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News A Monthly Communiqué for the Vascular Society of New Jersey - June 2003 |
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| To save important resources (time and money), we are building an email address list of members. The monthly report, and other important communications, can then be easily and efficiently emailed to the organization. Please provide your name and email address. From the President….Rocco Ciocca, MD Now, more than ever, physicians and surgeons must assess the value of what we do. These are difficult times. The costs of running a practice are rising in the face of decreased reimbursement. What we do as vascular surgeons is rapidly changing, while we face increased competition not only from within our specialty but from others. The academic paradigms with which we were trained are changing rapidly and dramatically. Within this context, the Vascular Society of New Jersey must change and we must re-define its value to its membership. As President I am asking for help with that endeavor. We have already experienced change. We have new administrative leadership. We have a long anticipated website but those are just a beginning. There are numerous ways to improve our society: Better communication within the society, electronic communication, stronger educational programs, consultative services via the Web, job listings, political action, etc. We need to re-invigorate our membership and I welcome your ideas as to how to best achieve a goal of increasing the value in membership in VSNJ.
Aetna settles with Medical Societies Aetna has agreed to settle class action lawsuits brought against it by individual physicians and 17 state medical societies. Medical society representatives are heralding the agreement as a model for potential settlements with 10 other health plans that are defendents in class action lawsuits in U.S. District Court in Miami. While the Aetna settlement calls for $100 million in payments to physicians, medical society representatives say the key feature is a set of agreements on determining coverage, processing claims and handling physicians’ appeals of Aetna’s decisions. Under the 82-page Aetna settlement, the company would basically agree to AMA-CPT guidelines for processing claims and to a definition of “medical necessity” for coverage decisions, which closely mirrors the AMA definition. In addition, Aetna would agree to follow AMA-CPT policy determining when CPT codes can be bundled or replaced, and Aetna would probably continue to use existing coding software, such as McKesson’s Claim Check, rather than reinvent new software, which could take years. Aetna’s new definition of medical necessity would be based on what a “prudent physician” would do, ruling out experimental treatments and choosing treatments that have been verified by peer-reviewed medical literature. Aetna, under the agreement, would give physicians access to its entire fee schedule and coding logic. The agreement would not be finalized until the Fall. First it must go to U.S. District Court in South Florida for preliminary approval. If approved, notices would be sent to 600,000 physicians in the class who would have a chance to opt out of the settlement and pursue their own lawsuits. Payments would be sent to doctors after the settlement is finalized, and would be paid at different rates, depending on whether or not they are in an Aetna network, how much they received in reimbursements from Aetna and whether they are retired.
Senate Approves “Know your Doctor” Database Bill The Senate concurred with Governor McGreevey’s amendments to legislation designed to help consumers learn more about the education, experience and professional conduct of individual NJ physicians. The “Health Care Consumer Information Act,” requires the Division of Consumer Affairs (the same agency which oversees medical licensures and the State Board of Medical Examiners) to maintain informational files on all physicians and podiatrists, and make those files available via the Internet. Records would include: educational history, criminal convictions and disciplinary actions by the Board of Medical Examiners over the last 10 years, any restrictions of privileges based on competence by a health care facility, and medical malpractice court judgments and any arbitration awards for the previous five years. Doctors will review copies of their respective profiles before making them available for public release – and would have 30 days to fix inaccuracies. The bill now goes to the Assembly for a concurrence vote. |