilitates quality access, care and outcome, is intended to be cost-efficient, and that clinical service and decision-making is based on appropriate clinical criteria, and not financial incentives or disincentives.

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