Specialty Class

2007 Rate

2008 Rate (19.1%

decrease)

2009 Rate (0.5%

decrease)

Overall Decrease

(2007-2009)

0 $2,997 $2,426 $2,414 -$583

1 $3,996 $3,234 $3,218 -$778

2 $5,595 $4,528 $4,505 -$1,090

3 $7,194 $5,821 $5,792 -$1,402

4 $8,992 $7,277 $7,241 -$1,751

5 $11,989 $9,702 $9,653 -$2,336

6 $17,984 $14,553 $14,480 -$3,504

7 $27,975 $22,638 $22,525 -$5,450

8 $33,969 $27,489 $27,352 $6,617

REPORTSREPORTSTuesday, January 20, 2009 www.ismanet.org

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For the second year in a row, the Indiana Department of Insurance (IDOI) has announced a reduction in physician Patient’s Compensation Fund (PCF) surcharge rates for 2009. The 0.5 percent reduction will be effective March 1, 2009.

Physicians received a 19.1 percent reduction in 2008, for a two-year total of 19.6 percent. Hospital rates were reduced by 1.3 percent in 2008 and 5 percent in 2009.

“These are the first decreases since the Medical Mal-practice Act’s inception in 1975,” said Julie Reed, ISMA legal counsel. “The ISMA is pleased to see more much-needed relief for physicians.”

Between 2003 and 2007, physicians were subject to steep surcharge increases to build up the PCF balance, now stabilized to $182,977,738.39 after the July payout.

Physicians are grouped by specialties into risk classes for purposes of paying the surcharge. Other health care providers, such as nurse practitioners, pay 110 percent of their commercial insurance premium as a PCF surcharge.

“These recent rate reductions can be attributed in part to favorable rulings from the Indiana courts on cases in which the ISMA participated as an interested third party by filing amicus curiae briefs,” Reed noted. “This is a great example of the work your ISMA dues dollars can achieve on behalf of all Indiana physicians. If this effort wasn’t undertaken by the ISMA, I’m not sure who would represent organized medicine in these cases.”

IDOI officials advised the ISMA that on Jan. 15 they will pay out $50,758,312.23 from the PCF for the semi- annual January payout. The fund generally pays $90 to $110 million per year. More details on the payout will be reported as available.

Malpractice insurance rates to decrease in 2009

Report highlights decreases for 2008 Each year, the Medical Liability Monitor, a national publi-

cation, researches and publishes medical malpractice insur-ance rates for internal medicine, obstetrics/gynecology and general surgery in all 50 states. The report is broken down by insurance companies and geographic regions for each state, making state-by-state comparisons slightly difficult.

Give us feedback, we’ll give you tools

Did you know that in some instances you can obtain tax credits and insurance company coverage for the use of interpreter services for your patients?

Tell the ISMA about your experi-ences providing interpreters and at the same time, you can access some helpful tools for your practice.

Resolution 08-27, submitted at the 2008 ISMA House of Delegates, expressed concerns about the chal-lenges faced by physicians caring for hearing impaired patients.

As a follow-up, the ISMA Board of Trustees asks you to complete a short survey about this issue. The feedback will be used to plan further action on this resolution at a Feb. 4 Board meeting.

In reading the survey, you’ll discover helpful tips to use in your practice.

Find the survey at www.ismanet.org.

Illinois rates are 167%-365% higher for internal medicine, 92-239% higher for general surgery, and 73-206% higher for ob/gyn.

Ohio rates are 52-180% higher for

internal medicine, 23-134% higher for general surgery, and 5-101% higher for ob/gyn.

Kentucky rates are 47% higher for

internal medicine, 39% higher for general surgery, and 25% higher for ob/gyn.

Michigan rates are 95-323% higher for internal medicine, 46-223% higher for general surgery, and 11% lower to 95% higher for ob/gyn.

Reed pointed out, however, that like past years, the 2008 rate survey indicated Indiana rates continue to be competitive with – and even better than – other states.

The report includes commercial insurance base rates (without factoring in claims history or credits) and state patient’s compensation fund surcharges where applicable. It shows 43 percent of premiums fell nationwide and an-other 50 percent did not change. Overall, carriers averaged a 4.3 percent drop in premiums nationwide. Indiana’s Pro- Assurance rates dropped 6 to 9 percent.

According to the report, total costs for an Indiana physi-cian insured through ProAssurance in 2008 (excluding Lake and Porter counties) were:

• $8,752 for internal medicine• $35,200 for general surgery• $58,222 for ob/gyn Insurance for physicians in Lake and Porter counties

was 26-29 percent higher, at $11,274 for internal medicine, $45,286 for general surgery, and $73,351 for ob/gyn. All surrounding states have much higher rates than Indiana.

ProAssurance Rates in Neighboring States

PCF Surcharge Rates (2007-2009)

California’s medical malpractice act is viewed by many as the model around the country because of its cap on noneconomic damages. (Indiana has a total cap.) Califor-nia’s rates varied widely, lower and higher than Indiana.

Our competitive rates are mainly a result of Indiana’s strong medical malpractice act, one of the first in the country dating back to 1975.

“The key features of Indiana’s act are a total cap on damages and the medical review panel process,” Reed said. “The ISMA will continue to work very hard to preserve the act in order to keep Indiana’s rates competitive and give Hoosier patients access to the care they need.”

Medicaid newsRead about proposed rate cut and letters about antipsychotic drugs

Second Anthem meeting setNew issue crops up, complaints continue

Virtual visits can workFishers physician discusses patient visits using a computer “portal”

Wellpoint woesInformation technology issues, earnings losses hit insurer

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If you missed reading the Jan. 5 ISMa Reports, you should know it contained information about a proposed payment “holdback” of 5 percent from Medicaid begin-ning in July. Because of budget requirements from the Daniels’ administration, the Indiana Family and Social Services Administration (FSSA) plans to begin paying its health care providers 95 percent of the Medicaid fee schedule per claim as of July 1, 2009.

On Dec. 24, after ISMa Reports went to press, FSSA Secretary Mitch Roob Jr., who has now left the agency, filed two Letters of Intent regarding payment changes to be adopted as emergency rules.

The documents, one of which pertains to institutions, like hospi-tals and nursing homes, indicate the reduction will be in effect through the end of the state’s fiscal year, June 30, 2010. The rate will return to the level currently in ef-fect beginning July 1, 2010.

Previously, FSSA had extended a 1.5 percent rate increase to physi-cians; therefore, the 5 percent hold-back would result in a net decrease

Here’s news of concern from the state’s Medicaid programof 3.5 percent in July.

“In reality, this represents an even greater revenue reduction for physicians caring for Medicaid patients,” said David Welsh, M.D., ISMA president. “Doctors already are struggling to keep the doors of their medical offices open and to continue caring for their Medicaid families. We’re facing practice costs that have increased more than 20 percent in less than a decade. The gap between costs and payment continues to grow, and anyone who has run a business or a household knows you can’t hang on forever.”

The ISMA urges you to explain what you’re experiencing and how this proposed holdback could im-pact your ability to continue treat-ing Medicaid patients! Submit your written comments to state officials.

Identify your correspondence with the notice COMMENT RE: MEDICAID RATE REDUCTION and send to:

IFSSA Office of Medicaid Policy and Planning

Attention: Pat Nolting402 W. Washington St.

Room W374

P.O. Box 7083Indianapolis, IN 46207-7083Read more at www.in.gov/

legislative/iac//20081224-IR-405080942NRA.xml.html.

Antipsychotic drugsThe Indiana Medicaid Drug Uti-

lization Review (DUR) Board, work-ing with the Mental Health Quality Advisory Committee (MHQAC), approved sending letters to prescrib-ers whose claims data indicate they have Indiana Medicaid patients, ei-ther in fee-for-service or a managed care organization, concurrently on two or more atypical antipsychotics for greater than 45 days.

The letters, likely mailed this month or in early February, state that there is currently a lack of supporting evidence for this type of therapy and ask for prescribers’ comments substantiating the use in their practices.

The MHQAC advises it will con-sider the responses in determining whether or not to proceed with a possible prior authorization require-ment for these types of cases.

A dedicated e-mail account has

been established to receive your responses to the letters. Find the address in the letter.

Take the opportunity offered by the letter to inform the MHQAC of your experience using this type of medication therapy.

Dr. Welsh said he understands the budgetary constraints of the FSSA because we are all facing tough financial times. However, he urged the Medicaid program not to add further bureaucratic paperwork to physicians’ workloads.

“The number of Medicaid pro-viders in our state is already inad-equate at a time when 41 percent of Hoosier doctors are over age 50 and reducing patient care activities,” Dr. Welsh said. “More paperwork and less pay would only cause more physicians to stop accepting new Medicaid patients, discontinue see-ing any of these patients or – worse yet – take early retirement or give up seeing patients altogether.”

He also pointed out that more Hoosiers are facing job loss today, and the numbers seeking assistance from Medicaid as July approaches is likely to grow.

ISMA practice management staff has heard from practices about a new issue involving Anthem claims reimbursement. Medical offices reported being paid for one unit of service when billing for a bilateral procedure using the 50 modifier.

Complaints came from a physi-cian who performs breast recon-struction and an ENT specialist.

Upon contacting Anthem, the ISMA was advised the problem with bilateral claims was identi-fied and fixed Jan. 6. Linda Barrabee, RVP, Indiana Network Management and Education at Anthem, said they are currently running claims reports to have

The ISMA continues to hear from you about Anthem issues

the claims reprocessed.The ISMA continues to field

calls from practices having pay-ment delays back to October 2007 when Anthem conducted a multi-phase computer change-over. (See Dec. 15, 2008, ISMa Reports.) A second meeting to discuss these problems with Anthem is set for Jan. 26.

If you continue to experience delays involving old claims, trouble accessing Anthem Customer Service or failure to receive appropriate interest on late payments, contact the ISMA. Complete a report at www.isma-net.org/forms2/anthemform.asp or call the ISMA.

The Centers for Medicare & Med-icaid Services (CMS) announced Jan. 7 that National Government Services or NGS was awarded the contract to administer Part A and B Medicare fee-for-service claims in Indiana and Michigan, which is Jurisdiction 8.

NGS served previously as the Medicare administrative contractor, referred to as the MAC, for Kentucky and Indiana, but Kentucky has been dropped from Jurisdiction 8. Michi-gan is now paired with Indiana.

NGS will continue serving as the

first point of contact for the pro-cessing and payment of Medicare fee-for-service claims from physicians – as well as hospitals, skilled nurs-ing facilities and other health care practitioners.

CMS said the MACs were selected using competitive procedures, and the contracts for each region are for a base period of time and four one-year options.

Learn more about NGS at www.ngsmedicare.com/ ngsmedicare/HomePage.aspx.

Medicare announces administrative contractor for Indiana

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January 20, 2009Page 3

How many times a day do patient calls interrupt you? David Pletzer, M.D., of Fishers Family Physicians has minimized interruptions from patients with routine or recurring problems.

He offers them the option of a “virtual visit.”

“Many things in medicine call for a discussion, but the patient does not need to be present in front of you,” said Dr. Pletzer. “Virtual visits eliminate the need for patients to leave work, drive to my office and wait for me to talk to them.”

While patients pay $25 for a virtual visit, typically what a co-pay would be, many prefer the option because it saves them time. They’re attractive to busy patients with simple or repeat conditions like a sinus infection, sore throat or back sprain, as well as for monitoring.

They’re also a good option for college students away from their regular physicians.

If you have Internet access, you can offer virtual visits too. They don’t require expensive electronic medical record systems, don’t steal time from nurses and staff, and don’t really cost a practice.

Fishers practice saves time, boosts revenue with virtual visitsHere’s how it works

The patient logs onto the practice Web site, uses an ID and password and enters a “portal.” Dr. Pletzer describes a portal as “an opening to a secure site so both parties can communicate but no one else can get in and see the information.” It passes the test for HIPAA.

On the screen, the software program offers patients a series of questions about their problem and, depending on the initial answers, other questions pop up. (About a cough, for example: How long have you had it? Is it productive?)

When the patient completes the questions, the physician receives an e-mail alert. Physicians may choose to order a prescription, offer advice or ask the patient to schedule an appointment.

Dr. Pletzer, who doesn’t pre-scribe over the phone, responds to his virtual visitors in the evenings and on weekends using his home computer, where he can access their medical records. So, patients can hear from him any time.

The system can also send a text message to the doctor’s cell phone, alerting him that a virtual visit is waiting.

Yes, but…Can you think of objections to

virtual visits? Dr. Pletzer has an-swers for most of them. Here’s a sample:• Reduces reimbursable office

visits – “My patients may choose to go to a retail clinic for a sore throat or rash and I wouldn’t know about it,” he said. “Now I can help them quickly and still have access to the information, to make the visits part of their records.”

• Requires initial financial outlay – Practices pay a monthly fee for the system but the savings in staff and physician time is substantial. At Fishers Family Physicians, virtual visit revenue pays for the practice Web site.

• Demands physician time – “This reduces demands on your time and diverts calls,” Dr. Pletzer said. For conditions he handles over and over, he prepares messages ahead of time. Then, when the virtual visit is about a common problem, he begins with a personal note, then pastes in his pre-written note on that condition.

• Interrupts off-hour time – “Doctors always get calls at home anyway and usually there is no reimbursement for those calls,” explained Dr. Pletzer.

• Only fits primary care – “Virtual visits will work for any specialty that gets calls of a less urgent nature,” said Dr. Pletzer. Cardiologists can use the system to monitor blood pressure or cholesterol. Dermatologists can use it to check on a patient’s acne, getting feedback about how a medication is working.

Dr. Pletzer would like virtual visits to become a bigger part of his practice.

“There are so many things about this that make sense,” he said. “For new problems, it wouldn’t work but for simple things, it’s great!”

Have more questions? E-mail Dr. Pletzer at dpletzer@ffpmd.com or call him at (317) 842-2727.

“Many things in medicine call for a discussion, but the patient does not need

to be present in front of you.” - David Pletzer, M.D.

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January 20, 2009Page 4

In adopting Resolution 08-03, members of the ISMA’s 2008 House of Delegates agreed that nursing home residents should receive 1000 units of vitamin D every day.

The resolution also commits the ISMA to educate nursing home personnel about the impor-tance of vitamin D.

In November, the ISMA mailed letters to nursing home admin-istrators throughout the state encouraging them to provide their residents a daily dose of

The ISMA calls for increased usage of vitamin Dvitamin D. The mailing included a handout pointing to a number of recent studies that demonstrate seniors are prone to osteoporosis, suffer falls and appear to be vitamin D deficient.

You too are encouraged to ensure elderly and nursing home patients in your practice are taking this osteoporosis-fighting medication.

Refer to the following sources for more information:Science Daily –

www.sciencedaily.com/releases/2007/02/ 070222160028.htm

British Medical Journal – www.bmj.com/cgi/content/full/330/7490/524

Agency for Healthcare Research and Quality – www.ahrq.gov/research/ mar08/0308RA10.htm

For a handout that can help you communicate the impor-tance of vitamin D to your patients, visit www.ismanet.org/pdf/healthful_hints/Vita-min_D.pdf.

The ISMA extends sincere sympathy to the families of the following members who have passed away.

Eddie R. Apple, M.D., Salem

C. Richard Bowers, M.D., Sarasota, Fla.

Phillip R. Dawkins, M.D., Jasper

Borivoj S. Divcic, M.D., Valparaiso

Robert Flanders Jr., M.D., Englewood, Fla.

M. Arthur Grant, M.D., Warsaw

Bradford R. Hale, M.D., Indianapolis

Jack W. Hannah, M.D., Elkhart

Harold V. Johnson, M.D., Evansville

Robert C. Keyes, M.D., Fort Wayne

Robert L. Marske, M.D., Carmel

Donald T. Olson, M.D., Notre Dame

Gene S. Pierce, M.D., New Albany

Wallace A. Scea, M.D., Muncie

Don A. Strehler, M.D., Pullman, Wash.

William J. Tierney, M.D., Anderson

Thomas E. Topper, M.D., Evansville

Richard L. Veach, M.D., Bainbridge

C. Kenneth Wilhelmus, M.D., Evansville

Gilbert M. Wilhelmus, M.D., Newburgh

Charles A. Yale, M.D., Marion

Finding a doctor the old fash-ioned way – by word-of-mouth – still is the preferred method for most Americans.

A new study by the Center for Studying Health System Change (HSC) found that about half of those surveyed relied on recommen-dations from friends, relatives and other doctors. Nearly two in five used multiple sources when choos-ing a primary care physician, and few actively shopped or considered price or quality information. Those polled also relied exclusively on physician referrals when choosing specialists and facilities for medical procedures.

The survey asked about various factors, such as cost, insurance coverage, perceived quality, doctor recommendation and convenience when choosing new doctors or facil-ities. Results revealed that patients’

chief concerns when choosing a doctor were quality, convenience (including location and short waits for appointments) and inclusion of the provider in their health plan network.

The study also found:• Few patients used online

provider information.• About 35 percent looked at

information from their health plan.

• More than one in 10 adults searched for a new primary care physician in the past 12 months.

• Nearly three in 10 needed a new specialist in the previous year.More than 13,000 adults were

surveyed between April 2007 and January 2008. The survey response rate was 43 percent. Find the study at www.hschange.com/CONTENT/1028/#ib4.

Patients still turn to family, friends when choosing a doctor

REPORTSI S M A

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David J. Welsh, M.D.

James G. McIntire

Adele M. Lash

Kathleen Hopper

Rhonda Bennett

Nicholas Peetz

Daniel Springer

PRESIDENT

EXECUTIVE VICE PRESIDENT

COMMUNICATIONS DIRECTOR

MANAGING EDITOR

ASSOCIATE EDITOR

PRODUCTION AND GRAPHICS EDITOR

COMMUNICATIONS ASSISTANT/WEB EDITOR

Published for member physicians. Nonmember subscriptions are $75 per year.

ISMAREPORTS

Comments? WRITE ISMa Reports 322 Canal Walk Indianapolis, IN 46202-3268

CALL (800) 257-4762 or (317) 261-2060 or VISIT www.ismanet.orgAdvertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Copyright 2009 Indiana State Medical Association

Angola hospital

won’t move Cameron Memorial

Community Hospital has decided to expand and renovate its existing facility in Angola instead of relocating closer to I-69. By staying in the current location, the hospital hopes to keep its critical-access status and federal funding.

No timeline has been set, but 95 percent of the current facility will be renovated or replaced.

Fishers starting town clinic Novia Care Clinics is helping Fishers turn part of its train station into a clinic for town employees. Officials hope the move will save $1 million in health care costs over the next three years.

The primary care clinic will be open for 12 hours a week, staffed by a physician and nurse. Medications will be available at wholesale prices to employees and, in some cases, may be free.

Community Health unites programs Community Health Network has joined with the Indiana Heart Hospital and various cardiovascular physician practices in central Indiana to form Community Heart and Vascular.

The new entity has more than 600 physicians from five hospitals and five physician practices, with a sixth practice to be integrated later this year. All doctors are expected to continue working at their current facilities.

New IU Eye Care Center opens The new $3 million Indiana University Atwater Eye Care Center is now open in Bloomington. The 22,000-square-foot facility is about a block away from the previous location and includes a video conferencing center, new diagnostic devices developed at the school, and an eyewear and fitting center.

The old building will be used for offices and research labs.

January 20, 2009Page 5

HappENINgSS TAT SHoosier State

ISMA Seminars• Coding Symposium, Feb. 26-27, Thursday-Friday, The Fountains Banquet and Conference Center, Carmel• Indiana Medicaid Update- March 4, Wednesday, Airport Marriott, Evansville- March 5, Thursday, Radisson Hotel, Bloomington- March 11, Wednesday, Hilton Garden Inn, South Bend- March 25, Wednesday, Fishers Conference Center, Fishers• The Independent Medical Practice, April 8, Wednesday, Renaissance Indianapolis North, Carmel* approved for CME ** approved for CEUCall the ISMA to register or e-mail seminars@ismanet.org.

Other events • ISMA’s Medicine Day at the Statehouse, Feb. 4, Wednesday, Indianapolis. Contact Sally Pierson at the ISMA for

information.• Medicare Coalition meeting, 10 a.m., and Medicaid Coalition meeting, 1 p.m., March 13, Friday, ISMA

Headquarters. For information, contact the ISMA, (800) 257-4762 or (317) 261-2060.• National Public Health Week Conference, April 7-8, Tuesday-Wednesday, IUPUI, Indianapolis. Sponsored by

Indiana MAPHTC. For information, visit www.publichealthconnect.org or contact Kate Nicholson at (317) 274-3178 or e-mail katlnich@iupui.edu.

Unless noted, all Happenings are held at the ISMA, 322 Canal Walk in Indianapolis (Canal Square Apartments at New York and West streets). Call the ISMA at (317) 261-2060 or (800) 257-4762 for more information.

Wellpoint, Inc., the India-napolis-based parent company of Anthem, told investors Jan. 12 it suffered losses of about $349 million in the fourth quarter of 2008. The company will make a federal filing of the earnings later this month. In the third quarter, Wellpoint experienced losses of $563 million.

On the same day, Bloomberg online news reported – and a press release from Wellpoint con-

firmed – the Centers for Medicare & Medicaid Services (CMS) has stopped the insurer from market-ing and enrolling seniors in the company’s Medicare Advantage and Medicare Part D plans.

Issues with Wellpoint’s computer systems have presented barriers to elderly patients, preventing some from receiving their prescriptions and causing others to be charged in-appropriately, Bloomberg reported. In a press release, Anthem stated,

“Since we have been meeting with CMS on a regular basis re-garding our remediation process, we were surprised by this recent action.”

For at least six months, Well-point has been trying to resolve issues identified through both internal and CMS audits. The move by CMS does not affect patients currently enrolled with Wellpoint’s Medicare products.

Wellpoint’s woes keep growing

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ISMA REPORTS322 Canal WalkIndianapolis, IN 46202-3268

PRESORTEDFIRST-CLASS MAIL

U.S. POSTAGE PAIDINDIANAPOLIS, IN

PERMIT NO. 952

Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Advertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.

Consider a day of service to your ISMA during the General Assembly

You can help the ISMA and complete your volunteer service in one day. Agree to serve as a Physician of the Day at the Indiana Statehouse in January or March 2009.

This Physician of the Day program allows Indiana physicians to treat minor ail-ments of state legislators and their staffs while gaining an insider’s view of the legislative process. Through this service, the ISMA enhances its presence at the Statehouse and allows member physicians the opportunity to observe the legislative process.

If you have questions about this program, e-mail the ISMA’s Sally Pierson at spierson@ismanet.org or call her at (317) 261-2060.

To read more about the Physician of the Day program and find the form for volunteers, visit www.ismanet.org/legislation/physician_of_the_day.htm.

Indianapolis Marriott Downtown 350 West Maryland Street, Indianapolis

For details, contact the ISMA’s Sally Pierson at (317) 261-2060.

WEDNESDAY, FEBRUARY 4, 2009

IndianaStateMedicalAssociation

Have an open position? Trying to sell office equipment or furniture? Need a job?

Try ISMA’s Classified Ads at

www.ismanet.org/resources/classifieds.

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