FLORIDA ASSOCIATION OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Tuesday, August 14, 2007, 12 – 3 pm
Orlando World Center Marriott
Thank you to
Chris Pogosyan from Pharma RX, for sponsoring our luncheon.
ANNUAL MEMBERSHIP AND BOARD OF DIRECTORS MEETING MINUTES
Presiding:
Dr. Gary Newcomer, President
Present in Order of Sign-In:
Joe Thomas, Stephen MacDonald, Gary Newcomer Michael MacDonald, Seth
Feldman, Raymond Priewe, Bhupendra Gupta, Richard Johnson, Eddie
Sassoon, Ben Barnea, T. Byron Thames, Harold Haase, Karen Carlson,
Kenneth Phillips, Zsuzsanna Seybold, Karen Olson, Hossein Joukar, Philip
Mehough, Robert Fleigelman, James McCluskey, Aurelio Ortiz, Barbara
Toeppen-Sprigg, Michael Band, Phyllis Gerber, Jock Sneddon, Joan
Watkins, Homi Cooper, Eileen Cooper, Ignacio Rodriguez, Richard Kuehne,
Jill Rosenthal, Robert Dehgan, Stan Haimes, Ronald Demeo, Michael
Copeland, Joseph Mignogna, Enrique Zamora, Bruce Bohnker, Monica
Grinberg and Diana McCluskey. Two individuals signed in, but the
signatures were illegible.
The meeting began with
self-introductions all around.
1.
Pharma RX
– Mr. Chris Pogosyan and 2 additional Pharma RX representatives
presented an overview of the services and products provided. Pharma RX
is a full service pharmaceutical management company that offers
in-office dispensing programs to Physicians, Medical Groups, Specialty
Clinics and Urgent Care Centers. They have a comprehensive dispensing
program, plus an enhanced patient compliance program. FAOEM members had
the opportunity to ask questions and discuss the plans offered by Pharma
RX. If anyone would like more information on Pharma RX, please visit
their website at:
www.pharmaxonline.com or contact Chris
Pogosyan at
chris@pharmaxonline.com .
2.
Minutes
of the August, 2006 Orlando meeting were discussed and approved.
3.
Membership Report
– Presented by Dr. Michael MacDonald, Vice President
Membership has remained the same as last
year with 165 members. We have seen fluctuations in our memberships due
to individuals moving out of Florida, being called into active duty and
retiring. New members have increased as a result of individuals moving
to the state of Florida.
Members who are late on their dues are
encouraged to renew their membership through the monthly newsletter,
personal contacts by ACOEM and by requests from the FAOEM executive
director.
4.
Treasury Report
– Dr. Michael Band, Secretary-Treasurer
We are in good financial shape. Ms.
McCluskey proposed that we provide $1,700 per delegate to go to the
SOTAC meeting this year. It takes place in Vancouver, BC, so the cost
of travel will be quite a bit more expensive. A motion was made to
approve this suggestion and all members present were in favor.
Current funds: $16,566.29
Total Deposits from Membership Dues
(September 2006 – the present): $18,572.32
-
11/10/06: $1,015.00
-
01/24/07: $10,712.32
-
04/20/07: $6,120.00
-
06/20/07: $725.00
Remaining 2007 expenses: $6,400
-
Executive Director: $3,000 ($750 per
month through December 2007)
-
Delegate to the FMA August Meeting:
$1,500
-
SOTAC Delegates (2): $3,400
-
Executive Director
Travel/lodging/meals for FWCI: $1,000 (Ms. McCluskey indicated that
the cost should be at least half of this amount)
-
Office Supplies/Copying/Misc: $500
5.
FMA Report
– Dr. Michael Webb, FMA Liaison, and Chair, FMA Medical Economics
Committee
Dr. Webb said that
not much has changed with respect
to occupational medicine and workers' compensation issues.
He encourages all FAOEM members to join the FMA and consider attending
the annual meeting. Dr. Webb
reminded members of the support that the FMA gave FAOEM when they needed
it the most. He encouraged their support for FMA issues, even when
they may have the appearance of representing only indirect or remote
relevance to Occupational and Environmental Medicine.
Highlights of work by the FMA during
the last legislative session were as follows:
·
Gains were made in tort
reform.
·
Recurring efforts against:
1) The ARNP proposal requesting prescribing ability and authority to
sign death certificates, 2) The bill for psychologists to be permitted
to request laboratory testing and 3) The request of pharmacists to
administer flu shots.
All of these items would expand the
abilities/duties through legislation rather than through education.
A short discussion about the leadership
of the FMA took place, with Dr. Webb assuring the FAOEM members that the
FMA is strongly business minded;
they are dedicated to protecting the interests of patients and the
practice of medicine. Dr. Webb
will attend the annual FMA meeting in late August. FAOEM
maintains specialty organization status and holds a seat in the House of
Delegates.
6.
DWC 25
– Dr. Band
A discussion about
the DWC 25 took place. Some members expressed a great dislike for the
form because they have to pay an employee to complete the forms, follow
up on them and ensure that everything is done correctly. This form has
not made physicians’ lives any easier though they were led to believe it
would. Several members commented that most physicians do not actually
use the checklist of special duties
identified on the form; they fill in
whatever they want and skip the check off boxes. It was suggested that
perhaps we should propose revisiting the content, purpose of the form,
and effectiveness from the doctor’s point of view. In addition, we
should eliminate the process of completing the form on a monthly basis
after MMI has been reached. This should be proclaimed by an official.
It would be useful if someone would make a phone call to the DWC to see
if these things are possible. We
should try to get specific about what it is that we don’t like, what we
would like changed and then try to get one of the larger groups at the
FMA (i.e. Family Medicine) to be on our side in this matter. Dr. Webb
volunteered to make a call to the DWC to see what can be done. In
addition, a subgroup from FAOEM needs to be formed to study what is
wrong with the form and to follow up on it.
7.
Update on ACOEM – Dr. M. MacDonald
Up
to 2 delegates from FAOEM are sent to each ACOEM meeting. Earlier this
summer Dr. MacDonald provided to the FAOEM members a written update on
the most recent ACOEM meeting (also included in the meeting folder) and
made the following points:
·
ACOEM membership numbers
are stable.
·
Dr.
Tee Guidotti did many great things for ACOEM and he did quite a bit of
lobbying on the behalf of OM physicians.
·
The purpose of the ACOEM
guidelines is to get each state to adopt ACOEM practice parameters as
their guidelines. ACOEM encourages members to adopt ACOEM practice
guidelines during their course of treating and managing patients. This
does not necessarily involve purchasing the guidelines but simply being
familiar with them.
·
The ACOEM membership
committee conducted the annual salary survey.
2000 ACOEM members were selected at
random with a 40% response rate. The vast majority of respondents are
not board certified.
8.
Election of Officers
For the 2007-2009 slate of officers,
each of the existing officers from the 2005-07 board will be bumped up a
level. A motion was made to approve the officers in their new roles.
All were in favor of the motion. Three individuals expressed interest
in running for the open position of Director:
-
Jill Rosenthal, MD, MPH
-
Karen Carlson, MD, MPH, FACOEM, FACPM
-
Richard Johnson, MD, MPH, FACOEM
Dr. Rosenthal was elected as to the new
position as Director.
9.
Functional Medical
Examination
Dr. Richard Johnson introduced his
associate, Mr. Michael Coupland, CPsych of AssessAbility. Mr. Coupland
provided a lecture on the Functional Medicine Evaluation (FME).
Detailed information about the FME can be found on his website:
www.assessibility.net. In his overview, Mr. Coupland stated that the
Functional Medicine Evaluation is a Physician Exam plus Functional
Testing. The FME is ordered by Prescription, and provides the Physician
the objective medical evidence for the Florida Workers' Compensation
DWC-25 form, other State's Workers' Compensation Forms, or other
documentation for Auto and Personal Injury. The FME can be performed
under Florida Workers' Compensation legislation by the Physician on
their own patient or on patients referred by Adjusters, Case Managers
and Attorneys. The Functional Medicine Evaluation is used to determine
if there is a measurable work limitation. The work limitation can be
attributed to the compensable injury or apportioned to a pre-existing
limitation. Patient effort issues can be identified and the functional
test results can be corrected for poor effort or stoicism.
10.
Other items of
Business
·
Dr. M. MacDonald
brought up a topic that has recently become a problematic and
potentially controversial issue for
OM physicians: Apportionment. He
explained that reportedly some insurance companies are asking physicians
to participate in the apportionment process by delineating the portion
of an injury that is work related, including impairment ratings, at the
beginning of a case. Using that determination some workers’ comp
insurance companies will then only pay that portion of the medical bill
going forward during the case, leaving the OM physician to bill for the
remainder. This creates significant legal, administrative and ethical
obstacles for the OM physician who is responsible for providing workers
comp medical care to the patient. This has created concerns that this
will result in physicians refusing to see patients from
employer/carriers who engage in this practice thereby creating access
problems, or even worse, practically forcing physicians to assume that
all injuries are 100% work related in order to avoid the situation
altogether.
Dr. MacDonald introduced Mr. Jerry
Fogel, a health care consultant who was actively involved in the
statutory and regulatory reform. Mr. Fogel provided an overview on the
issues as well as some suggestions on how to deal with the situation
responsibly until a more formal resolution can be affected either
through case law or legislative/regulatory action.
This discussion was in part prompted
by the comments made by an attorney during one of the FWCI Conference
breakout sessions, as well as from follow up discussions with staff at
the DWC, the Senate, the OJCC, and a number of practicing OM physicians
and attorneys. Apparently some defense attorneys are suggesting this on
behalf of their carrier clients. The Division’s EAO acknowledges that a
significant number of questions have been raised regarding this issue. A
number of scenarios and situations were discussed and some specific
suggestions were offered, including;
·
OM physicians should confine
their role to the issues raised in the statute and regulation as
articulated on the DWC 25.
·
Do not feel compelled to
answer a question from an attorney or make a determination that is not
appropriate, reasonable or consistent with responsible medical
principles and ethics.
·
A properly and timely
completed DWC 25 is a powerful tool for the physician (as well as the
employer, adjuster, nurse case manager, JCC, regulator, etc).
·
Submission starts the 3 day
clock (or 10 day depending on the procedure(s) recommended) for
authorization approval or denial. A failure to comply by the
employer/carrier signifies a tacit approval of requested services.
·
If there is a pre-existing
condition or co-morbidities, the physician should be clear in
documenting which condition they are addressing, i.e. is there a new or
advanced condition, or is this a flare-up of a pre-existing condition.
If it is a flare-up, do NOT address the apportionment issue; we should
be responsible for 100% of the flare-up, not a sub-portion of the
original condition. The treatment should aim at restoring the patient to
their pre-flare status, not attempt to manage the original/underlying
condition. There is no apportionment issue in most of these situations.
Do NOT try to apportion the flare-up in relation to the original or
underlying condition as that is not the “work related condition” you are
treating, it is only the flare component (i.e. swelling, tissue
irritation, etc).
·
Major contributing cause (MCC)
and apportionment are two separate issues and have unfortunately become
inappropriately intertwined.
o
Address MCC only and NOT
apportionment, which should technically not become an issue practically
until after the patient has reached MMI.
Mr. Fogel also emphasized that each
physician should be familiar with the following statutory provisions:
·
44.09 and 440.13 -
especially subsection (16) regarding clinical criteria for
determinations.
·
440.13(14) - regarding
reimbursement and enhanced levels of service, as well as the detailed
instruction set available from the DWC regarding the DWC25.
·
Dr. Johnson reported the
private practice section of ACOEM met with leaders of ACOEM, large
employer and carrier representatives in Washington DC. The purpose of
the meeting was to enhance the communication and joint effort for
managing work comp cases and return to work. All non-physicians were
very positive concerning the job occupational medicine physicians do
with work comp. Further meetings will be held in most states including
Florida. Contact Dr. Johnson:
rjohnson@lakesideoccmed.com for information.
The meeting was adjourned at 3:00 p.m.
Respectfully
submitted,
Diana McCluskey,
MPH
FAOEM Executive
Director
PRACTICE MATTERS
major workers’
compensation
reform by the 2003 legislature
-physicians get increase in
reimbursement fees
Fred Whitson, JD, FMA
Director of Medical Economics
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