Following is the text of a Letter to the Editor from County Medical Society President Thomas A. Bersani, M.D. which appeared in today's Post Standard. The paper gave the letter this headline: "Let's ensure health care for aging baby boomers."

To the Editor:

The Thursday, April 17 lead editorial, “Timely Medicine: Changes needed now to ensure health care for aging boomers,” correctly pointed out some major problems and challenges facing our country.

Unless changes are made, the increasing number of Americans who are Medicare beneficiaries will not have access to the medical care they expect and deserve.

The immediate task in Washington re: Medicare is to head off a proposed 10 per cent cut in reimbursement to physicians for care they render to patients with Medicare coverage . In the next several years, physicians have been told to expect a total reduction of 40 per cent in Medicare reimbursement.

At a time that we need more physicians to care for seniors, such drastic reductions will limit access to care for Medicare recipients.

Please join us in urging our elected officials in the U.S. Senate and House of Representatives to “ensure health care for aging boomers.” Call the Syracuse offices of Senators Charles Schumer, Hillary Clinton, and Congressman James Walsh.

The Onondaga County Medical Society is also deeply concerned about recruitment and retention of physicians in this area. Because of our concern, in February we established the Onondaga County Medical Society Medical Student Scholarship Fund. This fund initially will provide a $5,000 scholarship each year at Upstate Medical University for a graduate of an Onondaga County high school who will enter Upstate’s medical school this fall. We believe that someone who went to high school and medical school in this county will be more likely to stay here for the duration of his or her medical career.

Thomas A. Bersani, M.D.

President

Onondaga County Medical Societ

From the Onondaga County Medical Society,

June, 2006

PRESIDENT'S NEWSLETTER

ARTHUR P. VERCILLO, MD

Impending Medical Malpractice Insurance Crisis

The news on medical malpractice insurance in New York State continues to get worse and there is truly an impending crisis. That message came through loud and clear yesterday (Thursday, June 1) in a monthly teleconference with William R. (Rick) Abrams, executive vice president of the Medical Society of the State of New York.

Medical Liability Mutual Insurance Company has asked the State Superintendent of Insurance Howard Mills for approval to increase its rates nearly 27 per cent for the premium year beginning July 1. If that request is not approved, MLMIC is seeking to increase rates by 33 per cent over a three-year period. In recent years, MLMIC has seen its surplus drop dramatically from $1.25 billion to a dangerously low figure of $200 million.

The MLMIC rate filings also include a 6 per cent surcharge on the third layer of medical malpractice coverage, often referred to as the second excess layer. The 6 per cent surcharge would apply to entity or professional coverage paid for by a group practice.

Two major factors contributing to the decline in MLMIC’s surplus are jury verdicts and awards and a policy of the State Insurance Department to keep rates artificially low when actuarial data dictates that much higher rates, unfortunately, would be appropriate. The State Medical Society is finalizing an action plan designed to convince Governor George Pataki and the State Legislature to address this issue in the next three weeks.

There had been expectations earlier this year that the Governor would embrace a program advanced by a number of hospital organizations, MSSNY and specialty societies which would provide meaningful tort reform and premium relief.

We all hope that it doesn’t take a crisis in the state threatening access to care before the Senate, the Assembly and the Governor act responsibly. The State Legislature returns to Albany on Monday, June 5 after a week’s recess.

In the coming days and weeks, we will be calling upon members, family and staff to contact state legislators on this vital issue.

From the Onondaga County Medical Society and the American Medical Association,

December, 2005

PRESIDENT'S NEWSLETTER

ARTHUR P. VERCILLO, MD

STATUS OF MEDICARE CUTS STILL UP IN THE AIR

Despite bipartisan agreement by the U.S. Senate and the House of Representatives earlier this week to enact a freeze on Medicare reimbursement for 2006 at the 2005 levels, this issue is still unresolved. Each house of Congress has passed a different omnibus budget reconciliation bill during the week, which included $7.3 billion needed to fund the freeze on rates as opposed to the proposed 4.4 percent cut for 2006. Before a budget reconciliation bill can go to the President for his action, the same bill must pass both houses, who are now in recess for the holidays.

Following is a statement by the American Medical Association President J. Edward Hill on this issue. The County Medical Society office has been in constant communication over the past several days with Duane M. Cady, M.D., a former County Medical Society and MSSNY president, who currently serves as chair of the AMA’s Board of Trustees.

More information will be shared with you when there are other developments.

AMA: Congress fails to stop Medicare physician payment cut
Payment cut will harm seniors' access to care

Statement attributable to:
J. Edward Hill, M.D.
AMA President

Congress has failed to fulfill its responsibilities to Medicare patients and their physicians. On Jan. 1, the 2006 Medicare physician payment cut begins, and the AMA is deeply concerned that this will harm seniors' access to physician care. There is bipartisan agreement in both the U.S. House and Senate that this cut must be stopped to preserve seniors' access to care, and both the House and Senate have passed legislation to stop the cut.

Procedural issues in the Senate and House prevented final action on this critical access to care issue for Medicare patients.

A national AMA survey found that 38 percent of physicians will be forced to limit the number of new Medicare patients they accept into their practice when the cut begins Jan. 1. The 2006 Medicare physician payment cut of 4.4 percent is the first of six years of planned cuts totaling 26 percent. During this same time, practice costs will increase at least 15 percent.

Physicians cannot continue on the current path of being paid less than the cost of providing care without serious consequences for patients. For those physicians who will continue to treat Medicare patients, 61 percent of physicians told the AMA they plan to defer purchase of new medical equipment and 54 percent plan to defer purchase of information technology. When these types of decisions are made in order to keep medical practices open, the overall ability to improve health care delivery in the digital age suffers.

It is our hope that Congress will immediately take up this issue when they return to Washington in the new year to halt the payment cuts and retroactively adjust payments. The AMA will continue to strenuously advocate for a fair physician payment formula based on practice costs, as well as continue to advocate for sound quality improvement initiatives. Physicians are the foundation of Medicare, and Congress needs to act promptly to preserve seniors’ access to care.

If you are taking Vioxx, stop and contact your physician for instructions. As long as you have no allergies to tylenol or liver problems, substitute tylenol for now.

November 25, 2003

AMA CELEBRATES PASSAGE OF HISTORIC MEDICARE BILL

Statement Attributable to: Donald J. Palmisano, M.D., J.D. AMA President

"Today’s Senate passage of the Medicare bill is a historic victory for Medicare patients and their physicians. This Thanksgiving, Congress and the Bush Administration have given America’s seniors a Medicare bill for which they can be truly thankful.

"There are so many positive provisions in this bill. All Medicare patients will be eligible for a long overdue prescription drug benefit, and the neediest patients will receive the most assistance. All Medicare patients will receive a greater choice of health plans. Health savings accounts, which empower patients to have greater control over their health care decisions, will become a more attractive option for all Americans.

"This truly significant legislation also enhances access to care for seniors by halting Medicare cuts to physicians and other health professionals for the next two years. Instead of cuts, the Medicare bill provides at least a 1.5 percent increase in payments in 2004 and 2005. For next year, this represents a 6 percent difference in Medicare payments at a time when physician practice costs are on the rise.

"Patients also will benefit from a comprehensive package to strengthen health care in rural and underserved areas. This bill will reduce payment disparities in parts of the country where physician services are in great need and short supply. It also provides regulatory relief, so physicians can spend more time with patients and less on paperwork.

"The AMA applauds Congress for giving America’s seniors and disabled greater access to prescription drugs and medical care and increased choice under Medicare. We look forward to President Bush’s signature on this historic bill and to a stronger Medicare program for our nation’s seniors."

The New Yorkers for Civil Justice Reform, the 1200 member broad based coalition dedicated to seeking the enactment of tort reform, held a press conference to release a survey indicating the overwhelming support of New Yorkers for reasonable civil justice reforms. MSSNY Director of Governmental Affairs Gerard Conway participated in this press conference. The press conference was held in conjunction with an Albany Lobby Day held this week to demonstrate the extensive grass roots support for the enactment of reasonable tort reforms, including S.2944 (Volker), the Civil Justice Reform Act. Of particular note in the survey was that 62% of those persons polled supported a cap at some level on the non-economic damage portion of awards in medical liability cases. Moreover, over 80% of those surveyed agreed that "a medical malpractice insurance crisis is increasing the cost of healthcare, decreasing patient access to doctors and hospitals, and affecting the overall quality of care provided to patients. “ Also, almost 80% agreed that there are too many lawsuits today. Demonstrating how broad-based support for these reforms are, the poll respondents were divided almost equally between men and women across the State, and there were a similar number of poll respondents from every congressional, senatorial and assembly district in New York State.

MSSNY PREPS FOR TORT REFORM PUSH WITH MAY 20TH "STAND UP"
Physicians, medical office staffs and supporters are rallying for a major tort reform push with "Stand Up" rallies slated for more than 20 locations across the state on Tuesday, May 20. It is expected that more than 5,000 physicians will participate statewide. "This is the critical push," according to MSSNY President Jeffrey Ribner, MD. "At a time when physicians are being squeezed from all angles, it has become abundantly clear that neither patients nor physicians can any longer be subject to the outrageous costs associated with our runaway liability system."
Speaking in a recent editorial for an upstate newspaper, Dr. Ribner pointed out that physicians face greater liability exposure in New York than in any other state and that New York premiums are the highest in America. He also debunked the notion offered by trial lawyers that removing a few physicians from practice would solve the liability problem. "In the past five years MLMIC data indicates that fully 60% of their covered obstetricians, orthopedists and general surgeons, as well as 70% of their neurosurgeons have been sued," Dr. Ribner said. "These are amongst the most highly trained physicians in the profession, and they are delivering care to patients who frequently have life-threatening conditions. Are all of these physicians incompetent? I doubt it. They are victims of the trial bar "jackpot" system that doesn't acknowledge the difference between negligence and unavoidable adverse outcomes."
Dr. Ribner called for all physicians across the state to join with their county organizations at the "Stand Up" rallies scheduled for May 20.

US CONGRESS: MEDICAL LIABILITY REFORM WOULD SAVE GOVERNMENT $19.5 BILLION - DECREASE UNINSURED BY 3.9 MILLION
The Joint Economic Committee of the United States Congress has released an exhaustive report on the societal cost of the out-of-control medical liability situation in the U.S. The report finds that between 1994 and 2001 the typical malpractice award skyrocketed 176% to $1 million. This has resulted in steep increases in insurance premiums, which in turn has led to higher costs for health care services and reduced access to medical services. The report makes the case that the current liability system neither fairly compensates the victims of negligence, nor does it effectively deter negligent behavior. It concludes that the current system has a particularly adverse effect on women, low-income individuals and rural residents. Significant savings and public benefits would be created if comprehensive liability reform were enacted, the authors point out. They include:

This report adds yet another set of compelling facts to the overwhelming case for comprehensive liability reform. The Joint Economic Committee study, "Liability for Medical Malpractice: Issues and Evidence" can be viewed online at http://www.house.gov/jec/tort.htm.

URGENT CALL TO ACTION: CMS PROJECTS 4.2% CUT IN 2004 MEDICARE PHYSICIAN PAYMENTS; CONTACT YOUR REPRESENTATIVES AND SENATORS NOW!
Earlier this year, President Bush signed into legislation that replaced a 4.4% cut for 2003 with a modest increase of 1.6%. The Centers for Medicare and Medicaid Services (CMS) told Congress the legislation enacted last February would produce positive updates for the next few years. Recently, CMS issued a letter stating, " While we previously estimated positive updates for 2004 and later years, we now estimate updates will be negative for 2004-2007" with a 4.2% cut in 2004. Therefore MSSNY and the AMA strongly believe that the current Medicare MD payment formula must be replaced. Physicians are the only "providers" subject to the Sustainable Growth Rate (SGR). The SGR cuts payments if growth in Medicare patients' use of services exceeds the Growth in Domestic Product (GDP) of the entire American economy. The SGR is centralized government planning at its worst. The medical needs of patients do not decline during economic downturns. CMS should not penalize physicians for volume increases when the government promotes greater use of physician services through new coverage decisions, quality improvement activities and a host of other administrative decisions that are good for patients but aren't reflected in the SGR. From 1991-2003, payment rates for physician services fell 14% behind practice cost inflation as measured by the conservative estimates of CMS. MedPAC, an advisory group established by Congress, has recommended that the SGR formula be replaced with a more equitable process for updating Medicare physician payments (similar to the Medicare hospital update process). For 2004, MedPAC has recommended that payments be increased by 2.5% instead of the -4.2% cut. Multiple studies have shown that physician acceptance of new Medicare patients is declining and that this trend will accelerate if payments are again cut. Contact Your Representative and Senators Today! Urge your Representatives and Senators to implement the MedPAC recommendations to replace the SGR with a more equitable update process for Medicare physician payment and to increase 2004 payments by 2.5%. Please use the AMA Grassroots Hotline at (800) 833-6354 or point your browser to www.ama-assn.org/grassroots.

I sent this letter in response to the following request from the Medical Society of the State of New York, feel free to send your views to me at genufix@aol.com, or click on the link immediately below:

Dan Wnorowski, MD
3229 East Genesee St.; Syracuse, NY 13214
Orthopedic Surgery

Critical issues need attention to inhibit or better yet, reverse the downward spiral of deteriorating health care in NY and USA. We are in crisis!!
      Morale problems abound. Doctors and nurses speak of career changes, strikes, constant staff shortages, mandatory overtime (I am getting my MBA from Syracuse University, and may look for other work when finished).
      Insurance companies continue to cut reimbursements, while increasing co-pays, restricting access to specialists, tests, and procedures, AND PREMIUMS ARE GOING UP!! Where is the money going???   The hassle factor increases. Office staff spend more and more time away from patient care on the phone ON HOLD seeking authorization for tests, referrals, etc., increasing the costs of office care. Why do the insurance companies have a controlling choke hold on patient care?
      Medicare cuts have pushed hospitals toward financial ruin. Programs are cut (Crouse Health has closed a diabetes program, an outpatient PT facility, and an urgent care center, orthopedic patient education, to name a few), beds are closed. ER services are limited as ER's are closed due to staffing cuts. Our hospitals are crumbling, and they show it- dirty, dusty, paint peeling, ceiling tiles falling out. The money does not exist for capital improvements and investments. We need to decide, as a society, if quality care is worth more money.
      There is a worsening nursing shortage. Why anyone would want to be a nurse today is beyond me: more paperwork, less patient care, less money, staff shortages, more overtime, liability risk, less respect from patients/hospital management, etc.
      Medical liability reform remains an urgent need. We, as physicians, are caught in a vice between less involved, cheaper, quicker, more streamlined care and the constant threat of legal action. Defensive care remains costly, but necessary. The lawyers advertise increasingly re: the ubiquitous nature of malpractice, and the public responds. We need tort reform!
      Who will finance medical research and medical training? Managed care shows little concern for even essential medical services, like physical therapy, prompt access and evaluation by specialists, and testing. I am concerned that the distraction of "bottom line medicine" will divert attention and dollars from our future investments in health care: the development of medical techniques, procedures, drugs, research in disease etiology, prevention, management, and cure, and the training of future physicians and ancillary health care staff. I am worried about the future of our industry.
      All of this with an aging population. The volume and costs of medical care increase as the age of the patient rises. What will we have to offer our aging baby boomers in ten to twenty years?
       It is very difficult to imagine how things can improve in the next five years. I have a tough time visualizing the "light at the end of the tunnel". Managed care was touted as the solution to spiraling rises in the cost of care. It has only added to our woes. It has not controlled costs. Insurance premiums continue to rise, while patient access and choice have become increasingly limited, and patient financial responsibility has also paradoxically escalated (see rising co-pays).
      There has, in my opinion, been a general trend of interference with patient care. As clinicians, we can rarely make a move without asking for permission from the payors, and this wastes the valuable time of office staff, distracting from clinical patient care. The insurors have made a mockery of "customer service", hindering the authorization process with complicated phone menus, and unnecessarily long holding times and phone transfers, as well as insulting interviews with insuror staff substantiating straightforward tests and procedures.
      We must, as a society, decide whether, and how much, health care is desirable and valuable. We must, as individuals, take responsibility for our own care, and hold the payors as accountable as our providers for their decisions. Denial and delay of care based on financial reasons impact one's health. For example, arbitrarily limiting physical therapy treatments for a "frozen shoulder" to twelve visits for the proper management of a condition that may take 6-12 months to resolve can no longer be tolerated by those who pay larger premiums and get less in return.
      We must seek a better way to participate in decisions about our care, and realize that these decisions cost money. Medical savings accounts may help merge the consumer function with the payor function.

      I wonder if I can still derive satisfaction from my profession in 5-10 years.
The interaction with my patients still makes it all worthwhile at present, but this is increasingly devalued by the amount of time that is spent in non-clinical tasks mandated by the managed care environment.
      I can only hope that reform will occur that will free our profession from the drudgery of this managed care quagmire. This will take a revolt from the grass roots level. I do not think that the general public has yet to realize what it has lost, and what it is continuing to lose regarding health care. Quality is suffering. Morale is suffering. Access is suffering. Choice is suffering. It cannot be expected that continued cuts will not adversely affect quality care.
      Will I be practicing medicine (orthopedics) in five years? I hope so, but I am not certain, and I am only 42, in merely my eleventh year of medical practice. My daughter is a straight A, high honor student at Fayetteville-Manlius high school. I have been unable to recommend to her a career in medicine. I have advised her to consider Vet school instead! I will finish my MBA, and try to encourage change, by educating my patients, and all those who will listen.

Daniel C. Wnorowski, MD
genufix@aol.com

AMA: Congress fails to stop Medicare physician payment cut
Payment cut will harm seniors' access to care

Statement attributable to:
J. Edward Hill, M.D.
AMA President

American Academy of Orthopaedic Surgeons

Patient Safety

Member Alert

AMA: Congress fails to stop Medicare physician payment cut Payment cut will harm seniors' access to care

Statement attributable to: J. Edward Hill, M.D. AMA President

American Academy of Orthopaedic Surgeons

Patient Safety

Member Alert

AMA: Congress fails to stop Medicare physician payment cut
Payment cut will harm seniors' access to care

Statement attributable to:
J. Edward Hill, M.D.
AMA President