|2721 Capital Ave.
Sacramento, CA 95816-6004
Phone: (916) 446-5054
Message: (561) 873-8335
Fax: (916) 446-0500
|American Society of Dermatology, Inc.
A Voice for Private Dermatologists Since 1992
Join your colleagues at the Start making your plans to attend the 6th Annual Meeting of the American Society of Dermatology which will be held October 3-5, 1997 in San Antonio, Texas. Headquarters Hotel will be the historic La Mansion del Rio Hotel located with direct access to the heart of the famed Riverwalk.
This meeting is not just about Dermatology; not for those whose daily vision is limited by the parameters of their specialty. This meeting is for PHYSICIANS - Physicians who daily practice MEDICINE, particularly, with their specialty in Dermatology.
Dermatologists are not suffering from lack of Dermatologic expertise; Physicians are not suffering from lack of Medical skills. All Physicians are suffering for fulfilling their traditional roles of PHYSICIANS - that role that obligates them to the needs of their patients first and foremost - a role that puts them in conflict with the intrusions of Government and third party payors. FOR THESE PHYSICIANS, THIS MEETING IS DESIGNED AND DEDICATED.
The program will feature the mix of socio-economic and scientific presentations which has proved so successful at past Annual Meetings. A program of prominent and nationally recognized speakers is being finalized and will include:
Meeting and Laser Presentation
October 3-5, 1997 in San Antonio, Texas
Tim Berger, MD, "AIDS in the Private Practice Setting";
John Valencia, Esq., "How To Be Heard Where it Counts";
Neal Penneys, MD, "Managed Care - Physician Profiling";
Miguel A. Faria, Jr., MD, "The Loss of Ethics in Medical Practice";
Michael D. Tanner, Ph.D., Cato Institute, "The Ongoing Incremental Socialization of Medicine";
Jane M. Orient, MD, "AMAP Credentialing";
Edward R. Annis, MD, "Have We Learned Anything From the Past?"; with special video presentation of his Madison Square Garden reply to President John F. Kennedy's Senior Citizen's Rally in Madison Square Garden on May 20, 1962. Attempts are being made to obtain the video of President Kennedy's address also.
Arthur Huntley, MD, "Internet as a Resource in Private Practice";
David Tully-Smith, MD, Ph.D., "The Electronic Medical Record";
Stephen Moses, Ph.D., "Health Care is Not a Right";
Genevieve Young, Esq., "The Robert Wood Johnson Foundation" and it's impact on Health Care;
Chester C. Danehower, MD, "Why We're Losing Our Profession";
Stephen Cohen, MD, Founder and Past President of Physicians Who Care, "Being a Patient Advocate in an Era of Managed Care";
Andrew F. Schlafly, Esq., "Physicians On Trial";
Ron Paul, MD, United States Congress, "The Latest From Capitol Hill";
Jack Sedden, Executive Director of the Federation of Physicians and Dentists, "Physician Exploitation, Collective Bargaining and Patient Care";
Cleve B. Baker, MD, "The Vanishing Hipocratic Oath";and
Melissa K. Clements, MD together with Cynosure, Inc., "Vascular Lesions and Hair Removal by Laser." (This will be a 4 hour presentation you will not want to miss!)
CME credits will be available for the entire meeting!
October is prime time in San Antonio, and the attractions of the Alamo and other historic sites should appeal to the entire family.
For your hotel reservations, call toll free directly to the La Mansion del Rio Hotel at 800/292-7300. Be sure to identify yourself as an ASD attendee. Rates are $159/night (single or double) and additional persons are $25/night. Check-in time is 3 pm.
Included in your registration will be a reception on Friday evening featuring the Alamo City Jazz Band and a luncheon on Saturday.
Send in your reservation today!
Is Popularity Behind The Rising Enrollment Of Managed Care?
by Cleve B. Baker, MD
Over the past several years, the lay and medical press indicate that rising numbers of Americans are enrolled each year in managed care plans. These reports imply that this trend is the wave of the future and predict it will continue in public popularity. Popularity? IS POPULARITY THE DRIVING FORCE FOR RISING MANAGED CARE ENROLLMENT?
Everywhere I turn, in my office,
in social circumstances, people of all walks of life eagerly volunteer their displeasure with managed care. Certainly, American physicians universally seem to be a
most unhappy lot. The halls of government now echo rising public discontent with managed care’s operative practice, a cacophony inaudible to many reporting public contentment in studies underwritten by the managed care industry. Is public discontent with managed care the norm, or has indeed a fully informed public willfully abandoned its traditional relationship with their physician for the extolled benefits of “the Plans"; hence, the continuing rise in managed care enrollments.
Over the past 10 years my experience with my patients in my community, with colleagues, and third party payors suggest other forces, besides POPULARITY, at work. I would like to suggest, for want of a better word, “COERCION”; in fact, “INTERLOCKING COERCION." Managed care’s instrument of coercion is placing the health insurance consumer, then the physician into interrelated DILEMMAS, (“a choice between alternatives, equally undesirable, a predicament”; “between a rock and a hard place”). In the past, when the consumer has a choice between an HMO Plan, i.e. Kaiser, and readily available, non-HMO indemnity plan, coercion was not an issue - the consumer was free to choose. But today, with the disappearance of reasonably priced indemnity insurance, with choices only between various types of managed care plans offered by employers or government agencies “coercion”, cannot be ignored. The consumer is COERCED; take the offered plan with all stipulations, limitations, guidelines, and broken doctor relationships, or risk the possibility of a financial wipeout from a catastrophic medical event. The doctor is COERCED: join the plan with all it stipulations and rules or risk losing his/her patient and his/her business. The prudent person will probably reluctantly “choose” to be one of the touted “rising number" of managed care enrollees. The prudent doctor will probably “ choose’ to become one of the rising number of “preferred providers” rather than to lose critical numbers of patients through denied patient and primary care referrals. These two COERCION (extortions) “interlock”; one requires the other for managed care to succeed. Thus, we have replaced a successful healthcare system, based on trust and integrity, with one designed on coercion, intimidation, compulsion, hassles, production harassment, conflict of interest, report cards, etc. Is the public better off?
Unfortunately, the vulnerability to this kind of coercion is maximum on the young physician. Older M.D.’s with years of successful rapport with their communities and colleagues and who are approaching retirement, must not leave them to their plight. The young, just out of training with their medical school debts, full mortgages, college educations and retirement funding ahead of them cannot afford to antagonize their third party bosses nor the company medical directors who can fire them, decrease their pay, punish them through their “report cards”, and slant references for future employment. Young physicians are truly captives of the managed care industry. They are at personal risk, if in advocating for their patients or following the best ethics in their profession, they find themselves at odds with the dictates of their employers or managed care contractor.
I suggest that the “POPULARITY” of managed care to attract increasing numbers of patients and physicians to their ranks needs to be examined in light of managed care’s power to dominate patients and physicians by positioning them into interlocking dilemmas where PERSONAL RUIN is one option for both. The linchpin of the managed care system is depriving patients of their right to choose their physicians. Let’s restore this right, and at an affordable cost, restore also the right of physicians and patients to choose the specialty consultants of their choice, and above all, let’s demand that physician-patient relationships be immune to unacceptable third party interference. Let’s back these time tested and time honored medical ethics and then, let’s chart the course of managed care statistics as they reflect public “popularity", or lacking it, what the real factors are.
Medical Savings Accounts
by Holly Fritch Kirby, MD
If you haven’t yet taken advantage of the potential savings available through MSAs, you might wish to consider the following option. Contact MSAver (the MSA portion) for an application by calling 1-888-367-6727. The application describes both the MSA and high deductible plan requirements.
MSAver is a knowledgeable organization that can answer your accounting questions related to MSAs. They can get you started on the right foot and if you find a better deal later, you are free to switch. But, remember you need to setup the MSA with a high deductible policy ($1,500-$2,250 for an individual or $3,000-$4,500 for a family) during this window of opportunity which could close September 1 or October 1.
Second, you will need to select a qualified high deductible plan as required in the legislation. Ask your agent to verify that your policy is MSA compatible. For example, the maximum out-of-pocket costs are $3,000 for an individual policy and $5,500 for a family policy. Second, if the deductible for a family plan is $3,000, then insurance cannot start paying for your health care until the family has paid $3,000; some plans which would begin paying for services after a family member reached a lower deductible are not allowed.
If you ask MSAver to set up a properly designed MSA, you should find a broader selection of high deductible plans including those by companies who have not created a MSA instrument. For example, if your Blue Cross carrier does not have a MSA plan, you could still purchase a qualified high deductible Blue Cross plan to combine with your MSAver MSA. MSAver may also have some recommendations for plans in your area.
Finally, you might wish to consider the Association of American Physicians and Surgeons high deductible plan through Maginnis and Associates (1-800-621-3008 ext. 284). A unique feature of this plan is that it allows you to keep a private insurance policy beyond the age of 65 if you remain a member of AAPS (1-520-325-2689). Although this is a bottom-line summary, hopefully it will be a useful and easy to implement plan.
ASD v. Shalala Update
On April 14,1997 oral arguments were heard by the Washington D.C. Appellate Court concerning ASD v. SHALALA. Kent Masterson Brown presented our case in a masterful manner. In fact, the attorney for Health and Human Services was “roasted” by the appellate judges. The three judges gave every indication that they understood the issues in the case, and from the discussion it appeared that there was no way for us to lose. Needless to say when a negative decision was rendered by the appellate court confirming United States District Justice Norma Holloway Johnson’s original findings, we were appalled. This decision was rendered within two weeks of the oral arguments, and lacked an appropriate explanation.
Still feeling certain that the CPT Editorial Committee, the CPT Editorial Advisory Committee, the Relative Value Update Committee, the Relative Value Update Advisory Committee, and the Physician’s Multispecialty Advisory Committee were all FACA Committees, we asked our attorney to petition the appellate court to hear our case “en banc” i.e. for all of the Washington D.C. appellate court judges to hear the case. Unfortunately this request was also denied, and again an appropriate explanation was lacking.
It was our hope to open the RBRVS process. In this quest we were unsuccessful. If we had been successful every physician in this country would have benefited. We will now have to put our lack of success in this lawsuit behind us, and move on to the battles that are sure to follow. We learned much in this quest about the judicial process, and we have obtained reams of information. In fact we have only started to evaluate the volumes of material we obtained during the investigative phase of the lawsuit; information that will surely be valuable to the ASD in the future.
Now we must move forward. We have stood up to the oppression of our out of control federal bureaucracy, and we have sent them a message. We will be watching, and will not hesitate to take appropriate steps, when in the future, governmental agencies violate the law in their dealings with our patients and/or physicians. We can be satisfied that we were in the battle. Where was the rest of organized medicine?
A Note of Thanks:
The Board of Directors of the
American Society of Dermatology sincerely thanks all of you who
contributed to the FACA fund.