Table Of Content

A PATIENTS IN MANAGED CARE page ", ( 7 > iL4nL *i 1995 NO- l 63501 V.*7 iROO C-T>t XLLINrOI.^^ Mbu ol Ti; D working If j (III The dual- degreed, physician PAGE 5 PAGE 8 ILLINOIS STATE MEDICAL SOCIETY • JANUARY 13 1995 INSIDE IDPA revises Medicaid IDPH ordered reform plan timetable to release cancer registry IMPLEMENTATION: Recipients will have more time information to choose a provider, byKathleenfurore CHICAGO Responding to nuity ofcare, henoted. ~^ NPRAOPTERITYOONF ATHLE c[oncerns rais]ed by the U.S. In its response to HCFA, the Health Care Financing Admin- department proposed a five- LIBRARY OF istration in November, the Illi- month enrollment process, medicine nois Department of Public Aid which would be repeated until revised its proposed time line all eligible clients were enrolled, for implementing MediPlan said A. George Hovanec, Plus, the Medicaid reform pro- administrator of IDPA’s divi- gram. The timetable changes sion of medical programs. If FRIENDS and relatives of rehabilitation patients cele- are included in a Dec. 20 IDPA HCFA gives IDPA the go- brate the holidays during a December party held at document addressing 150 ques- ahead, that process would Copley Memorial Hospital in Aurora. PAGE tions HCFA said must be beginMay 1. 3 answered before the program The expanded enrollment receives federal approval. Many period would replace the mass Any willing provider of the explanations also deal enrollment originally proposed with ISMS’ concerns about the by IDPA, which was questioned DEPARTMENTS plan, said John Schneider, MD, by HCFA because it allowed laws vary nationwide an ISMS Third District trustee recipients only 20 days to News Briefs 2 and chairman of the Society’s choose a primary care provider. Third Party Payment Processes Such a shortchoice period could INSURERS: Physicians have different degrees of Committee. have caused up to 70 percent of Commentary 4 protection, byKathleenfurore “We need [the extra] time to Medicaid recipients to default educate patients and physi- intomanagedcareplans. CHICAGO With managed In Illinois, for example, an ISMIE Update 7 cians,” Dr. Schneider said. “Our concern was that the f ] care activity gaining momen- any willing provider statute is ISMS favors a longer enroll- original plan would have tum across the United States, contained in the state’s insur- Classifieds 13 mentperiod forMedicaid recip- defaulted patients into managed ance code and dates back to the ients because it would help care plans they didn’t want to MANAGED CARE 1960s. Specifically, the statute ensure patientchoice and conti- (Continuedonpage 15) requires traditional indemnity insurance plans to allow any monor“eanayttewinltliionngipsrboeviindgerf”ocluaswesd, qiunasluirfeidesd,phsyasiidciIaSnsMStoGterneaetraitls HCFA releases final rules for 1995 legislation that addresses physi- Counsel Saul Morse. But the RBRVS cian inclusion or exclusion Illinois law doesn’t cover Medicare fee schedule from insurance plans. However, HMOs or PPOs, meaning that these laws vary significantly. (Continuedonpage 11) GPCIs: Increases in conversion factors help offset cuts in the geographic practice cost indices for Illinois physicians, byKathleenfurore OIG targets lab business practices CHICAGO Reim- Third District trustee. The higher conversion [ ] bursement rates for many of factors helped offsetthe cuts to the geograph- FRAUD: The federal government is reinforcing the services delivered by Illi- ic practice cost indices for Illinois that were nois physicians who treat announced by the Health Care Financing its efforts to eliminate abuses in Medicaid and Medicare patients will rise Administration in the draft RBRVS rules Medicare, byKathleenfurore in 1995 because ofincreases released in June 1994, Dr. Schneider said. in the conversion factors Dr. Schneider The final rules published in the Federal Regis- [ WASHINGTON ] Physi- Statute. The law is part of the used to determine payment ter in December left those GPCI cuts intact, cians’ arrangements with clini- Omnibus Budget Reconciliation under the RBRVS fee schedule, said John he noted. cal laboratories are the focus of Act of 1989, which took effect Schneider, MD, chairman of the ISMS Third GPCIs, which reflect expenses related to a fraud alert recently issued by in January 1992, said Michael Party Payment Processes Committee and a (Continuedonpage 12) the U.S. Department of Health lie, an attorney in the AMA’s and Human Services’ Office of health law division. Inspector General. In conjunc- “We support the idea of such tion with an ongoing crack- alerts because we have a legal down on Medicare and Medi- climate in which there are 200 caid fraud and abuse, the OIG broadly worded statutes and 0103 lli i identified potential situations very narrow safe harbors,” lie NATIONAL LIR OF MED ts-index Menicus tahnadt cMoeudlidcvaiiodlatAentthie-KMiecdkibcaacrke explaine(dC.on“tTihniusedkionndpoafgeal1e0r)t dBE6GTOH tRSOOCKVILLE PIKEMD 20014 2 • ILLINOIS MEDICINE JANUARY 13 1995 Council develops programs JAMES CLANAHAN, MD (left), of Belle- on medical education ville, presents the Illinois Press Associ- ation’s Medical O Writing Award to the InaceScMoSomfplCitoshuhenmceimnltasjooonrf working gMIilDlsit,noaiasn,dCshcaioicduancgSiaoltynamepeAhmhrbuoejlrao.,- rReocgoegrniStciholnueotferhiisn Education and Manpow- Compiled by a council three-part series on er in 1994 was the 7th if subcommittee, the recom- AIDS published in annual seminar for resi- you mendations addressed the Belleville News- dency program directors, ways to promote primary Democrat. The which featured a presen- care medicine to medical annual award is tation on licensure, said council chair- students and encourage them to practice sponsored by ISMS. man Joan Cummings, MD. The 17- in Illinois. “We looked at the problems member council studies and evaluates all [primary care doctors] face and at how aspects of medical education. It also to give incentives to students to go into Northwestern network Covenant Hospital in Chicago entered communicates with medical school primary practice and stay in the state, the Northwestern network. Currently, deans and the directors of residency especially in underserved areas.” The expands to Joliet the network has more than 4,000 physi- training programs and medical educa- report was used to help develop ISMS’ cians, operates 3,208 beds and admits tion to provide practicing physicians’ input to the Special Joint Task Force on CHICAGO Silver Cross Hospital in more than 135,000 patients annually. [ ] perspectives on medical issues. In turn, Family Physician Shortages, which was Joliet is the newest member of Chicago- Northwestern University Medical School the council obtains their input on issues established bythe GeneralAssembly. based Northwestern Healthcare Net- is also affiliated with the system, the related to medical school and graduate An ISMS delegate, Dr. Morse said his work. The hospital is a not-for-profit, spokesperson said. medical education. involvement in council activities stems nondenominational health care facility. “Silver Cross is an outstanding commu- The council annually asks medical from his strong support of organized It operates seven satellite locations in the nity health care provider serving Will schools in the state for statistics on medi- medicine. “Doctors need an organiza- Jolietarea. County, one of the fastest growing areas cal students whochooseprimarycare res- tion to represent them, and ISMS is the “We are extremely pleased to be join- in the region,” said Bruce Spivey, MD, idencies, Dr. Cummings said. In addition, best arm to do that. Participation in the ing the Northwestern Healthcare Net- network president and chief executive it monitors resident work hours, analyzes council and in organized medicine is work,” said Rabbi Morris Hershman, officer. “Its hospital and medical staffgive bills on such topics as licensure of very worthwhile. I think it is something chairman of Silver Cross’ board of our rapidly growing network a strong acupuncturists and compiles statistics on otherphysicians shouldconsider.” trustees. “This affiliation will strengthen providerinthesouthern Chicagoarea.” Match results and the licensure process. Dr. Bordeaux is a former ISMS dele- Silver Cross Hospital’s already strong Network officials expect to add more Other activities include offering the Illi- gate and a pastchairman ofISMS’ Com- position at a time when managed care health care providers in the southern nois Department of Professional Regula- mittee on CME Accreditation and Com- and other market forces are making Chicagoland area and its growing sub- tion advice on physician licensure and mittee on CME Activities. He said his increasingly greater demands on inde- urbs, Dr. Spivey said. One of the net- discipline, and overseeingISMS’ Commit- participation has been rewarding. “The pendent hospitals.” work’s primary goals is linking strong, tee onCMEActivities. Peoria County Medical Society is a melt- Silver Cross is the ninth Chicago-area community-based health care institu- The Council on Education and Man- ing pot for practicing physicians. It gives hospital to join the network, which was tions and physicians into a delivery sys- power is one of 25 ISMS councils and them a common ground, regardless of founded in fall 1993 by Northwestern tem that provides comprehensive health committees that provide members an their [hospital] affiliations. The state Memorial Hospital, Children’s Memori- care services to the entire Chicago opportunity to become active in state- [society] is the next echelon of that. It al Medical Center, Evanston and Glen- region, the spokesperson said. level organized medicine. Participation brings the counties together for a com- brook Hospitals and Highland Park In related news regarding hospital net- allows physicians to express their views moncause.” Hospital, according to a network works, the boards of directors of EHS on topics affecting medicine and help spokesperson. During the past year Health Care in Oak Brook and South directISMS actions. Watch for future stories highlighting alone, Ingalls Health System in Harvey, Suburban Hospital in Hazel Crest have Serving on thecouncil for two years has otherISMScouncilsandcommittees. Northwest Community Hospital in approved an affiliation agreement that enabled David Morse, MD, a cardiologist Arlington Heights and Swedish will unite the two institutions, pending at Carle Clinic in Urbana, to provide approval by the Federal Trade Commis- inputintothecontentofthe 1994residen- sion. “The affiliation gives us an cy directors seminar. “I polled the admin- PHYSICIAN FACTS expanded managed care delivery capa- istrative staff of our residency program bility as well as access to services that regarding their needs and concerns and will enhance quality and reduce the passed that information along to council overall costs of health care for our ser- memberswhoplannedtheseminar.” Leading causes of hearing loss vice area,” said Robert Rutkowski, One common concern was that resi- South Suburban’s president and chief (Percent of individuals 3 and older) dents often face delays in obtaining an executive officer. Illinois medical license, he explained. Chicago’s Ravenswood Hospital Med- “When a resident comes here with no ical Center also joined the EHS network license, and it’s only a matter of [miss- in 1994. The health care system will ing] paperwork, it can create chaos.” In serve more than 850,000 patients a year response, the council planned a discus- at 104 care sites, according to an EHS sion with members of the state Medical spokesperson. The University of Illinois Licensing Board regarding residents’ at Chicago Health Sciences Center is temporarylicensing. also affiliated with EHS. In addition, the “The residency program directors FTC recently approved the merger of seminar was very important because EHS with Park Ridge-based Lutheran there is a great deal of concern about General HealthSystem. residents not being able to gettemporary licenses in a timely fashion, particularly as we see more and more residents grad- IllinoisMedicine(ISSN 1044-6400andUSPS005-244) uate from international schools,” said ispublished biweeklyexceptthefirstweekofJanuary Dean Bordeaux, MD, a council member andJulybytheIllinoisStateMedicalSociety,Twenty NorthMichigan Avenue, Suite700,Chicago,Illinois and retired Peoria family practitioner. 60602;(312)782-1654;1-800-782-ISMS.©Copyright “The council really opened the lines of p1o9s9t5agbeyptahiedIlaltinCohisicSatgaote,MIeLdiacnadlaStocaidedtiyt.ioSneaclonmdaicllianssg communication between IDPR and resi- offices.PrintedintheU.S.A. dency program directors in Illinois, to POSTMASTER: Send address changes to Illinois Medicine,TwentyNorthMichiganAvenue,Suite700, facilitate [the licensing] process. There Chicago,Illinois60602.Subscribers:PleasenotifyIlli- was feedback not only to the department noisMedicineofficeofanyaddresschange,withold but also to the directors and their staffs mailinglabelifpossible. Subscription$12.00peryear,inadvance,postagepre- on how to complete the applications so paidfortheUnitedStates,Cuba,PuertoRico,Philippine they’reprocessed more effectively.” Islandsand Mexico. $19.00 peryearforall foreign countriesincludedintheUniversalPostalUnion.Cana- Another council project was develop- da:$12.50.U.S.currentsinglecopiesavailableat$1.00 ing ISMS’ Principles on Training and ($1.30bymail),back issues$1.50. Retention of Primary Care Physicians in JANUARY 13 1995 ILLINOIS MEDICINE *3 Watch Illinois Department of Public Health to disclose IDPH ordered to release cancer registry information raw data concerning cancer patients by type, date and ZIP code and the question- DISCLOSURE: Court rules that confidentiality will not be compromised, byKathleenfurore naires specifically composed, compiled and generated for use in the epidemiologic study of neuroblastoma cases in Illinois,” [ SPRINGFIELD ] In a move the Illi- privileged under the Illinois Health and registry,” according to a summary of the Society brief said. The amicus brief nois Department of Public Health said Hazardous Substances Registry Act and IDPH’s argument. In addition, the Medi- also reiterated IDPH’s contention that dis- sets a dangerous precedent, the state the Illinois Medical Studies Act. Releas- cal Studies Act “prohibits the discovery closure would be contrary to the provi- Supreme Court in October refused to ing the information would violate those of interviews, data or other information sions of the Health and Hazardous Sub- hear a case involving the disclosure of statutes, the department contended. For used in the course of medical study for stancesRegistryandMedicalStudies acts. confidential patient information retained example, the Health and Hazardous the purpose of reducing morbidity or “For our purposes, it’s over. We’ve by IDPH under the state’s Cancer Reg- Substances Registry Act “prohibits the mortality or for improving patient care,” turned over all the information as istry Act. By declining to hear the case, department from disclosing anygroup of the summarysaid. ordered by the court,” Schafer said, the high court let stand trial and appel- facts that identifies or tends to identify ISMS filed an amicus briefin support of adding that the data IDPH released did late court rulings directing IDPH to any cancer victim whose condition or IDPH’s position. “The trial court erred in not include patients’ names, addresses or release cancer patient data to plaintiffs treatment was submitted to the cancer requiring the director of the Illinois other potential identifiers. who are suing the Central Illinois Public Service Co., said IDPH spokesperson Tom Schafer. The plaintiffs in May vs. CIPS request- BlueCross BlueShield AMemberofthe BlueCrossand ed the registry data from IDPH. They ofIllinois BlueShieldAssociation, alleged that they or their young relatives AnAssociationofIndependent Blue Crossand BlueShield Plans contracted neuroblastoma, a rare child- hood cancer, from environmental expo- sure to coal tar pollution released from a REPORT former coal gasification site in Tay- lorville that is owned by CIPS, Schafer explained. “[IDPH was] involved because we refused to give up the confidential information, and we thought it for Illinois Physicians was serious enough to take to the Supreme Court. The issue was not necessarily just the Taylorville case, but the issue oftrustand precedence.” The trial court ordered IDPH to ILLINOIS MEDICARE PART B creolmepasleetdeetdaibleydfqaumeistliyonmneaimrbeesrtshatofwetrhee SELECTED CHANGES FOR 1995 Taylorville cancer patients as part of the department’s investigation of the cancer cluster. IDPH was also told to release the type ofcancer, date of diagnosis and Physician Fee Schedule ZIP code of all cancer victims listed in Illinois’ cancer registry, Schafer noted. • 12.2 percent increase for surgical services The completed questionnaires and spe- • 7.9 percent increase for primary care services cific cancer registry data would not • 5.2 percent increase for other non-surgical services (including anesthesia) reveal the identity of cancer victims or tend to lead to their identity, according Antigen Services to the court’s ruling. The appellate court upheld that opinion, and IDPH appealed tothe Illinois Supreme Court. • paid under physician fee schedule rather than reasonable charge system The department was concerned that if the data were released, patients could be Physician Care Plan Oversight Services identifiable, their medical information could reach unauthorized third parties • separate payment forcare plan oversight services ofhome health and hospice patients like insurance companies and the integri- • payment limited to one patient per physician if 30 or more minutes of service provided ty ofthe registry could be compromised, per month Schafer said. “Forregistrydata to be ofvalue for sta- End Stage Renal Disease (ESRD) tistical and research purposes, the data recorded must be as complete, accurate • elimination of payment for both hospital inpatient dialysis and an evaluation and andreliable ascircumstancespermit,” said management service on the same day Holly Howe, chief of IDPH’s epidemiologic studies division, in an affidavit filed • monthly capitation fee forall outpatient ESRD-related physician services placed under inthecase. “These standards ofhigh qual- physician fee schedule ity can be achieved only when the public and the physicians and institutions treat- Limiting Charges ing cancer patients are confident that the data required to be reported are necessary • Medicare law changed to clarify that no person is liable for payment of any amounts for the objectives of registration and billed in excess of limiting charges research and that confidential data will be • change also authorizes the Health Care Financing Administration to impose civil money adequately safeguarded.” Releasing such penalties and/or exclusion from the Medicare program for infractions information would set a precedent that ultimately could be used to secure data Mandatory Assignment for Non-Participating Practitioners from other similar sources, such as the state’sAIDSregistry, Schaferadded. “We fought this because we’re serious • mandatory assignment now applies to all covered services furnished by: aboutthe issue oftrust and confidentiality,” said IDPH Director John Lumpkin, physicians assistants certified nurse midwives MD. “If the state can’t protect informa- nurse practitioners clinical social workers tion physicians provide about their clinical nurse specialists clinical psychologists patients, we’re afraid they’ll stop turning certified registered nurse anesthetists it over. And if they don’t give us the information, we won’t be able to accom- (Issue: 01/13/95 - DB) plish thegoals ofthecancerregistry.” Specifically, IDPH argued that the requested documents and data were JANUARY 13 1995 Medicine Illinois EDITORIAL VOLUME 7, NUMBER 1 JANUARY 13, 1995 Try a little Illinois Medicine is published every other week except the first week ofJanuary andJuly by the Illinois State Medical Society, 20 N. Michigan Ave., Suite 700, Chicago, IL 60602. Phone (312) 782-1654, (800)782-ISMS;fax(312)782-2023.Officehours:Mon.-Fri.8:30a.m.-4:45p.m. tenderness ©Copyright 1995 bytheIllinoisStateMedical Society.Viewsand opinionsexpressed in Illinois Medicine arenotnecessarilyendorsedbytheIllinoisStateMedicalSociety.Editorialsdonotnecessarilyreflectofficial Y pmoelmibceyrosfhitph.eIllinoisStateMedicalSociety,butareintendedtoraiseissuesinmedicineofimportancetothe ou can catch more flies with through misunderstandingand anger. honey than vinegar, the saying Other studies have found similar Illinois Stale Medical Society goes. Vinegar may not entice results. A 1993 survey by the Texas AlanM.Roman,MD President flies, but a vinegary bedside manner may Medical Association revealed that of263 RonaldG.Welch,MD ChairmanoftheBoard attract malpractice lawsuits. Physicians patient families thatcollected malpractice AlexanderR.Lemer ExecutiveVicePresident are more likely to be sued if their damage awards or settlements, more patients feel the doctors have been rude, than halfwere so distressed by the physi- rushed office visits or failed to answer cian’s attitude that they wanted to sue Illinois Medicine Committee questions, according to ISMIE’s ongoing beforethe alleged malpractice occurred. EdwardJ.Fesco,MD,Chairman WilliamE. Kobler,MD risk management advice and studies For years, ISMIE has tracked the rea- AlfredJ.Clementi,MD DavidB.Littman,MD published inJAMA in late November. sons plaintiffs file malpractice suits. Two RichardA.Geline,MD SandraF.Olson,MD In one study ofobstetric cases, patients causes on the list are a personality con- RaymondE.Hoffmann,MD JanisM.Orlowski,MD were asked how long they waited before flict between the physician and the JaneL.Jackman,MD ErloRoth,MD seeing the doctor, how much time the patient and the patient’s feeling that HaroldL.Jensen,MD ArthurR.Traugott,MD doctor spentwith them, whetherthe doc- access to the physician was restricted or tortreatedthem respectfullyand whether thatvital information was withheld. the doctor listened to them. The physi- A recent guest editorial in Illinois Illinois Medicine Staff cians who had been sued the most Medicine was written by a physician Editor,LynnKoslowsky;ExecutiveEditor,TamaraStrom received the lowest ratings on almost all who said he believes he has never been Production/DesignManager,CarlaNolan; the questions. But physicians who had sued primarily because he treats his ProductionArtist,RitaM.Maltezos;ProductionAssistant,SeanMcMahan never been sued were most likely to be patients like friends. perceived by their patients as concerned, The advice to communicate with Advertising Information accessible andcommunicative. patients and maintain a pleasant bedside Sendalladvertisingorders,correspondenceandpaymentsto:IllinoisMedicine,20N. MichiganAve.,Suite The second study looked at obstetri- manner may sound simplistic, but it can J7a0n0u,arChyicaangdo,JulIyL.6A0d60c2o.pyIllminuosits MbeedireccienievewdilfloubrewpeuebklisshperdiorevteoryisostuheerdeTsiureesdd.aAyltehxoceupgthtthheefIilrlsitnowieseSktaotef cians’ history of malpractice claims and make a difference. Of course, a strong Medical Society believestheadvertisementsinthesecolumnsto be from reputable sources,ISMS does not the quality of clinical care the doctors physician-patient relationship doesn’t investigate the offers made and assumes no liability concerning them. ISMS reserves the right to decline, provided 5 to 10 years after those preclude the possibility of a claim or a withdrawormodifyadvertisementsatitsdiscretion. claims. Interestingly, the study showed lawsuit. No amount of kindness will AdvertisingGuidelines no difference between the clinical care necessarily eliminate bad outcomes or AdvertisementsinthisissuehavebeenreviewedtocomplywiththePrinciplesGoverningAdvertisingin Illi- provided by doctors who had been sued excessive awards. That’s one reason a nois Medicine. A copy ofthese principles is available on request. Theappearance ofadvertising in Illinois and thosewho had not. cap on noneconomic damages is critical. MedicineisnotanISMSguaranteeorendorsementoftheproductorserviceortheclaimsmadefortheprod- A possible explanation was proposed Maybe physicians can’t control some uctorservicebytheadvertiser. by one of the authors of the study, who of the problems and outcomes in PharmaceuticalAdvertising Representative said that even though physicians may medicine. But isn’t it fortunate that rela- Lifetime LearningInc., 15W. 700N. Frontage Rd.,Suite 134,Hinsdale,IL60521. Phone(708) 655-2500; not make technical mistakes, they can tionships with patients can always be fax(708)655-2602. still provoke a malpractice claim improved? PRESIDENT’S LETTER With heart and soul Y Alan M. Roman, MD ou’ve got the weekend off, perhaps three days if you’re Professionalism goes beyond beinggood physicians. Itisreflected by lucky. Time with your significant other hasn’t been that caring physicians who always function as advocates for our patients, significant. Most weeks you put your 40 hours in before especially for the poor and vulnerable. Our unique blend of art and lunchtime on Wednesday. That great career and lifestyle have scienceenables ustoserveothersratherthanseekfinancialrewards. somehow remained just over the horizon. In so many ways, we live Caring for patients is our highest priority. Public esteem and trust like everyoneelse. are the greatest rewards of practice and differentiate medicine from But in other ways, we’re different. Consider some simple arith- otheroccupations. Certainly, societycan learn lessons from the efforts metic. Take one dedicated man or woman, add a medical career, ofitsphysicians. Lessonsonservingothersregardlessoftheirabilityto add a spouse and children, and perhaps a promotion. Now, add pay and on treating people equally. Lessons of working nights and pressure, frustration and change and subtract time. There are no weekends with the only reward being improving the lot of others, time-outs. Noexcuses. We are expected to-and do-deliver a level while your family waits for you at home. How often I see colleagues of excellence seldom matched by other professions. Concerned takeextratimewithpatientswhodesperatelyneed it. aboutthe present butkeepingan eye on the future, wego flatout. At ISMS, we not only talk the talk, we walk the walk. Our beliefs Our unique Doctors work long hours, time spent understanding patients and are supported by thoughts, feelings and action. We give our time, addressing their concerns. We respond to endless patient problems, our energy and our expertise, believing that the more we under- blend ofart many of which are beyond our control. Many physicians carry the stand, the more we can do. At your Society, it’s not a matter of workloads ofthree orfour people. how farwe’vecome, but how farwe’regoingto go. and science In the average American household, dinner lasts about 30 min- In so many ways, we doctors do live like everyone else. We work. utes. In many doctors’ families, it is less than 15. Doctors skip fami- We make mortgage payments, and we struggle over concerns relat- enables us to ly events and work long days that are tired extensions of sleepless ed to children, in-laws and even money. There is so little time, so nights. Many physicians are exhausted, transient boarders who much to achieve, and we, too, gettired. serve others rarely arrive home during daylight. What little sleep there is, is However, physicians have another dimension. They are the true often interrupted by nighttime calls from nursing units or trips to heart and soul ofour health care system. The art ofcommunication rather than the emergency room. We have a strong impulse to work too hard. is not what you hear being said from people, but what you can feel Scarce time and accelerating change confront most physicians. from their hearts and see in their eyes. A heart without charity is seek financial Doctors in Illinois areconcerned about loss ofcontrol and decision- theworst hearttrouble ofall. making authority, as well as increased competition. The pace of Physicians’ kindness, honesty and gentleness let others know we rewards. change is breakneck in a society where, according to the U.S. care. Our patients continue to receive the best possible care when Department of Labor, three out of every four workers will need they demand nothing less than the true power of our ability. You retraining by the year 2000, and in the next century, the average know what counts is not always what is in our heads but what is in U.S. workerwill change jobs six times and professions three. our hearts. You knowthat. I know that. Our patients know that. JANUARY 13 1995 ILLINOIS MEDICINE *5 9 9 4 1 HIGHL IGHTS working ISMIE Physician-First Service for As part ofits ongoingcommitmentto place policyholders first, ISMIEcontinued its risk management you seminars in 1994. Programs covered loss-prevention strate- gies for physicians, management of malpractice suits and Legislative risk reduction for office staff. A timely new seminar, “Risk achievements Management Issues in Man- aged Care,” focused on liabili- ISMS supported an economic ty related to managed care. credentialing bill that passed the One of the speakers was General Assembly, becoming Alfred Clementi, MD, chairman of the ISMIS J. the first Board ofDirectors. such state law in the country. 1994 election The mea- sure pro- The attainment of a medical vides due majority in Springfield com- process bines control in the General protec- Assembly with a friend in the tions for governor’s office for the first hospital time in 24 years. With medical IMPAC, ISMS worked tire- staff lessly to ensure that your members. needs and those of your So if your patients would be well met. medical The Society continued its posi- staff priv- tive working relationship with ileges are the governor. ISMS President threat- Alan M. Roman, MD, attend- Granberg ened for ed the signing of a bill aimed economic reasons, you are now atosteoporosis prevention. ensured a fair hearing and other due process provisions. The bill’s sponsors were Sen. Robert Madigan (R-Lincoln) and Rep. Firstperson level because doctors at the local level Kurt Granberg (D-Carlyle). make personal contacts with legislators Making friends and getting involved and conduct phone-a-thons to raise New state legislation, backed funds for physician-friendly candi- by ISMS, allows for the cre- dates. Through IMPAC, I have met MD ation of medical savings ByJamesMilam, not widely affected our area yet, state- many elected officials in the area and accounts to help patients make level discussions and actions yield good provided input about physicians’ con- funding decisions about their § Fresh out of my residency, I information we can take back to the cerns on legislative issues in Illinois. health care. opened a solo Ob/Gyn practice in physicians in ourcommunity. I’m now on a first-name basis with the Vernon Hills in January 1991. I didn’t That information exchange benefits legislator who represents the district Another bill endorsed by ISMS know much about organized medicine physicians year-round. For example, that includes the and passed by the General then, other than that a large group of many physicians here in Lake County *5 hospital where I Assembly requires health care physicians from ISMS went to Spring- are just beginning to feel the effects of « practice, Condell providers to use uniform insur- field in 1985 to lobby for tort reform. managed care. It has been useful for us •§• Medical Center. ance claim and billing forms, as But I decided to join organized to see how those issues are being dealt ° I’ve heard people part of an incremental medicine to socialize with other physi- with in areas experiencing greater liken organized approach to insurance reform. cians and make local contacts in the managedcare activity. medicine to insur- medical community. Illinois physicians have also gained ance: You don’t The Society successfully In 1993, I was elected to serve as an protections through ISMS advocacy. want to think opposed attempts to set term alternate delegate from Lake County to Although economic credentialing has about it until you limits of four consecutive years the ISMS House of Delegates. Then in not been a problem in Lake County, need it, and then for members of the Medical 1994, 1 moved up to full delegate. As a we learned about the practice when you really want its support. Physicians Disciplinary Board. The mea- delegate, I can bring the local concerns ISMS sought codification of due pro- are often pulled in several directions - sure also required a two-year of physicians to the attention of the cess provisions for physicians’ hospital from their practice, family and civic wait before reappointments. state House of Delegates. The state medical staff privileges. Now we’re on and religious organizations, all com- society represents all 18,000 physician guard, and we knowthatwe have legal peting for time. But we can’t afford to A bill supported by ISMS and members, butthe Lake CountyMedical protections regarding economic cre- say we don’t have time for organized passed by the General Assembly Society numbers only about 600 mem- dentialing. Recently, our hospital med- medicine. As I say to myself, If I don’t mandates that court-ordered bers. So sometimes a local issue may ical staff changed its bylaws to incor- do it, whowill? awards to crime victims include not have statewide appeal. But the pro- porate thoseprotections. After four years in organized payment to providers of prod- cess does work. I see firsthand through The success of ISMS programs and medicine, I can honestly say that I’ve ucts or services, such as health the business conducted at meetings that activities depends on the participation realized the original purpose for which care providers. the interests of local physicians are of individual members. IMPAC, the I joined: I’ve made some very good always considered. And even if issues Society’s political action committee, is friends. And I’ve derived personal satis- affecting other areas of the state have a perfect example. It works at the state faction fromgetting involved. (Continuedon page 6) 61LLINO9IS MEDICINE JANUARY 13 1995 9 4 HIGHLIGHTS Patient advocacy and education ^AED ISMS focused on public health issues in 1994. To promote Health system reform ISMS’ Teen AIDS and STD Awareness Program, Chris ISMS worked hard on your behalfto keep a patient Zorich of the Chicago Bears and to enable membersto thrive in the emerging and former Chicago Bull John ketplace. Member briefings were held Paxson recorded public service aboutthe bills before Congress. announcements. Through the Washington Presence program, ip and brIoncchluurdeed“iSntrtahieghptroTgarlakmtios tTheeens About: Sex, AIDS and Dis- grass-roots physicians metwith keyIllinois legisl nation’s ease,” to be used in physicians’ offices and schools. Call (800) capital. ISMS Third District trustee Janis Orlo and Neil Winston, MD, are shown below talking Carol 782-ISMS or (312) 782-1654 for freecopies foryour office. Moseley Braun (D-Chicago). The Society repres your patientswell inthe national healthcarereformd Tort reform progress The 1994 general election victories provide the most favorable environ- ISMS referral networks ment in years for achieving caps on Helping ISMS members through the noneconomic damages in Illinois in maze ofchanges in the medical mar- 1995. The Society will continue this ketplace was paramount in 1994. battle, and with your continued support, wecanmount a strongoffense! The Society introduced the Lawyer Referral Network to put you in touch with the legal expertise you need. The foundation was also laid for a consultant referral network, which will be available in 1995. For help,justcall (800) MD-ASIST. A lot of satisfied patients and one disgruntled trout. Rankedin 1990byInc. 500asoneofthenation’sfastestgrowingprivatelyheldcompa- nies,JSAcontinuestoadvanceasaleaderinmanagedcare.Andourexceptionalpatient satisfactionratingsspeakforthemselves. Ifyou’reapracticingphysicianspecializingin internalmedicine, familypractice,orpediatrics,you’repositionedtoshare inoursuccess. Primarycare istheheartbeatofJSA. WithournewWaukeganoffice Vhat do you get scheduledtoopeninearlyspring, youcanchoosebetweenopportuni- ties inthenorthernChicagosuburbs when you cross orourexistingKenosha,Wisconsin site. Bothlocationsfeatureour conceptofa“one-stop”Family a physician with HealthCenterwhichputsall ancillaryserviceson-site including laboratory, radiology, mammography, JSA Healthcare andpharmacy.JSAmanagesthe practice,soyouca—nspendyourtime Corporation? where it’sneeded withthe patient. Ifyou’reboardcertifiedorboard prepared,witheitherIllinoisorWisconsin licensure,you’llfindJSAaworthypartner. Ourcompensationandbenefitspackage includesan impressiveprofitsharingplan, uniquelydesignedtoputphysicianswhocareback inbusiness. Formore information,call Susan A. Bray, Director, Professional Recruitment, JSA Healthcare Corporation, MD 5565 SterrettPlace, Suite 200, Columbia, 21044. Phone (800) 966-2811; Fax (410) 964-0598. EOE. HEALTHCARE CORPORATION Partners in Great Medicine P JANUARY 13 1995 ILLINOIS MEDICINE • 7 Try a little ISMIE seminars provided risk tenderness management information to policyholders to avoid in 1994 lawsuits PAGE 5 Case in Point patient’s health is not jeopar- Good record keeping is always dized, he noted. a necessity, but it is even more “Keep in mind that the physi- important in cases involving a cian has to always be a friendly physician whose advice may Treating patients within the advocate for the patient’s inter- conflict with the treatment or ests,” added Glenn. “In a man- referral guidelines of a man- managed aged care plan, doctors have to aged care plan. “The vast constraints of care HMOs walk a narrow line because they majority of are not HMO may need the to fund going to question a physician’s their practice. However, if the decision to send a patient to a BYRICKPASZKIET of ketoacidosis, the internist The points this case makes: managed care plan opposes a specialist,” said Scott Cooper, increased the insulin dosage and This case demonstrates not only doctor’s treatment, such as MD, an emergency room physi- A physician’s first priority is to urged her to observe strict the importance of documenta- referring a patient to a special- cian at St. Francis Hospital in provide the bestpossible patient dietary precautions. However, tion but also the problems that ist, the physician should do Blue Island. “But no matter care. But managed care plans the internist failed to document can result when patient care is what is right forthe patient, not what the situation entails, a sometimes have a different pri- theconversationinwhich heout- compromised by managed care the HMO.” physician has to keep accurate, ority-namely, cutting costs. As lined the dietary instructions and plans in the name of cost con- Another issue this case raises detailed documents.” the following case demon- restrictions. In addition, he made tainment. A physician’s contract is at what point a physician Poor documentation is the strates, patient care must never no notations in her medical with a managed care plan never should refer patients to a spe- legal downfall of many medical be compromised in favor of recordsregardinganyadjustment supersedes his or her duty to a cialist. “At the outset, the practitioners, Dr. Cooper added. costcontainment. ofherinsulindosage. patient, said Kevin Glenn, internist should have referred “Notes that are handwritten, During the patient’s eighth senior partner with the Chicago the patient to an endocrinolo- illegible and too brief are unac- HMO The case in brief: An month of pregnancy, she saw law firm Bresler, Harvick and gist, especially since the patient ceptable today, when it comes to gatekeeper internist referred the internist several times. Her Glenn Ltd. was high risk,” said Wesley record keeping. In this case, the a 30-year-old patient who was blood sugar levels were abnor- “Because the internist in this Gregor, MD, a Chicago internist did sloppy documenta- in the fourth month of a preg- mal on all visits. Although the situation was faced with a high- internist. “This situation tion. Astrictaccountofthesugar nancy to an internist wanted to refer the risk pregnancy, he or she had required an almost compulsive levelsshouldhave beenmade.” Ob/Gyn in patient to an endocrinologist or no choice but to refer the dedication on the part of the Given the constraints posed the HMO an Ob/Gyn specializing in high- patient to a specialist in fetal- gatekeeper internist, the by the HMO, the wisest course for prena- risk pregnancies, no referral maternal medicine,” said Ob/Gyn and an endocrinolo- for the gatekeeper internist tal treat- was made because of the eco- Glenn. “Although the managed gist, because of the mortality would have been to send every- ment and nomic constraints of the man- care plan’s guidelines may have and morbidity associated with one concerned - the patient, delivery. agedcare plan. recommended anothercourse of this form ofdiabetes.” Ob/Gyn and HMO personnel - The patient At her last visit to the treatment, the internist, acting Since all the warning signs a certified letter that document- had a 15- internist, the patient com- in the patient’s best interests, existed, the physician should ed the physician’s prescribed year history of insulin-con- plained of severe abdominal should have appealed the plan’s have made a referral, regardless treatment, Glenn said. “Even if trolled diabetes mellitus. pain. He immediately referred decision.” of the managed care plan’s the patient decided not to see During her pregnancy, the her to the Ob/Gyn. The woman A managed care plan’s guide- guidelines, Dr. Gregor said. the specialist, at least the physi- patient continued to see the delivered a stillborn infant later lines are based on broad experi- “This was a judgment call on cian would have given himself internist for monitoring of her that day. ence and, in many cases, simply the partofthe physician, and he some form ofprotection.” diabetes. At each visit, the Subsequently, the patientsued may not apply to an individual should have pursued his recom- patient was found to have high the internist for failing to refer patient’s condition, Glenn mended course oftreatment [by “Case in Point” is a regular sugar levels and to be insulin- her to a specialist for her dia- explained. The gatekeeper is referringto a specialist].” feature using hypothetical case dependent. betes. The case was settled in responsible for appealing deci- The lack of adequate docu- histories to illustrate loss-pre- When the patient showed signs favorofthe plaintiff. sions in such cases to ensure the mentation was also a factor. vention maxims. ROUNDUP Mfl L RflCT CE I Hospital negligentfor HIV-tainted transfusion Court says relative’s consent OK An Ohio woman who contracted the AIDS virus from a blood transfusion during A New York appeals court recently ruled that obtaining informed consent from a elective back surgery in 1985 will receive an undisclosed sum from the Columbus patient’s relative was a complete defense to the plaintiffs’ claim of lack of hospital in which the transfusion was given, accordingto a summary ofJeanne vs. informed consent, according to a summary ofTibodeau vs. Keeley in Malpractice the Hawkes Hospital of Mt. Carmel, reported in the National Law Journal. Law 8t Strategy. During the trial, the defendant physician said he told the patient Before the surgery, the patient had donated her own blood in case she needed a that he needed surgeryto clamp an aneurysm. The doctor said he informed a rela- transfusion. But when a second unit of blood was necessary, she was given blood tive of the patient about possible surgical risks and options because he feared the that proved to be tainted with HIV. The patient tested positive for the AIDS virus information would have adversely and substantially affected the patient. The trial 15 months after surgery. Subsequently, she sued the hospital for negligence and courtruled infavor ofthephysician, and the plaintiffs appealed. for administering an unauthorized transfusion, the article said. The appeals court affirmed the lower court’s ruling. The court said the plaintiffs A jury initially awarded $12 million to the patient, who remains healthy. The “had failed to rebut the defendant doctor’s testimony with evidence that the trial court judge reduced the award to $8.15 million, a decision that was upheld patient’sconditionwas less serious thanthe doctorhad indicated in histestimony.” by the Ohio Court ofAppeals. The hospital appealed to the Ohio Supreme Court The appeals court also found that the plaintiffs had failed to prove the physician because the $8.15-million award exceeded the state’s cap on noneconomic dam- could have told the patient about some of the surgery’s risks and alternatives in ages in medical malpractice cases. Prior to the Supreme Court hearing, however, spite of his condition. In addition, the plaintiffs hadn’t shown “that a reasonable the cap was declared unconstitutional in an unrelated case. The hospital ultimate- person in the patient’s position would have decided against undergoing the proce- ly settled for an undisclosed sum, according to the article. dure,” even ifthephysicianhad described the risks and options, thecourtsaid. 8 LLINOIS MEDICINE EDUCATION The dual-degreed physician More doctors are rounding out their credentials with advanced business training. BY RICK PASZKIET A master’s degree in business administration, Callan, MD, vice president for medicine and regulato- often touted as a prerequisite to the execu- ry affairs for Abbott Laboratories and chairman of tive suite, is now being pursued by a seem- ISMS’ Medical Legal Council. “In my case, I think ingly unlikely group of professionals - that my MBA increased my stature in the organization physicians. In today’s marketplace, an and showed that I was more than just an MD. Sud- MBA is deemed essential for physicians denly, Iwasperceived in a differentmanner.” who aspire to executive management positions in hos- Along with the MBA, the master of health adminis- pitals and health-related companies. But it is also tration degree has become the preferred credential of becoming a more populartool to help doctors manage senior managers in hospitals. “Once I committed to thecomplexities ofrunning a modern practice. beinga manager on a full-time basis,I feltthatI needed The dual-degreed physician is no longer a novelty. the range ofknowledge associatedwith an MHA,” said Nearly 10 percent of physicians in management posi- Bob Klint, MD, CEO of SwedishAmerican Health Sys- MHA tions have MBAs, while 38 percent of all such physi- tems in Rockford. “The gives the physician exec- MBA cians are working on an or planning to enter an utive a good background in medical staffing, quality MBA program, according to a recent survey conducted assurance, risk managementand medical planning.” by Witt/Kieffer, Ford, Hadelman & Lloyd, an Oak An MBA exposes a physician to the business side of Brookexecutiverecruitingfirm. medicine, Dr. Callan noted. “The doctor who has an At the University of Chicago Graduate School of understanding ofthe business environment has a com- Business, about 5 percent of the students pursuing petitive edge over the doctor who understands only MBAs are physicians, said Don Martin, director of the clinical side. The MBA gives the physician more admissions and financial aid. “Although the percent- credibilityand therefore more options.” age may seem small, this is a vast increase from about The MBA’s appeal, though, goes far beyond the 10 years ago, and everyyearthe numbers increase.” physician who is solely interested in an executive man- “Twenty years ago, no physicians had their MBAs,” agement or administrative position. For example, the said John Lloyd, vice chairman of Witt/Kieffer. “But Witt/Kieffer survey showed that many doctors are the MBA and other similar management degrees pre- enrolling in MBA programs to cope with the increasing sent an opportunity for physicians to enter into senior business demands intheirpractices. management. “My motivation for getting an MBA was personal “Physicians who want to become CEOs realize the enrichment,” said Bipin Bhayani, MD, a Kankakee necessity of possessing a firm grasp of business issues, urologist. “With the encroachment of business and from financial management to marketing and sales,” institutional providers into the medical arena, I he continued. “The MBA and health services adminis- thought that I needed a stronger command of busi- trative degrees give them the extra knowledge and ness-related issues. Quite simply, I saw the MBA as a skills required ofupper managementpositions.” way to enhance my practice, increase productivity and In fact, manyphysicians have found that the MBA is improve the quality ofhealthcare to my patients.” a successful - and sometimes expedient - way to gain Dr. Bhayani earned his MBA from Olivet Nazarene impressive business credentials. “Two months after University in Kankakee. Designed for working man- receiving my MBA, I was promoted,” said Clair agers, this two-year MBA program covers such sub- LLINOIS MEDICINE *9 jects as financial management, human resources, me to get my MHA while I continued my career at the accounting, business ethics and marketing. “From a hospital.” practical standpoint, this program taught me how to “The demands in pursuing an MBA are strenuous, operate a computer, use a spreadsheet program and and yet most professionals can work the program into learn some basic accounting principles. More impor- their schedule,” said UIC’s Martin. “In a typical year, tantly, it showed me how to use an analytical we have 100 students in our part-time MBA program, approach when it comes to addressing the issues that which takes about two to five years to complete. affectthe business side ofmypractice.” Because the part-time program is geared for the busy Dr. Bhayani said he applies the lessons he learned in executive, the classes and course workgive the student graduate business schoolto his ownpractice. “I’ve seen a bitmore flexibility.” the results ofmy dual degree. My practice is operating For most physicians, an MBA brings more thanpres- more smoothingand efficiently becauseI’mincorporat- tige to a resume. It gives a doctor an entirely new per- ing businessprinciples intomyday-to-day activities.” spective on health care. “Medicine for a while was so “The MBA program really opened my eyes. Every fragmented,” said Dr. Bhayani. “Ifa patient wanted an course I took helped me at my job,” said Dr. Callan. expensive test done, the doctor wouldn’t dare say no. “The computer science instruction alone was invalu- Today, physicians haveto show some degree ofrespon- able. Now I know the scope of a computer’s capabili- sibility when it comes to curbing exorbitant medical ties and how itcan assistme.” bills. The MBA program has re-emphasized to me that Accountingwas the most dauntingcourse Dr. Callan qualitymedicinedoesn’thaveto beexpensive.” completed while pursuing her MBA. “Like many busi- With increasing numbers of doctors seeking MBAs ness subjects, it was something that I hadn’t really and similar advanced degrees, Dr. Bhayani said physi- encountered before in much detail. I had never taken cians will become more successful in discussing costs any undergraduate courses in business. But what sur- and other business-related issues with hospital man- prised me isthatnowI understand the fundamentals of agement staff, insurance and pharmaceutical compa- accountingand ammore adeptinthis area.” nies and even their own patients. Perhaps one of the biggest deterrents for physicians “There is a vast difference between the clinical and seeking an advanced degree is the time demands businesssidesofmodernmedicine,” saidDr. Klint. “The required of a doctor who practices medicine full time. physician with the MBA or MHA background has the An MBA or MHA program cannot be entered into advantageofbeingexposedto boththesesides.” lightly, because most programs require a minimumoftwoyears. “In one respect, I was very fortunate, since my practice, home and school are all in a four-mile radius,” said Dr. Bhayani. “But even though I wasn’t commuting that much, the rigors that go along with running a busy practice and MBA gettingan were still there.” In response, many graduate business schools are tailoring their programs to meet the pressures of physicians’ schedules. For instance, the University of Michigan has a two-year program whereby physicians spend four days each month in all-day classes in Ann Arbor, while the rest of the course work is done athome. Other physicians like Dr. Callan never set foot in a classroom. “The MBA degree offered by the Univer- sity ofPhoenix was an on-line program that was specifically designed for executives who couldn’t predict when they’d be in class,” she explained. “As long as I had access to my laptop computer, I could attend classes without the constraints imposed by physically going to a classroom several times a week.” Most MBA and health administrative programs take into account that their students have only limited time to devote to the program. Dr. MHA Klint pursued his parttime at the University of Minnesota, even though he was working full time as a hospital administrator. “TheMin- nesota program relied heavily on independent studies. This enabled . 10 ILLINOIS MEDICINE JANUARY 13 1995 * Lab business practices high volumes of patient specimens free pickup and disposal of biohaz- an inducement for business,” said Erlo (Continuedfrompage 1) every day,” according to the document. ardous waste products that are unrelat- Roth, MD, a Hinsdale pathologist and “Since the physician, not the patient, ed to the collection of test specimens, ISMS 11th District trustee. Physicians gives [physicians] a sense ofwhat the IG generally selects the clinical laboratory, and they cannot provide physicians should scrutinize any “freebies” or is thinking and what prosecutorial deci- it is essential that the physician’s deci- with computers or fax machines unless favors they are currently receiving from sions mightbe made.” sion regarding where to refer specimens they are used exclusively for work relat- a lab or other provider of medical-relat- The anti-kickback statute penalizes is based only on the best interests ofthe ed to the lab, the alert said. By offering ed services, Dr. Roth advised. “Stop anyone who knowingly and willfully patient.” free tests for health care providers, their accepting anything that’s been discount- solicits, receives, offers or pays in cash The OIG alert listed several possible families and employees, labs are also ed or you’re not paying market value or in kind for referrals, purchases, leas- violations. For example, allowing a lab- risking violation of the anti-kickback for, so you don’t risk being accused of es or orders for products or services employed phlebotomist to perform statute. fraud orindicted.” delivered to Medicare or Medicaid tasks normally done by a physician’s The alert also cited violations related patients, the alert said. “Many physi- office staff and paying below market to managed care. In particular, waiving following on the heels of the govern- cians and other health care providers prices for tests related to dialysis and charges for tests physicians perform on ment’s fraud alert, expanded self-referral rely on the services of outside clinical end-stage renal disease could be consid- managed care patients is also possibly provisions mandated by OBRA ’93 went laboratories to which they may refer ered violations. Labs cannot provide fraudulent. “Under the terms of many into effect Jan. 1, 1995. Those expan- managed care contracts, a provider sions prohibit referrals for physical and receives a bonus or other payment ifuti- occupational therapy, radiology and lization ofancillary services, such as lab- diagnostics, radiation therapy, home oratory testing, is kept below a particu- health care, and inpatient and outpatient YOCON lar level,” the OIG alert explained. hospital services if those referrals are “When the laboratory agrees to write off made by physicians who have financial charges for the physician’s managed care relationships with the service providers, work, the physician may realize a finan- lie said. The law also bans patient refer- YOHIMBINE HCI cciraelatbeednefbiyt tfhreomaptpheeamraanncaegetdhactaruetilpilzaan- rfailnsanctioalcoinmtpearensiteisn itfhpehmysaincdiainfsthheacvoem-a tion oftests has beenreduced.” panies are involved in the production If labs offer their referral sources any and sale of durable medical equipment; Description: Yohimbine isa3a-15a-20B-17a-hydroxyYohimbine-16a-car- valuable products or services that those outpatient prescription drugs; prosthet- AbolxsyoliicnacRiaduwmoeltfhiyaleSsetrepre.ntTihneaa(lLk)aloBiedntish.fouYnodhiimnbRiunbeaciesaaenanidndroellaaltkedyltarmeiens.e sources have not purchased at fair mar- ics, orthotics and prosthetic devices; and alkaloid with chemical similarity to reserpine. It is a crystalline powder, ket value, the government could infer parenteral and enteral nutrients, equip- odorless. Eachcompressedtabletcontains(1/12gr.)5.4mgofYohimbine that the gifts are intended to induce mentand supplies, he said. Hydrochloride. Action: Yohimbine blocks presynaptic alpha-2 adrenergic receptors. Its referrals, the alert said. Accepting those “There are increasingly large gray actiononperipheralbloodvesselsresemblesthatofreserpine, though itis offers is also potentially illegal for refer- areas [regarding fraud and abuse],” lie weakerand ofshortduration. Yohimbine’s peripheral autonomic nervous ral sources, including physicians. The concluded. “Physicians should seek very ssyymsptaetmheetfifcect(aidsretnoergiincc)reaascteiviptayr,asyftmpiasthteotibce(ncohtoeldinetrhgaitc)inanmdaledecsreexausale OIG defines fair market value as “value sophisticated legal advice if they have or performance, erection is linked to cholinergic activity and to alpha-2 ad- for general commercial purposes” are considering any economic interest in dreencerregaiscedblpoecnkialedeouwthfilcohwomrabyotthh.eoreticallyresultinincreasedpenileinflow, reflecting an “arms-length transaction a facility to which they refer patients.” Yohimbineexertsastimulating action on the moodand may increase [that] has not been adjusted to include He cited participation in integrated net- anxiety. Suchactionshavenotbeenadequatelystudiedorrelatedtodosage the additional value [that] one or both of works as one situation that creates a aanlttih-oduigurhettihceyaactpipoena,rtpororbeaqbuilryevhiiaghsdtoimsuelsatoifotnheodfruhgyp.otYhoahlimmibcinceenhtaesrsamaiMnldd the parties have attributed to the referral complex and potentially problematic releaseofposteriorpituitaryhormone ofbusiness between them.” financial relationship for physicians. Reportedly,Yohimbineexertsnosignificantinfluenceoncardiacstimula- Physicians and clinical labs thatviolate “The law isn’t obvious. Physicians must tpiroenssaunrde,otifhearnye,ffweocutsldmebdeitaoteldowbeyrBit-;ahdorweenveerrgincoraedceepqtuoartse,sittusdeifefsecatreonatbhlaonodd the anti-kickback statute are subject to becareful.” toquantitatethiseffectintermsofYohimbinedosage. criminal penalties and exclusion from For general information about the Indications:Yocon®isindicatedasasympathicolyticandmydriatric. Itmay the Medicare and Medicaid programs, Medicare and Medicaid Anti-Kickback hCaonvteraacitnidviictaytaisonasn:apRhernoadlisdiiasce.ases, and patient’s sensitive tothedrug. In the alert said. Statute, physicians maycall ISMS’ health viewofthelimitedandinadequateinformationathand,noprecisetabulation “The important thing for physicians to care finance division at (800) 782-ISMS canbeofferedofadditionalcontraindications realize is that any favor they receive or or (312) 782-1654, ext. 1131. Wmaursntinngo:tbGeeneursaeldlyd,urtihinsgdprrueggnisanncoyt.prNoeiptohseerdifsotrhiussedriungfepmraolpeossaenddfocrerutsaienliyn anything they get that they pay less than For legal advice about specific referral pediatric, geriatric or cardio-renal patients with gastric or duodenal ulcer market value for from outside labs or arrangements, ISMS members may con- history. Norshould itbe used in conjunctionwith mood-modifyingdrugs hospitals that provide lab work for tact the Society’s Lawyer Referral Net- AsduvcehrasseaRnteiadcetpiroensss:anYtosh,iomrbiinnepsryecahdiialtyripcenpeattriaetnetssitnhege(neCrNaSl).andproducesa physician’s offices can be interpreted as work at (800) MD-ASIST. complexpatternofresponsesinlowerdosesthanrequiredtoproduceperiph- erala-adrenergicblockade. Theseinclude,anti-diuresis,ageneralpictureof central excitation including elevation of blood pressure and heartrate, in- creasedmotoractivity,irritabilityandtremor.Sweating,nauseaandvomiting arecommonafterparenteraladministrationofthedrug.12 Alsodizziness, headache,skinflushingreportedwhenusedorally.1-3 Illinois hospitals ranked among country’s best Dosage and Administration: Experimental dosage reported intreatmentof eorraelcltyi.leOicmcpaostieonncael.s1i-3de-4eff1etcatbslretep(o5r.t4edmgwi)th3tthiimsedsoasadgaey.arteonadauulsteam,aldeiszztiankeesns CHICAGO Evanston and Glen- Glenbrook Hospitals. “Clearly, this otrimneesrvaoduasyn,efsosl.lowInedthbeyegvreandtuoaflsiindcereefafseecststodo1staagbeletto3bteirmeedsuaceddayt.oVRietpaobrletted3 b[rook Hospitals]and Community Hospi- award is due in large part to the excel- therapynotmorethan10weeks.3 tal of Ottawa have been named among lence of our professional staff, whose HowSupplied:OraltabletsofYocon®1/12gr.5.4mgin thecountry’s 100 best-performing hospi- clinical skills and leadership allow us to bottles of 100's NOC 53159-001-01 and 1000's NDC tals. The rating was based on a 1993 continue to provide high-quality, cost- 53159-001-10. References: nationwide study of some 4,000 acute- effective patient care.” The study also 1. A. Moralesetal., NewEnglandJournalofMedi- care hospitals conducted by Mercer ranked Evanston and Glenbrook Hospi- 2. Gcionoe:dm1a22n1,.GNiolvmeamnb—er1T2h,e1P9h8a1rmacologicalbasis Health Provider Consulting in New tals among the top 15 major teaching ofTherapeutics6thed.,p.176-188. York and HCIA, a health care informa- hospitals nationwide, a hospital McMillanDecemberRev. 1/85. tioncompany in Baltimore. spokesperson said. 3. W1e9e83k.lyUrologicalClinicalletter,27:2,July4, The study, “100 Top Hospitals - “We’re very proud that our hospital is 4. A.Moralesetal.,TheJournalofUrology128: Benchmarks for Success,” placed hospi- considered to be among the best in the 45-47,1982. tals in five peer groups according to size, nation, especially after reviewing the Rev.1/85 geographic location and teaching status, qualifications necessary to be included in and examined their clinical, operational this group,” said Robert Schmelter, pres- and financial performances, according to ident of Community Hospital of a report in Modern Healthcare. Other Ottawa. “It is clear from the study that AVAILABLEATPHARMACIESNATIONWIDE U.S. hospitals would save $21.6 billion, changes made within the hospital indus- PALISADES trim patient stays by a day and lower try over the past few years are beginning CHO PHARMACEUTICALS, INC. mortality rates by 17percent and compli- to takeeffect. It is alsoclear that is cation rates by 14 percent if they per- moving in the right direction by striving 64 North SummitStreet formed at the same level as the hospitals to reduce costs without sacrificing quali- Tenafly, NewJersey07670 cited in thetop 100,thestudyconcluded. ty ofcare or the financial viability ofthe (201)569-8502 “We are pleased to receive such hospital.” Community Hospital of 1-800-237-9083 national recognition,” said Mark Nea- Ottawa was one of only 20 rural hospi- man, president and chief executive offi- tals with fewer than 250 beds that made cer of Evanston Hospital Corporation, the top-100 list, according to a hospital which owns and operates Evanston and spokesperson.