Clark County Medical Society

County Line

Newsletter 81 October 06

Malpractice Filings Against Health Care Providers, Jan 2001 – Aug 2006

Member News

2006-2007 CCMS Committees

Southern Nevada Health Officer Report

Alliance Message

LIABILITY LIMITS OF $500,000/$1,500,000 - PRUDENT OR IMPRUDENT?

Congress Considering New Mandates for Medical Providers

Minutes Synopsis

Classified Ads

CME Calendar

County Line Advertisers

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PRESIDENT’S MESSAGE

By Florence Jameson, M.D., 2006-2007 CCMS President

Dear Fellow Medical Professional

I am writing to you this month on a very urgent matter. We are fast approaching the General Election in November. There are candidates who have vowed to help the medical community in providing better access to medical care. It is vital that we show our support and that we encourage our patients to show support to the candidates who have vowed to provide better access to medical care.

I wish to share with you a few key races that deserve our attention. I am also providing a handout which you can easily copy and pass along to patients. In the work on Tort Reform the medical community has shown that it can be a formidable force for progress. We must continue to show the same resolve. There are those who would unwind the progress that we have made.

Governor's Race

In the race for governor there are two candidates who have worthy credentials for being our next governor. While both have shown their support for the medical community, one candidate stands out, on balance, as being the better candidate, Jim Gibbons. The Democratic candidate, Dina Titus, opposed the Tort Reform embodied in Question "3". If we had lost that hard-fought battle, it is clear that many more physicians would have left the state. Jim Gibbons has always served our interests while in Congress, just recently by advocating in Congress for action on the Medicare sustainable growth rate (SGR) formula. If left unchecked under the current scheme, the SGR will cut payments to physicians and health care professionals by almost 5%, effective January 1, 2007. This is completely unacceptable, and Jim Gibbons is leading the fight in Congress to protect physicians.

Several physicians, including myself, have met with Jim Gibbons and he has assured us that he understands the issues facing access to good medical care in Nevada and will continue to fight hard for better access to medical care. Recent polls show the race for Governor to be extremely close. All of us need to work very hard for the election of Jim Gibbons. Please show your support by displaying banners and signs. In southern Nevada headquarters, call Brittney Evans at 702-987-3279. In northern Nevada headquarters, call Laura Woods at 775-322-4546.

Supreme Court Races

Next to the race for Governor, the next most important race is for the vacancies in Nevada's Supreme Court. In electing a candidate for the Supreme Court, it is also vital that you understand that this position has the potential to either promote access to medical care or turn back the progress that we have made thus far. Again, Clark County Medical Society has met with the candidates. The candidates we are endorsing have a reputation for following the law, rather than being lawmakers. On the basis of our meetings with the candidates we encourage you to support in all ways Michael Cherry, Cynthia Diane Steele and Nancy Saitta for the Nevada Supreme Court. Thanks to support from the medical community and others, Michael Cherry is running unopposed. Don't ever underestimate the importance of your contribution to this process.

Senate and Assembly Races

Both the Senate and Assembly races are very important. Once again there are candidates who have vowed to help access to medical care in Nevada. We want to encourage their success in November. In the Assembly, we are especially appreciative of the fine work of our fellow physicians, Garn Mabey and Joe Hardy. In the Senate, we are thankful for the goodwill and efforts of Sandra Tiffany, Barbara Cegavske, Joe Heck and many others. Please join the Clark County Medical Society in supporting the following candidates in their races by 1) your vote, 2) your contribution to their campaign, and 3) your solicitation of your patient population for their vote.

Assembly

Linda West Meyers, District 1

Garn Mabey, MD, District 2

Francis Allen, District 4

Valerie Weber, District 5

Chad Christensen, District 13

Joe Hardy, MD, District 20

Brian Keane, District 21

Lynn Stewart, District 22

Steve Grierson, District 23

Michael Smith, District 29

Senate

Sandra Tiffany, District 5

Barbara Cegavske, District 8

Dennis Nolan, District 9

Warren Hardy, District 12

We need candidates elected who will uphold the laws in place to provide access to medical care in Nevada. We need you to request banners and posters for the above candidates to display in your offices. Please hand out flyers to your patients. It is critical in the aftermath of Questions "3," "4," and "5" that every physician be both vigilant and committed to the fight for access to good medical care in Nevada.

As you are well aware, there is widespread voter apathy. Having traveled to many countries and seen other forms of government, I do not need to tell you how immeasurably blessed we are to live in a democracy, where we have both the privilege and the obligation to vote. As responsible citizens of the community, we should all vow to make our votes count and to encourage our patients to celebrate the freedom that is represented by a democratic system. My intention is not to be sappy about this matter; my intention is to merely impress upon you that the battle for access to medical care is far from over. Your participation is vital.

There are those who are sharpening their knives ready to slice up the progress we have made. Many of us still live on thin ice in our profession. For many it is difficult economically, psychologically and physically to keep up. We have got to make the environment better for quality medical care. That requires all of us to work hard on the political front. If we suffer reversals either in the Executive Branch, the Legislative Branch or the Judicial Branch it may well be permanent for some of us. Let us keep our resolve firm. Let us encourage our patients to vote responsibly. Thank you for getting the word out, now!

Included with this article is a handout that you can give patients. Please do so. Thank you.

Your Doctor

Urges You to Vote in November

For Candidates who have vowed to assist Access to Medical Care and

Keep the KODIN Initiative Question #3 unchanged

Your support is Critical in this Election Year

Governor: Jim Gibbons

NV Supreme Court: Michael Cherry, Cynthia “Diane” Steele, and Nancy Saitta

Attorney General: Catherine Cortez Masto

Senate: Sandra Tiffany, District 5

Barbara Cegavske, District 8

Dennis Nolan, District 9

Warren Hardy, District 12

Assembly:

Linda West Meyers, District 1

Garn Mabey, MD, District 2

Francis Allen, District 4

Valerie Weber, District 5

Chad Christensen, District 13

Joe Hardy, MD, District 20

Brian Keane, District 21

Lynn Stewart, District 22

Steve Grierson, District 23

Michael Smith, District 29

District Court: Timothy Williams, District Court 16

Susan Johnson, District Court 22

Bill Henderson, District Court 23

Initiative #5: Vote YES

Initiative #4: Vote NO

Stay alive, vote yes on 5

Shut the door, vote no on 4

Endorsed by the Clark County Medical Society’s political action committee, MedPac

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 – Aug 2006

2001 2002 2003 2004 2005 2006

Jan 39 33 108 61 41 50

Feb 20 14 98 72 63 61

Mar 35 30 169 123 64 38

Apr 37 34 111 81 70 58

May 37 35 126 65 14 71

Jun 27 24 103 90 65 83

Jul 19 100 114 45 66 74

Aug 54 51 76 67 33 82

Sep 20 65 105 79 36

Oct 37 83 110 59 26

Nov 38 184 59 78 68

Dec 9 170 67 47 30

Sum 372 823 1246 867 581

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Member News

Congratulations and Welcome to the Clark County Medical Society New Members –

September 2006

· Carl E Allen, MD - OB-Gyn, PO Box 15645, Las Vegas, NV 89114

K Leslie Avery, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Tracy J Butler, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
L Eugene Daugherty, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
John H Duong-Tran, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Ruchi Garg, DO – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Joseph A Gassen, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Diane C Lipscomb, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Eva D Littman, MD - Reproductive Endocrinology, 653 Town Center Dr 206, Las Vegas, NV 89144
Michael S Mall, MD - Family Practice, 3201 S Maryland Pkwy 220, Las Vegas, NV 89109
Porferia D Montesclaros, MD – Psychiatry, 6450 Spring Mountain Rd 8, Las Vegas, NV 89146
Michelle M Pastorello, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Kevin Sinai, DO - Family Practice, 3201 S Maryland Pkwy 220, Las Vegas, NV 89109
James D Swift, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Paula A Vanderford, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109

Congratulations and Welcome to the Clark County Medical Society

New Student Member - September 2006:

Patrick A Thompson - Touro University

Applicants to Go Before Credentialing Committee

If you have any pertinent information about the following membership candidates, please contact:

Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120

Atoya B Adams, MD - Internal Medicine
Wilbert Cain, MD - Family Practice
Shanker N Dixit, MD - Neurology
Timothy J Eichenlaub, DO - Family Practice
Donna M Miller - OB-Gyn
Charmaine G Yap, MD – Endocrinology

Reinstated Members:

Stuart Hoffman, MD - General Surgery
Carlos Araujo, MD - Hematology/Oncology

For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989.

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2006-2007 CCMS Committees

Bylaws, Policies and Procedures Staff person - Jamie Alberti

1. Warren Evins, MD - Chair

2. Max Doubrava, MD

3. Chandra Narala, MD

4. Joram Seggev, MD

Building Committee Staff person - Jamie Alberti

1. John Nowins, MD - Chair

2. Jay Coates, MD

3. Ron Kline, MD

CME Committee Staff person - Jamie Alberti

1. Michael Gross, MD - Chair

2. Daniel Fabito, MD

3. Louis Fink, MD

4. Mitchell Forman, DO

5. Michael Lee, MD

Community Health/Relations Staff person - Marlaina Burns

1. Jerry Jones, MD - Chair

2. Farooq Abdulla, MD

3. George Alexander, MD

4. Daniel Batlan, MD

5. Jonathan Bernstein, MD

6. Susan Boyd, MD

7. Vasana Cheanvechai, MD

8. Lesley Dickson, MD

9. Florence Jameson, MD

10. Ron Kline, MD

11. Beata Kwiatkowska, MD

12. Chandra Narala, MD

13. Marietta Nelson, MD

14. Lausanne Orendain, UNR Student

15. Mel Pohl, MD

16. Hamidreza Sanatinia, MD

17. Joram Seggev, MD

18. Irwin Simon, MD

Credentials Committee Staff person - Marlaina Burns

1. Carol Vanderharten, MD, MD - Chair

2. Joseph Adashek, MD

3. Howard Baron, MD

4. Mitchell Forman, DO

5. Parker Kurlinski, MD

6. Nafees Nagy, MD

NSMA Government Affairs Staff person - Dot Freel

1. Max Doubrava, MD - Chair

2. Daniel Batlan, MD

3. Keith Brill, MD

4. Raj Chanderraj, MD

5. Jay Coates, MD

6. Lesley Dickson, MD

7. Michael Lee, MD

8. Sanjay Malhotra, MD

9. Nafees Nagy, MD

10. Rhonda Robbins, MD

11. Carol Vanderharten, MD

Membership Committee Staff person - Marlaina Burns

1. Noel Harrison, MD - Chair

2. Chandra Narala, MD

3. Archie Perry, Jr., MD

NSMA Delegate Committee Staff person - Jamie Alberti

1. Annette Teijeiro, MD - Chair

2. Jonathan Bernstein, MD

3. Max Doubrava, MD

4. Warren Evins, MD

5. Parker Kurlinski, MD

6. Donald Kwalick, MD

7. Michael Lee, MD

8. Peter Mansky, MD

9. Anita Pomerantz, MD

10. David Pomerantz, MD

11. Rhonda Robbins, MD

12. Himansu Shah, MD

13. Ronald Slaughter, MD

14. James Tate, MD

15. Carla Turner, MD

16. Carol Vanderharten, MD

17. Jonathan Zucker, MD

Nominating Committee Staff person - Marlaina Burns

1. Michael Verni, MD - Chair

2. Michael Colletti, MD

3. Warren Evins, MD

4. Ron Kline, MD

5. Frank Nemec, MD

6. Ronald Slaughter, MD

7. Carol Vanderharten, MD

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Southern Nevada Health District Report

Improving low immunization rates in Clark County

By Donald S. Kwalick, MD, MPH, Chief Health Officer, Southern Nevada Health District

The Centers for Disease Control and Prevention released the results of the 2005 National Immunization Survey (NIS) on September 14, 2006. The NIS provides vaccination coverage estimates among children 19-35 months for each of the 50 states and selected urban areas. Of the 27 areas separately sampled Clark County was identified as having the lowest immunization rates for the age group and series of vaccines surveyed.

The Clark County vaccination coverage rate for children aged 19-35 months is 58.8 percent. The overall rate for Nevada is 63.2 percent and the rate for the rest of the state (not including Clark County) is 75.8 percent.

This survey marks the first time Clark County was assessed separately from the rest of the state. Clark County was selected to be surveyed as a separate urban area due to the unique challenges that result from the tremendous growth of the county and the 24-hour nature of the community.

When the health district was asked to participate as an urban area in the survey process they immediately agreed. Staff knew the rates for Clark County were much lower than what had been portrayed in the past when it was included with the rest of the state. The 2005 rates released in the survey demonstrate the need to concentrate more immunization resources in Clark County in order to keep children in Southern Nevada healthy and appropriately immunized.

The Southern Nevada Health District provides more than 300,000 immunizations each year to children and adults. The district tracks vaccine coverage rates for its clientele that correspond to those released in the NIS. Health district client coverage rates for the corresponding vaccines range from more than 70 percent to 86 percent.

A recent study conducted by the American Journal of Public Health evaluated the direct impact of the CDC's Immunization Grants program on vaccination coverage rates. The results showed that increases in funding were significantly associated with higher rates of vaccination coverage.

We have worked closely with the CDC to evaluate our program and have continually received feedback confirming that the health district is utilizing all resources available and has developed an effective immunization program. We now need to secure additional resources that will enable the health district to expand its programs and work with community partners and health care providers to ensure they have the resources they need to appropriately immunize the children they serve as well as have access to an integrated system for tracking coverage rates.

The results of the survey were not a surprise to the staff at the health district. We participated in this program knowing it would be an opportunity to demonstrate the need for increased programs and funding in order to improve immunization services for children in Clark County. Physicians that participate in the state's Vaccines for Children (VFC) program can have a significant impact on Clark County rates by ensuring they accurately track the vaccinations they administer and implementing a recall system for alerting patients when vaccinations are due.

The recommended vaccine series detailed in the survey includes: four doses of diphtheria and tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids vaccine, or diphtheria and tetanus toxoids vaccine and any acellular pertussis vaccine (DTP/DT/DTaP); three doses of poliovirus vaccine; one dose of measles, mumps, rubella (MMR) vaccine; three doses of Haemophilus influenzae tybe b vaccine; three doses of hepatitis B vaccine; and one dose of varicella (chicken pox) vaccine. The survey included children born during February 2002 -

July 2004.

More information about the Southern Nevada Health District immunization program is available at: http://www.southernnevadahealthdistrict.org/nursing/immunizations.htm or by calling 759-0850.

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Alliance Message

By Pauline Lee & Andrea Yu, 2006-07 CCMS Alliance Co-Presidents

For nearly 40 years, the Alliance has had a tradition of hosting fundraising events benefiting various local charities and community projects. This year, the Executive Board of the Alliance has selected the American Stroke Association and the American Heart Association as the beneficiaries of the Alliance's year long fundraising efforts. The decision to support the American Stroke Association (ASA) and the American Heart Association (AHA) was an easy one as the ASA and AHA sponsor specific local programs directed towards stroke victims in Clark County.

For example, the Stroke Peer Visitor Program involves the participation of stroke survivors and caregivers whose mission is to provide information and support to hospital patients, who have recently had a stroke, and their caregivers. The Stroke Visitor Program trains survivors and caregivers to become outreach volunteers to those newly affected by stroke. The training focuses on stroke education and information, basic counseling skills and sharing of community resources. Once a volunteer is trained as a Stroke Peer Visitor, the volunteer then visits stroke patients in hospitals, nursing homes and rehabilitation centers to help them begin the recovery process. Currently, seven support groups meet regularly in Las Vegas at participating hospitals, community centers and faith-based organizations.

Another worthwhile program is the Saving Strokes Golf Clinic, which is a golf fitness and training program for stroke survivors. Stroke survivors in all states of recovery are evaluated by physical therapists and then teamed with golf pros for hands-on experience proving how golf can play an important recovery in their physical and emotional recovery. This year, the clinic will be held on October 20, 2006 at the Las Vegas Municipal Golf Course and will be supported by the PGA - the National PGA has chosen disabled golf as their priority for "growth of the game."

One of the goals of the AHA is to reduce stroke and stroke risk by 25% by the year 2010. To attain this lofty goal, the ASA desires to deliver a series of comprehensive campaigns to aggressively educate and promote awareness of stroke prevention to those at highest risk. At this stage, the Power to End Stroke campaign will target African Americans to increase awareness of risk factors and stroke prevention and recruit ambassadors (spokespeople) to raise funds to support the campaign and promote activities and neighborhood based community programs.

The ASA also sponsors a Heart and Stroke Conference which is a call to action to the medical community to move stroke care to the forefront and to improve clinical outcomes. The conference concentrates on education for survivors and caregivers and provides proposals for redesigning systems for health car professionals to detect and prevent stroke and heart disease.

With your support and enthusiasm, the Alliance hopes to provide more than sufficient funding for these very worthwhile local programs this coming year. For more information, please contact us at info@ccmsa-lv.org.

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LIABILITY LIMITS OF $500,000/$1,500,000 - PRUDENT OR IMPRUDENT?

By Weldon (Don) Havins, M.D., Esq., CEO, President-Elect, & Special Counsel, Clark County Medical Society

Two months ago, the County Line published an article regarding the reduction of Professional Liability Insurance (PLI) required minimums for staff privileges at our largest Nevada hospital. The reduction of required PLI limits from $1million/$3 million to $500,000/$1,500,000 created an opportunity for PLI carriers to offer reduced PLI premiums for reduced insurance coverage to physicians. Thus far, the maximum reduction in annual premium for the reduced coverage is about 20%.

The relatively low risk of being successfully sued for medical malpractice contrasts with the potentially devastating consequences of an award or settlement over the insured's policy limits. Confusion and anxiety may result when a health care provider ponders whether the increased risk of an award or settlement exceeding reduced policy limits justifies a 20% reduction in PLI premiums. More directly, is a 20% reduction in annual premium worth reducing insurance coverage by 50%? For an OB-Gyn with an annual premium of $100,000, is a $20,000 reduction in premium worth reducing insurance by 50%? For an internist with an annual premium of $30,000, does a $6,000 reduction in premium justify one-half the prior insurance coverage?

During the recent medical malpractice insurance crisis, the Nevada Trial Lawyers Association researched medical malpractice trials in Clark County from 1996-2001. The information they provided in public forms revealed that of the 58 trials in Clark County District Court, 25 (43%) resulted in a verdict and award for the Plaintiff. The Defendant health care provider(s) prevailed in 57% of the trials. An edited chart of those verdicts is hereby appended as Exhibit A. Of the Plaintiff verdicts rendered from 1996 -2001, 60% were for greater than $500,000.

In October 2002, the A.B. 1 medical tort reform of the Legislative special session became effective. A.B. 1 eliminated the Medical Dental Screening Panel and did not provide for a firm $350,000 cap on non-economic damages. While A.B. 1 contained a few beneficial provisions, it was a disaster in addressing the continuing medical malpractice insurance crisis. The number of medical malpractice claims filed in Clark County District Court exploded, and half the insurance companies in Clark County stopped writing PLI insurance to physicians or left Nevada altogether. Those insurers remaining increased their premiums at unprecedented double digit rates annually. On November 24, 2004, the medical tort reform provisions of Ballot Question 3 (aka, the KODIN Initiative), voted into law by the people of Nevada, became effective. Ballot Question 3 medical tort reforms have stabilized the PLI insurance market, albeit at a record high level. Since November 2004, none of the five remaining PLI insurers (seven if one counts the national Anesthesiology and Ophthalmology insurance programs selling insurance to those Nevada specialists) has left Nevada or ceased selling PLI insurance. For the first time in many years, two new PLI insurers have begun selling insurance in Clark County. Virtually all insurance policies have been for the $1 million/$3 million minimum policy limits. The medical tort reforms implemented in November 2004 have facilitated the reduction of policy limits. Objective data to assist physicians in their decision to hold at the present PLI limits or to opt for the reduced policy limits is scarce.

The Clark County Medical Society has gathered some information which may be of some interest in this matter. Research by Jamie Alberti, the new CCMS office manager, and the CCMS office staff, found 62 medical malpractice trial verdicts between 2003 and 2006. Fifteen (15) of those sixty-two (62) medical malpractice verdicts (24%) were for the Plaintiff. Health care providers prevailed in 76% of medical malpractice trials during this period. A chart of the Plaintiff verdicts found by CCMS is appended as Exhibit B. Of the 15 Plaintiff verdicts, three (20%) of the awards were for greater than $500,000.

Testimony by PLI insurers during the hearings for A.B. 1 in 2002 and for Senate Bill 97 medical tort reform in 2003 indicated that only 5% of claims actually proceeded to jury trials. Ninety-five percent of claims were settled or dropped by the Plaintiff. Therefore settlement levels appear to be very relevant. Typically, medical malpractice claims settlements contain a provision disclaiming liability on the part of the health care provider. Settlements typically contain a confidentially clause provision restricting the parties from revealing any of the details of the settlement. The parties bound by these provisions are the Plaintiff and the Defendant. However, both licensed physicians and PLI insurers are mandated, under Nevada law, within 45 days of the judgment, award or settlement, to report the details of the judgment, award or settlement to the Insurance Commissioner and to the professional licensing board (the Nevada Board of Medical Examiners and the Nevada Board of Osteopathic Medicine). The Boards are not parties to the settlement agreement and are not bound by the confidentiality provision in the agreement. For several years, the Nevada Board of Medical Examiners published the allegations and settlement amounts (and jury awards) of each licensed physician on the Board's website. Two years ago, the Board reversed that policy and removed that information from its website. However, the information regarding settlements, awards, and verdicts pertaining to any particular physician is available to any member of the public through a phone call to the NBME (888-890-8210 toll-free from Clark County). Any member of the public can obtain information regarding a court claim alleging medical malpractice made against a physician by accessing the Clark County District Court's webpage. A member of the public can then call the NBME to determine if that claim resulted in a settlement, award, or judgment against the physician, including information on the allegations, and whether the Board has taken any action(s) against the licensee.

CCMS' staff was able to find 125 settlements from 2004 to early 2006. Of these 125 settlements, 25 (20%) were for more than $500,000. These settlements and the association allegations are described in the accompanying table. These are just the settlements in Clark County that CCMS was able to find. Undoubtedly, there were more settlements in this period than CCMS was able to find. There may be even more settlements greater than $500,000, but this table should give the reader some notion of the areas of medicine more likely to encounter greater risks.

The NBME does not keep its claim data in cumulative or aggregate form. They cannot provide information, in detail, on the number of settlements or the number of settlements for greater than $500,000. The Commissioner of Insurance data is not available to the public except in a format presented to the Legislature each legislative session. This information is "out-dated" in that the most recent information is over a year old. The Insurance Commission's report can be obtained by your Legislator and sent to you during the session, after the Insurance Commissioner formally presents this information to the relevant Legislative Committees. This report may contain information relevant to a physician's inquiry into the reasonableness of incurring increased risks of a settlement or award above PLI policy limits.

For CCMS members contemplating reducing their PLI insurance coverage to the lower PLI limits, we hope this information contributes to your deliberations in a meaningful manner. CCMS members can obtain the detailed unedited charts presented in this article by calling Jamie Alberti, CCMS office manager.

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Congress Considering New Mandates for Medical Providers

By Mr. Michael Pieper, Washington, D.C. representative for R & R Partners

The U.S. House of Representatives recently passed legislation, H.R. 4157, which will require all physicians' offices to accommodate the new International Classification of Diseases (ICD-10) billing code system by 2010. There is concern throughout the medical community that full implementation of the new system by 2010 may be unworkable and even impossible to achieve.

The current billing code system, ICD-9, uses a total of 24,000 codes. The ICD-10 system will increase the total amount of codes to more than 200,000. There certainly is some benefit to increased detail within the coding system, but it is absolutely not possible to have the systems up and running with the new codes four short years from now, as proposed in the new legislation.

The change-over to the new coding system will result in unprecedented cost for each physician's office. It will require a complete redesign of your business processes and systems; extensive training for your office staff and a significant increase in office equipment and computers needed to handle the new coding system. Pen and paper will no longer suffice to code diagnoses - physicians will need new decision support technologies at the point of service to identify the correct codes. Unless physicians have the support systems in place to perform real-time coding while the patient is in the office, it will not be possible to achieve the benefits from the greater specificity of ICD-10. Physicians will not be able to rely on clearinghouses, as they did for HIPAA transaction standards. (Clearinghouses translate claims into HIPAA-compliant formats and forward those claims to payers.) Physicians and their staff will need to assign ICD-10 diagnoses themselves.

The health care industry is already facing considerable challenges with the implementation of HIPAA transactions - which the medical community generally agrees need to be completed before we turn our attention to upgrading to ICD-10 - in addition to dealing with the major changes to Medicare. Before the transition to ICD-10 can begin, industry must move to the next generation of HIPAA computer code transactions standards (version 5010) because the current version (4010) will not work with ICD-10. Version 5010 is a major re-write of the HIPAA transaction standards, with more than 850 individual changes.

The American Medical Association House of Delegates voted in their June meeting to delay implementation of the ICD-10 coding system to ease the burden on practicing physicians. The Resolution is available on the AMA web site: http://www.ama-assn.org/ama1/pub/upload/mm/471/719a06.doc .

The Bush Administration's own working group, the Workgroup for Electronic Data Interchange (WEDI), serving an advisory role to the Secretary of Health and Human Services, supports delayed implementation. WEDI has expressed that the HIPAA transaction standard upgrades are "too significant to be done in conjunction with ICD-10." Former Health and Human Services Inspector General Chief Counsel Thornton has stated that implementing the new ICD-10 billing codes too early would cause the rate of improper payments made by Medicare to increase significantly.

In addition to these three national powerhouses, the following national organizations oppose an early implementation date:

American Academy of Dermatology Association

American Association of Neurological Surgeons

American Association of Orthopedic Surgeons

American Chiropractic Association

American Clinical Laboratory Association

American College of Emergency Physicians

American College of Obstetricians and Gynecologists

American Society of Cataract and Refractive Surgery

American Urological Association

Blue Cross Blue Shield Association

Congress of Neurological Surgeons

Medical Group Management Association

American Gastroenterological Association

In Nevada, the following groups have spoken out to in favor of a delayed implementation date:

Nevada Health Care Association

Administrator of the Nevada Division of Health Care Financing and Policy

President of the Nevada Orthopedic Society

Southern Nevada Medical Industry Coalition

Sunrise Hospital

The bill is expected to be under consideration in a U.S. Senate conference committee in September, with a final vote possible in late September. Senator Ensign will play a key role in this issue. As a member of the Senate Health, Education, Labor and Pensions Committee, it is likely that he will serve on the conference committee meeting in September. Regardless, he is expected to be involved in final negotiations on many provisions within the bill by virtue of his position as Chairman of the Republican Technology Task Force. For this reason a number of physicians and other health professionals have contacted Senator Ensign to let him know of their strong opposition to any implementation date before October of 2012, at the absolute earliest.

With the current focus on advancing health information technology, medical providers are at risk that this bill involving major technological advances will be mandated without thinking through the consequences of what will be required to successfully achieve those advances.

Given the substantial costs involved in running a medical practice and the significant financial and operational costs an early implementation of the new coding system will have, physicians should watch closely as Congress works on a final bill. Physicians can share their insights and concerns with Senator Ensign, stressing the need for an implementation date no sooner than 2012.

You can Reach Senator Ensign at:

Send a letter: 356 Russell Senate Office Building, Washington, D.C. 20510

Send an Email: http://ensign.senate.gov/forms/email_form.cfm

Place a phone call: Carson City: 775-885-9111

Las Vegas: 702-388-6605

Reno: 775-686-5770

Toll Free: 877-894-7711

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Minutes Synopsis

CLARK COUNTY MEDICAL SOCIETY Executive Council MEETING

Tuesday, August 15, 2006; 6:00 P.M.

Minutes (July 2006)

The minutes were approved unanimously.

Financial Report

Revenue was up from last year at this time. The revenue for July was $24,064.51. Expenses were about the same as last year, $22,819.29. The bank account balance at the end of fiscal year was $391,941.99.

UNSOM Report

Dr. Lenhart stated that the three committees addressing the Nevada Health Sciences Center continue to make progress. The school has hired a dean for graduate medical education, Mimi Bar-On from University of Chicago. She begins November 1.

Touro University

Paul Kalekas, DO reported their third class has been selected and will matriculate August 7th. The first 27 medical residents at Valley Hospital appear to be doing well. Touro still needs doctors to volunteer as preceptors.

Health District Report

Dr. Kwalick was unable to attend but provided a written report to the Board on current Health District concerns.

Alliance

Pauline Lee confirmed a membership drive event will take place on September 21 at the Fletcher Jones Mercedes Benz dealership on Sahara. There will be a hosted bar and wine tasting sponsored by Prudential, and refreshments provided by the dealership. MedPac representatives are invited to attend to solicit contributions. The Alliance is hoping for an attendance of at least 200. They intend to have judicial candidates attend.

Membership Report

Marlaina Burns reported there were 814 dues-paid members, an increase from the 756 paid members last year at this time. There were 45 unpaid members this year which were resigned as of 7-15-06.

Credentials Committee Report

Marlaina Burns announced 2 reinstatements: Thomas Kelly, MD - Ophthalmology and Richard Klatt, DO - Pediatrics.

MedPac

Dr. Evins reported MedPac would meet after the Executive Council meeting, and MedPac will be interviewing Assemblywoman Francis Allen. He stated MedPac has provided endorsements and $2,000 to both Senator Barbara Cegavske and Senator Sandra Tiffany, and endorsed Nancy Saitta for the Nevada Supreme Court and donated $2,500 to her campaign. MedPac has endorsed both Garn Mabey and Joe Hardy, the two doctors. Dr. Evins encouraged the Board members to ask their patients and staffs to vote.

NSMA Report

Dr. Evins reported the NSMA Executive Committee continues meeting monthly. He stated it shocks him how many committees Larry Matheis is a member of on behalf of the NSMA.

AMA

Dr. Nelson reminded everyone that the November AMA meeting will be held in Las Vegas November 11-14 and volunteers are still needed. Interested members and Alliance members should contact Larry Matheis or Lynn Horne.

NBME Report

Dr. Rodriguez stated there is a legislative report which will be discussed at the next BME meeting. Dr. Havins stated he did not believe there was any significant controversy from the doctors in the BME's legislative plan.

President's Report

Dr. Havins reported the death of member Charles Ruggeroli, MD - Cardiology.

Old Business

Dr. Havins described the merchant card services offers from various banks. He stated that although all of the offers were competitive, Bank of Nevada (aka BankWest of Nevada) presented the best offer but were unable to restrict their offer to CCMS members only. This issue will be revisited after more information and bids have been received.

Future Meetings

The next monthly meeting will be for the Executive Council, although all Board members are invited to attend. This meeting will occur on Tuesday, August 15, 2006 at 6 PM.

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Classifieds

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OFFICE IN SOUTHWEST FOR LEASE: Rainbow-Quail Plaza, 5755 S Rainbow Blvd., 1609 sf. Rainbow frontage near 3 hospitals. Completely built out. Available immediately. Call 280-1003. RE/MAX One.

PHYSICIAN WANTED: Tired of paying 60%-70% overhead in your practice? Leave your worries behind and let us take care of the headaches. Looking for a hard working, ethical, honest primary care physician to join me in an established practice. Call 286-0906.

OFFICE FOR LEASE IN SOUTHWEST: Spanish Trail Business Park, near Spring Valley Hospital at Rainbow & Tropicana. 2500 sf available beginning November 2006. Building currently under construction. TI allowance. Call 280-1003 or 222-0500. RE/MAX One.

office share/sublease: Seven Hills location adjacent to Siena Hospital. 2500 sq ft very upgraded interior. 3-4 exam rooms and a procedure room. For information call 566-8300.

office space available: New stand alone physician’s office located near Mountain View Hospital. Space flexible - furnished exam rooms available. Call Dr. Rosenberg at 838-0001 or email at murravlv@msn.com

PHYSICIANS WANTED: With the opening of the new Southwest Office, established Eye, Ear, Nose & Throat practice is looking for both an Ophthalmologist and an Otolaryngologist to compliment group. For more information contact Judy Duncan, Nevada Eye & Ear or jduncan@nee-nv.com

22” X 24” FRAMED LITHOGRAPH: By known local artist John Pacheco. Coach Jerry Tarkania with his signature, and signatures of famous 1990 and 1991 UNLV champion basketball team members. Collector’s item valued at $1500. Make offer. Call 255-3545.

for sale: Quinton treadmill with defibrillator $1,000, gray steel exam room equipment cabinet $100, two couches $50 each, assorted chairs $10 each, small refridgerator $20. Call Neal Carmena, MD, 878-8108.

Physician or PA Needed: Established Primary Care Practice needs practitioner part-time for office practice only. At least 20 hours per week, good salary, benefits negotiable. Call 702 612-7832.

Office space available: Desert Professional Plaza, 2225 E Flamingo Rd, 2 suites available - 1,200 sq ft and 1,100 sq ft can be combined for 2,300 sq ft. Completely built out - call 221-7000 for more information.

Spanish trail business park: Office space near Spring Valley Hospital at Rainbow & Tropicana lease 2500 sq ft available beginning November 2006. Building currently under construction $2 per sq ft , 3 year min lease, TI allowance. Call 280-1003.

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CME CALENDAR

Bechtel Nevada 295-0208

NV Chapter AACE 434-8400

Pri-Med Institute (877) 4PRI-MED

Sierra Health Services 242-7735

October 12 - “Identification and Management of Common Cardiac Arrhythmias”

Southern Nevada AHEC 318-8452

Southwest Medical Associates 242-7735

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

UMC 383-2604

Valley Hospital 388-4847

Only CME Activities held at the Clark County Medical Society office are specifically endorsed by CCMS.

Do you need “pain management” CME’s for renewal of your California license? The tapes listed are available for members to view at the Medical Society headquarters. Please call 739-9989 to set up a viewing time.

Advanced Care Planning (2 CME $20.00)

Establishing the Advanced Care Plan is the basis for the total care philosophy of the patient facing the end of life. Learn how to make a very sensitive issue part of routine medical practice.

Communicating Bad News & Establishing the Goals of Care (3 CME $30.00)

No one wants to deliver "bad news", but establishing the facts, planning the goals of care and implementing the care plan are necessary skills for physicians.

Depression, Anxiety & Delirium (2 CME $20.00)

Responding appropriately to unrecognized and untreated depression, anxiety and delirium improves the quality of life for terminally ill patients and their families.

Elements & Models in End-of-life Care (1 CME $10.00)

Learn about the new and evolving palliative and end-of-life care models that enhance the quality of patients' lives.

Gaps in End-of-life Care (1 CME $10.00)

Begin the EPEC series with an overview of the history and current practices regarding end-of-life care in the USA.

Last Hours of Living (2 CME $20.00)

Understand the death process and the necessary tasks physicians must undertake to shift the focus of attention from the dying patient to the support of the grieving family members.

Legal Issues (1CME $10.00)

Many questions concerning the obligation to "do everything" and other aspects of care for the terminally ill are discussed.

Managing Physical Symptoms Part I & II (3 CME $30.00)

Controlling physical symptoms other than pain affords patients the most comfortable death possible. Learn how to manage the most common end-of-life physical symptoms.

Next Steps (1 CME $10.00)

Tools necessary for implementing changes in institutions and health care professionals are presented along with outcome information regarding pain management and end-of-life care from the Missoula Demonstration Project.

Pain Management Part I & II (3 CME $30.00)

Managing pain may be the most critical task for physicians caring for terminally ill patients. Learn about the best options available for relieving pain and suffering.

Responding to Requests for Physician Assisted Suicide (2 CME $20.00)

Being prepared to respond to patient requests for assistance committing suicide is challenging for physicians. Learn to explore underlying motivation, clarify requests and offer alternative options for such requests.

Sudden Illness & Medical Futility (3 CME $30.00)

Responding to sudden illness and accident situations is a critical skill for physicians. Learn to use time limited trials, begin to clarify goals of care, medical futility and establish relationships with family members during times of extreme crisis.

Whole Patient Assessment (2 CME Hours, $20.00)

The complete end-of-life patient assessment requires evaluation of the physical, psychological, social and spiritual needs. Learn the skills to perform theses assessments and identify patients having spiritual crises.

Withholding and Withdrawing Therapy (2 CME $20.00)

Not providing therapy or removing established therapies often causes physicians particular anxiety. Learn to set limits, utilized time limited trials and know how to eliminate therapies not consistent with the goals of care.

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County Line Advertisers

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Brown and Partners Advertising …. 967-2222

Clark County Credit Union … 383-4002 …www.ccculv.org

Consultants in Marketing….944-2464

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Lee & Associates…………739-6222….. www.LeeLasVegas.com

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Red Rock Radiology ….. 731-2888 ….. www.redrockradiology.com

Robertson Wood Advertising …. 949-7777 …. www.robertsonwood.com

Rose-Glenn Group….Fair, Anderson & Langerman ….775-827-7311

Tegra Health Care Properties …. 801-451-5365 … www.thomasarts.com

T Scott, LLC…. 602-999-0380 … www.tscottassociates.com

United Blood Services ………228-4483

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