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Medigram - November 29, 2007


TOP STORY

Court upholds $8.4 million malpractice award

A Wisconsin appellate court today upheld the verdict in Greenfield v. Physicians Insurance Company, a 2006 medical liability case in which a Dane County jury awarded $8.4 million to a patient who suffered serious health problems following surgery. The award included $4.25 million in damages for pain and suffering, and was handed down after the Wisconsin Supreme Court removed the cap on noneconomic damages in medical liability cases. The new cap on noneconomic damages, which was passed approximately nine months after the Supreme Court's decision, is inapplicable to the Greenfield case. The Wisconsin Injured Patients and Families Compensation Fund (Fund) is a defendant in the Greenfield case and might be liable for a significant portion of the damages. The degree of the impact on the Fund of the Greenfield verdict combined with the state's $200 million raid on the Fund is not yet clear.

On June 8, 2007, the Legislative Fiscal Bureau issued Paper Number 377 to the Joint Committee on Finance, noting that the Fund was facing a year-end deficit of $60 million by fiscal year 2008-09, without a raid on the Fund. According to that paper, a raid of $175 million had the potential of creating a Fund deficit of an additional $235.1 million above the amount that was projected without a raid. The Legislative Fiscal Bureau has not yet calculated the amount of the Fund deficit that the $200 million raid will cause. Certainly, the projected deficits coupled with large damage awards could quickly plunge the Fund into a severe shortfall to the detriment of injured patients as well as the physicians and other health care professionals who pay into the Fund.

NEWS BRIEFS

CMS cautions: Some physicans reporting Social Security Numbers in publicly-disclosed fields

As the Centers for Medicare and Medicaid have mentioned in previous outreach messages and on the CMS NPI Web site, some health care providers have reported their Social Security Numbers (SSNs), or the SSNs of other health care providers, in their National Plan and Provider Enumerations System (NPPES) records in fields that CMS is required by the Freedom of Information Act to make publicly available. For example, there are instances where SSNs are reported in the “Other Provider Identification Numbers,” “License Number,” and “Employer Identification Number (EIN)” fields in providers’ NPPES records. The information that providers report in these (and certain other) fields is fully disclosable by CMS to the public and, therefore, SSNs should never be reported in any of these fields.

CMS urges physicians to review their NPPES records immediately to ensure that they did not inadvertently report their, or someone else’s, SSN in a disclosable field. If they did, they need to delete that SSN immediately and, if appropriate, replace it with the correct information (e.g., an EIN). For more information, visit the CMS Web site at this link.

If you have not applied for an NPI number yet, click here to apply on-line or call the NPI enumerator to request a paper application at 800.465.3203.

Madison and Dane County Health Departments merge

Dane County Executive Kathleen Falk and Madison Mayor Dave Cieslewicz on Tuesday signed the legal documents to officially merge the city-county public health department. The department merger has been discussed for many years as a way to improve the delivery of public health services to area families.

“Public health issues cross municipal boundaries and so should our approach to them,” said Mayor Dave Cieslewicz, in a press release. “This merger allows us to take a truly regional approach to addressing public health issues and improving service delivery to families throughout Madison and Dane County.”

The merger was guided by the Joint Board of Public Health, which includes Alan Schwartzstein, MD, past President of the Dane County Medical Society and past Board member of the Wisconsin Medical Society. The Director of the joint department is Tom Schlenker, MD, who was hired in January 2006.


Resolution deadline date for 2008 Wisconsin Medical Society Annual Meeting

The 2008 Annual Meeting of the Wisconsin Medical Society will convene Friday, April 11, 2008, at the Monona Terrace Convention Center in Madison. The deadline for receipt of resolutions, so they can be included in the House of Delegates handbook, is Monday, February 11, 2008. Resolutions must be submitted, in proper form, to the CEO’s office no later than two months prior to the opening session of the House of Delegates.

Unanimous consent of the House of Delegates shall be required for the introduction of any late resolutions, except those that are submitted by the Board, a Board member, or the Society’s constitutional officers. The Board of Directors will submit recommendations regarding the acceptance of late resolutions to the House at its opening session.

When drafting resolutions for submission, please note the following:
  • The title of the resolution should appropriately reflect the action for which it calls.
  • Information contained in the resolution should be checked for accuracy.
  • The resolves should stand alone, since the House adopts only the resolves and the whereases do not appear in the proceedings.
  • It is strongly encouraged, but not required, that all resolutions submitted to the House of Delegates for its consideration, contain a statement by the author as to existing Society policy on the topic, or that the Society does not have any current policy on the topic.
  • Any resolution submitted to the House of Delegates for its consideration, which requests that the resolution be taken forward to the AMA for its consideration, should contain a statement by the author as to existing AMA policy on the topic, or that the AMA does not have any current policy on the topic.
Fiscal notes will be added to all resolutions whose implementation would require funds not normally included in the Society’s budget. For each resolution submitted, a sponsor should be in attendance at reference committee hearings to provide background information.

Just a reminder that members can submit issues year round to the CEO using the Member Idea Form, which is available on the Society Web site at this link. Issues presented are then referred to a specific Council for further study and recommendations will be considered at a future Board meeting. Also, if desired, assistance will be provided to develop a resolution that reflects a policy change you are possibly seeking.

Resolutions may be sent to Susan L. Turney, MD, CEO/Executive Vice President, Wisconsin Medical Society, PO Box 1109, Madison, WI 53701 or e-mailed to noreenk@wismed.org.

For further information, contact Noreen Krueger at 608.442.3904, toll free 608.442.3800, ext. 3904 or e-mail noreenk@wismed.org.


Nominate a candidate for Physician Citizen of the Year

It’s easier than ever to nominate a dedicated physician for the special honor bestowed by the Wisconsin Medical Society—the Physician Citizen of the Year Award. Just click here and complete the nomination process on-line. The deadline is January 15, 2008.

The award recognizes Wisconsin physicians who volunteer their time and talent to help better their community through cultural, civic or other activities. Last year’s winner was Patrick Wolf, DO, of Marshfield, who established and operates a free clinic there. For the complete rules, click here.


Robert Wood Johnson Foundation Clinical Scholars - Call for applications

The Robert Wood Johnson Foundation Clinical Scholars program is now accepting applications. This program fosters the development of physicians who will lead the transformation of America’s health care. These future leaders will conduct innovative research and work with communities, organizations, health care professionals and policy-makers on issues important to the health and well being of all Americans. Program highlights include leadership training, mentoring, protected research time, national networking, health services and community-based research training, and financial support for research projects and professional travel.

The application deadline is February 29, 2008. To learn more, click here.

YOUR PRACTICE. YOUR FUTURE.

Society seeks to file an amicus brief in the Schultz case

The Wisconsin Medical Society delivered a request to the Milwaukee Circuit Court to file an “amicus brief”—also known as a friend of the court brief, along with a copy of its brief, in the case of Schultz v. Wisconsin Injured Patients & Families Compensation Fund, et al., 2007CV296 on November 20, 2007. The Society took action because the Society and its members have a strong interest in some of the issues in the case, particularly the potential erosion of the stability of Wisconsin’s medical liability climate and the potential adverse impact on training for medical students and residents.

The Schultz case involves a medical liability claim for injuries allegedly caused by the injection of certain contrast materials by Graham Case, MD, a licensed physician working at Aurora/St. Luke’s Medical Center. The Schultz case is unique because the Wisconsin Injured Patients and Families Compensation Fund (Fund) filed a Third-Party Complaint against Aurora/St. Luke’s to recover money under Aurora/St. Luke’s general liability policy on the theory that Aurora/St. Luke’s did not adequately train and supervise Doctor Case.

Generally, a physician’s and/or hospital’s primary medical liability insurance policy covers medical liability claims up to the amount of the policy limits for negligent acts and omissions in medical practice. The Fund generally pays any excess liability amounts above the primary liability insurance policy limits for Fund participants. Doctor Case and Aurora/St. Luke’s are Fund participants. There is no precedent in Wisconsin for characterizing medical acts and omissions as general liability claims. The Society’s brief states, “members of the medical industry, both practitioners and insurers alike, do not consider physician training as inseparable from other aspects of the practice… Because of the understandings which exist within the medical professional industry, policies are underwritten with the understanding that the protections of ch. 655 are in place for physicians who assume supervisory roles.”

The Society’s brief highlights the fact that the Fund’s attempt to obtain contribution from Aurora/St. Luke’s general liability insurer could increase the costs and risks to physicians who might train medical students and residents, thereby discouraging them from providing the clinical training that is critical to the development of medical students and residents. The Society’s brief states on page 9, “The consequences of recognizing the Fund’s claim would most surely be a deterrent to anyone considering serving in a training capacity.” The Fund’s claim could also undermine the quality of health care in Wisconsin by significantly reducing the ability of medical students and residents to advance their medical education and enhance their skills outside their academic institutions. You can read the Society’s brief by clicking here. The Society will provide future updates regarding the status of the Schultz case.

EDUCATIONAL PROGRAMS

‘What’s New for 2008’ is just around the corner

With more than 240 new codes, 300 revisions, 50 deleted codes and new E/M codes, you won’t want to forget to sign up for What's New for 2008, being presented December 4-12 throughout the state. Why spend your valuable time researching the changes when we have done the work for you? Come to the full-day session nearest to you to learn all of the changes to CPT, what Medicare will and will not be paying for in 2008 and what impact the new codes are going to have for you and your practice.

For more information or to register for this seminar, click here. And if you have specific questions you would like answered during the seminar, please e-mail them to sandyg@wismed.org.

FYI: FOR YOUR INSURANCE

PIC Wisconsin shows support of Society lawsuit

In the aftermath of the raid of the Injured Patients and Families Compensation Fund (Fund), it is a relief to know that one malpractice insurance carrier in Wisconsin is standing behind Wisconsin physicians. PIC Wisconsin, a ProAssurance Group company, is and has always been a proud supporter of the Wisconsin Medical Society and Wisconsin physicians.

Click here to read letter from PIC Wisconsin addressing their commitment to the Society, physicians and their patients. And if you are not insured by PIC Wisconsin, ask yourself if your malpractice carrier is doing the same for the physicians of Wisconsin.

To learn more about PIC Wisconsin and Wisconsin Medical Society Insurance and Financial Services, visit our Web site or complete our on-line contact form for more information.

FOUNDATION FOCUS

Kenneth M. Viste, Jr., MD, 2008 Young Physician Leadership award nominations being accepted

The Wisconsin Medical Society Foundation is pleased to request nominations for the 2008 Young Physician Leadership Award in honor of Kenneth M. Viste, Jr., MD. The deadline for nominations is Monday, February 11, 2008.

This award was established in 2006 in Dr. Viste’s memory to recognize a young physician who demonstrates the attributes of commitment to patients, community and the profession of medicine. A young physician is defined as a licensed Wisconsin physician who is less than 40 years old or has been practicing medicine fewer than five years. Both the nominated and nominating physicians must be members of the Wisconsin Medical Society. Noel N. Deep, MD, of Antigo received the first award last year.
 
Kenneth M. Viste, Jr., MD

In addition to an engraved award, the Foundation will make a $500 contribution to a 501 (c)(3) charitable organization of the recipient’s choice. For more information, click here.

FAQ

Question:
Can I bill for an infusion if the physician simply has the normal saline continue flowing until infused at the same time as we are administering chemotherapy? I can't find that the drug requires the normal saline to be running at the same time, and the chemo drug has already been mixed in fluid to run it in to the patient. The saline and chemo drug are running through two different lines.

Answer:
According to the physicians who presented at the AMA CPT Symposium recently in Chicago, unless it is medically necessary and documented as such, it would be inappropriate to bill for the additional fluid running through the separate line with the infusion codes. If it is medically necessary, and the documentation supports same, then it would be appropriate to bill the 90761 code based upon the time that the saline was being infused into the patient. It would also be important to be sure that the start and stop times are documented by the nursing staff as well in order to bill.

If you have questions about this or other coding matters, click here to review our FAQ archives, or e-mail efaq@wismed.org.

QUALITY CORNER

New report on patient- and family-centered care available

Quality and safety are advanced by bringing patients and families directly into the planning, delivery, and evaluation processes. The challenge for many hospitals is understanding how to link patient- and family-centered care with their overall mission and how to get started. “Advancing the Practice of Patient- and Family-Centered Care,” a new report issued from the Institute for Family-Centered Care, provides suggestions for addressing these challenges.