volume 90 no

caring doctor,a formidableacademic andaccording tothose who knewhim, a very clever man.

Case WesternReserve UniversitySchool ofMedicine,Reminger &RemingerAttorney at Lawand Butler Wicksponsored theeighth annualprogram that ispresented byCleveland Magazine to honor the city’s distinguished med-ical community. Proceeds from the event supportscholarships for Case medical students. n

Touting Tort Reform to Business Leaders

PHYSICIANVolume 90 www.amcnoma.org No. 1

C L E V E L A N D

Academy of Medicine of Cleveland/Northern Ohio Medical Association • January/February 2005

INSIDE THIS ISSUE

AMC/NOMA6000 Rockside Woods Blvd.Ste. 150Cleveland, OH 44131-0999

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AMC/NOMA President Presents at Medical Hall of FameThe AMC/NOMA congratulates Dr. John

D. Hines, a hematologist/oncologist at TheCleveland Clinic in Strongsville and Parma, whowas recently inducted into the 2004 ClevelandMagazine Medical Hall of Fame, held Wednesday,Nov.3 at Windows on the River. Dr.Hines,a physi-cian specially trained in chemotherapy treat-ments that attempt to kill cancer cells byinjecting chemicals into the bloodstream,was oneof three doctors this year to earn the distinction.The two other physicians inducted were fromUniversity Hospitals while a Ph.D. from LernerResearch Institute and a Case faculty memberwere recognized for Excellence in Research.

The AMC/NOMA President Dr. William H.Seitz, Jr., M.D., had the honor of presenting the2004 posthumous award to Charter Memberinductee Dr. Frank Nulsen, M.D., former chair-man of the Case Western Reserve UniversitySchool of Medicine’s Neurosurgical Departmentand past AMC/NOMA member who died in 1994.Dr. Nulsen was known as the innovator for theutilization of the shunt in hydrocephalus, a forcein the treatment of gun-related nerve injuries, a

The AMC/NOMA President, Dr.William H. Seitz, Jr., M.D., presentsthe 2004 posthumous award toCharter Member inductee Dr.Frank Nulsen, past AMC/NOMAmember who passed away in 1994.

Dr. John A. Bastulli, AMC/NOMA’s vice presi-dent of legislative affairs, was recently invited byThe TurnAround Management Association, theonly international nonprofit association dedicatedto corporate renewal and turnaround manage-ment, to discuss the topic of medical liability andtort reform during a one-hour debate titled:“TheHealthcare Crisis: Is Tort Reform the RightMedicine?”

More than 100 turnaround practitioners,attorneys, accountants, investors, lenders, venturecapitalists, appraisers, liquidators, executive

Physician AdvocacyPage 2, 3, 4, 5, 16, 18

Insurance IssuesPage 5

Legislative ReportPage 6, 7

Patient WellnessPage 8, 10, 11

Public HealthIssuesPage 9, 16

PracticeManagement2, 19

GovernmentRegulationsPage 13, 14

Member MattersPage 17, 20

(Continued on page 2)

Dr. Bastulli (far left) explains to Turnaround Managementattendees that caps on noneconomic damages will go a longway to help the state’s current medical liability crisis.

recruiters and consultants attended thedebate held on Wednesday, Nov. 10 at theMarriott in downtown Cleveland.

Others on the panel included: a med-ical malpractice attorney, an executivefrom a health care association, and anaccountant with a firm representing busi-nesses. Panelists were asked to discusscurrent tort reform law in Ohio. The mal-practice attorney stated that in his opin-ion proponents of caps on non-economic damages always try to give theimpression that these caps do not meana lot since the plaintiffs are being com-pensated for medical bills and expenses.He explained this is not what his casesare about. There is a loss of functionality,loss of sight as well as pain and sufferingthat must be accounted for somehow.He indicated passage of the tort reform

P H Y S I C I A N A D V O C A C Y

2 Cleveland Physician n January/February 2005

Touting Tort Reform to BusinessLeaders (Continued from page 1)

laws were “premature” since they hadalso established the Ohio Medical Mal-practice Commission through the OhioDepartment of Insurance (ODI) at thesame time “to study the issues.” He statedthe study should have taken place beforethe reforms were put into legislation.

Dr. Bastulli responded by stating theAMC/NOMA has had numerous opportu-nities to meet with the ODI, and it isimportant to note that not only is ODIputting together data on the issue, butthey are also trying to write a proposalfor a patient compensation fund as wellas looking at other forms of alternativedispute resolution such as mediation orarbitration. In addition, it has beenclearly shown that caps on non-economic damages as well as attorneycontingency fees do have a definiteimpact on curbing medical liability costs.Bastulli said, “As far as the current tortreform law goes, there is still a need totest the legislation at the Ohio SupremeCourt (OSC) level.” He said,“There are 10cases or more out there working theirway through the courts. We need to seeif the OSC will uphold this legislation. Inthe past tort reform had passed in Ohioonly to be overturned by a previous OSC.The staffs running these medical liabilityinsurance companies are waiting to seewhat these court challenges will bring inOhio.”

Then the moderator directly asked Dr.Bastulli:“What are the consequences onquality and access to care due to themedical liability crisis?

Dr. Bastulli stated the AMC/NOMAfound escalating costs of medical liabilitypremiums increases the overall costs forthe entire health care system. He saidaccess to care is also becoming an issueas physicians retire, leave the state orstop conducting high-risk proceduressuch as OB/GYN or stop taking ER call.He commented, there are plenty of exam-ples of physicians exiting the state andthe ODI tracked more than 180 physi-cians who have done so. He said manyphysicians outlined how they reducedtheir scope of practice or left their prac-tice altogether. There were also exam-ples noted of emergency rooms unableto get physicians to take call. So, he said,quality of care is definitely impactedthrough lack of access to care.

The attorney quoted studies thatshowed that there has been no reductionin doctors due to medical malpracticecosts, and he also noted that a recent arti-cle in our local news indicated that thenumber of physician licenses are actuallygoing up in Ohio. Dr.Bastulli replied that

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THE CLEVELAND PHYSICIAN (ISSN# 1084-0982) ispublished bi-monthly by the Academy of MedicineCleveland/Northern Ohio Medical Association(AMC/NOMA), 6000 Rockside Woods Blvd., Suite150, Cleveland, Ohio 44131. Periodicals postage paidat Cleveland, Ohio. POSTMASTER: Send addresschanges to CLEVELAND PHYSICIAN, 6000 RocksideWoods Blvd., Suite 150, Cleveland, Ohio 44131.Editorial Offices: AMC/NOMA,6000 Rockside WoodsBlvd., Suite 150, Cleveland, Ohio 44131, phone (216)520-1000. $36 per year. Circulation: 2200.

Opinions expressed by authors are their own, andnot necessarily those of the Cleveland Physician orThe Academy of Medicine of Cleveland/NorthernOhio Medical Association. Cleveland Physicianreserves the right to edit all contributions for clarityand length,as well as to reject any material submitted.

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PHYSICIANC L E V E L A N D

the numbers published in the news didnot reflect the real data and if you drilldown on the numbers published by theOhio State Medical Board, what wasquoted in the newspaper was completelyincorrect. The numbers as publishedincluded podiatrists, massotherapists,anesthesiologist assistants and otherhealth care practitioners, not just physi-cian licensees in Ohio. Bastulli furthercomments that in fact the AMC/NOMAreviewed the physician number data aspublished and sent a letter to the editorwhich was published — that clearlyshowed that their reported data wasflawed.

The attorney stated that most lawyersbelieve the true solution to this problemis to reduce the percentage of medicalmalpractice costs by having real insur-ance reforms in place. He said insurancecompanies are exempt from antitrustand the sole regulator for many medicalmalpractice insurance companies isthrough the ODI in Ohio, which he feelsis a department struggling financially withleadership made by political appoint-ments. He then mentioned Proposition103 in California and indicated thisstatute, which passed in California, wasthe real reason rates went down in thatstate not the fact that MICRA was imple-mented.

Dr.Bastulli interjected and said that thetort reform bill originally introduced inOhio was modeled completely afterMICRA, the California legislation whichhas worked to bring down medical mal-practice rates. He said one of the maincomponents stripped from the Ohio bill,important in MICRA, was the cap onattorney contingency fees. He indicatedthe sliding scale set up in MICRA causedmore money to go to the plaintiffs andprohibited attorneys from filing frivoloussuits. Dr. Bastulli stated that Proposition103 was targeted to California’s autoindustry and not implemented until1988, many years after MICRA startedand some time after California saw atrending downward of the medical mal-practice rates. In truth, it was the MICRAlegislation, not Proposition 103 thatbrought down the rates in California. Dr.Bastulli closed by stating physicians inNortheast Ohio are in a medical liabilitycrisis and, he believes, caps willultimately help the situation.

For more information on AMC/NOMA’stort reform initiatives, contact Elayne R.Biddlestone at (216) 520-1000 ext.321 orvia e-mail at [email protected] n

A M C / N O M A B O A R D O F D I R E C T O R S A D V O C A C Y R E P O R T

Cleveland Physician n January/February 2005 3

AMC/NOMA Leadership’s Voice Heard Locally and at the State Level

AMC/NOMA Leadership Brings the Lack of MetroHealth Funding toLocal Politicians and Editors’ Attention

AMC/NOMA President William H. Seitz, Jr., M.D., recently respondedto County Commissioners: Jimmy Dimora, Peter Lawson Jones and TimMcCormack’s decision to allocate MetroHealth Medical Center only 3 per-cent of the County’s overall $1.3 billion budget via a letter addressing theproblem. Within the letter, Dr. Seitz reminds the Commissioners thatMetroHealth was promised, expected and deserves an increase in Countyfinancial support from $21 million to $42 million this year as a result of thepassage of the Issue 15 Levy but instead only received $27 million towardits $585 million annual budget.He writes,“MetroHealth Medical Center pro-vides a safety net to thousands of County residents who do no otherwisehave access to healthcare. The potential ripple effect of loss of service atMetro is unthinkable and the commissioners must act responsibly and pro-vide Metro with the funds that were promised to them as a result of thepassage of Issue 15.” (see letter this page)

The AMC/NOMA president was then interviewed by Crain’s ClevelandBusiness. The article quoted Dr.Seitz’s letter to the commissioners and alsoreported that Peter Lawson Jones said he plans to meet with Mr. Sideras,MetroHealth’s CEO,“well before the end of the year” to discuss putting onthe ballot next year a 0.7 or 0.8 mill levy that would raise about $100 mil-lion over 10 years strictly for MetroHealth’s capital expenditures. However,that levy wouldn’t answer MetroHealth’s stated need for additional moneynow. Commissioner Jimmy Dimora last week reported his hopes that thecommissioners will be able to give the hospital enough money for 2005,but indicated increases of $15 million would be difficult to muster becausethe county already must cut $20 million from its 2005 budget. TheAMC/NOMA will continue to follow how the commissioners proceed withthe MetroHealth funding issue.

AMC/NOMA Leadership Sends Comments on ODI Draft RulesThe Ohio Department of Insurance filed a rule on data collection with the

Joint Committee on Agency Rule Review pursuant to House Bill 215. Thislegislation requires the Superintendent of the Ohio Department of Insur-ance to file a rule requiring every authorized insurer, surplus lines insurer,captive insurer, risk retention group, self-insurer, the medical liability under-writing association, if created, and any other entity that provides medicalmalpractice insurance to risks located in Ohio to report information to theOhio Department of Insurance at least annually regarding all medical, den-tal, optometric, and chiropractic claims asserted against a risk located inOhio, if the claim resulted in a final judgment or settlement in any amountor a final disposition resulting in no indemnity payment on behalf of theinsured. The data would have to be filed in a report to the Director priorto May 1 each year and persons failing to file a timely report would be sub-ject to a fine not to exceed $500. The information filed with the Directorwould be considered confidential and privileged and not a public record.

In a letter dated, Dec. 2, 2004,AMC/NOMA President Dr. William H.Seitz, Jr., M.D., submitted comments regarding the draft rules to theDirector of the Ohio Department of Insurance,Ann Womer Benjamin. Dr.Seitz suggested having ODI require data submission from plaintiff attor-neys, having ODI include in the rule an item requiring insurers to providedata on insureds who have been named in a claim (sent a claim letter) orcomplaint that has subsequently been dropped. The letter suggested thatODI specify, for suits, the mechanism of dismissal (ie, dismissal withoutprejudice or dismissal with prejudice and whether that defendant/insuredwas dismissed after filing of an affidavit of noninvolvement). JCARR passedthe rules without any changes; however, there was an amendment made toHB 425 — which was a bill originally dealing with coal mines was amendedto include several unrelated provisions, one of which deals with MedicalMalpractice reporting. Continuing law requires medical malpractice insur-ers to report information to the Department of Insurance at least annually (Continued on page 4)

THE ACADEMY OF MEDICINECLEVELAND

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FROM THE EXECUTIVE OFFICES www.amcnoma.org216-520-1000 • FAX 216-520-0999

NOMANorthern Ohio Medical Association

on all malpractice claims resulting in afinal judgment of any amount, a final set-tlement,or a final disposition of the claimresulting in no indemnity payment onbehalf of the insured. (see LegislativeReport on pages 6 and 7 for more infor-mation.) The AMC/NOMA will continueto pursue our other suggestions with theDirector of the Ohio Department ofInsurance.

AMC/NOMA Leadership ProvidesContinuing Concerns to ODIRegarding the Issue of “Tail” Coverageand Proposes Model Policy Language

In a letter dated, Nov. 24, 2004,AMC/NOMA Secretary/Treasurer andPhysicians’Advocacy Committee Chair, J.Richard Ludgin, M.D., J.D., submittedto the Director of the Ohio Departmentof Insurance, Ann Womer Benjamin, a let-ter outlining our continuing concernspertaining to the issue of “tail” coveragein Ohio. The letter, which was approved



by the AMC/NOMA Board of Directors,was the direct result of ongoing con-cerns voiced to the AMC/NOMA frommembers regarding this issue. Duringour review of this matter, it has beenshown that the policies from the majorinsurers require a physician receiving adeath, disability or retirement (DDR) tailnever practice medicine again or, if hedoes, he risks having his reportingendorsement contract voided.The AMC/NOMA believes that there are manypressing social issues in healthcare thatmake this waste of talent a travesty.Wewant to see adoption of a series of excep-tions that will not void the tail coverage— such as,working in a free clinic, teach-ing interns, residents and fellows.

The AMC/NOMA views this issue in thesame light as enterprise liability.Physicians who want to work anotheryear or two have been “forced” to retireearly because their group is switchinginsurers and they will have to remainwith that insurer for three to five years inorder to qualify for a DDR tail. To encour-age physicians to remain in practice, the“waiting period” for tail coverage needs

to accommodate the realities of the pub-lic’s need for care.

Draft model policy language, suggestedby Dr. Ludgin on behalf of AMC/NOMAincluded language to have professionalliability companies consider a policy thatprovided for a “No Cost ExtendedReporting Endorsement.” This suggestedpolicy asks that if the named insuredshould die or become physically or men-tally disabled to where he can no longerpractice medicine, the company shalloffer, at no additional cost, an extendedreporting endorsement with new limitsof liability at the limits in effect for thenamed insured at the time of death or thedate on which his disability requires hestop practicing medicine.

Other suggestions made to ODIincluded that if the named insured electsto retire from the active clinical practiceof medicine, the company shall offer, atno additional cost, an extended reportingendorsement with new limits of liabilityat the limits in effect for the namedinsured on the date of his retirement.The draft policy submitted to ODI also

AMC/NOMA Leadership’s VoiceHeard Locally and at the State Level(Continued from page 3)

Notes from the First Volunteers in Health Care TeleworkshopRecently, AMC/NOMA staff participated

in the first Volunteers in Health CareTeleworkshop. More than 100 organiza-tions tuned into the conference callsponsored by The U.S. Department ofHealth and Human Services’ new federalprogram (Free Clinic FTCA MedicalMalpractice Program) designed to providemedical malpractice coverage to clinicalvolunteers at free clinics across the country.

The teleworkshop helped callers deter-mine if this program is appropriate forspecific clinicians and explained exactlyhow to apply for coverage. ShannonDunne Faltens, JD, from the Departmentof Health and Human Services’ Bureau ofPrimary Health Care provided informa-tion about this new federal program andanswered questions. She was joined byVolunteers in Health Care’s Gayle Goldinand Paul Hattis,MD, JD,MPH, for a discus-sion on how this program is likely toaffect free clinics across the country.

Participants heard background on howCongress enacted FTCA medical mal-practice protection for volunteer freeclinic health professionals throughSection 194 of HIPAA (Public Law 104-191) by amending Section 224 of thePublic Health Service Act (PHS Act) (42U.S.C 233).

If a volunteer health care professionalmeets all the requirements of theProgram, the related free clinic can spon-sor him/her to be a “deemed” federalemployee for the purpose of FTCA med-ical malpractice coverage. The FTCAdeemed status provides the volunteerhealth care professional with immunityfrom medical malpractice lawsuits result-ing from his/her subsequent perform-ance of medical, surgical, dental orrelated functions within the scope ofhis/her work at the free clinic.

Claimants alleging acts of medical mal-practice by the deemed volunteer healthcare professional must file their claimsagainst the United States according toFTCA requirements. The payment ofclaims will be subject to the Federal gov-ernment’s appropriation.

In order to qualify, free clinics mustsubmit an annual FTCA deeming applica-tion on behalf of their volunteer freeclinic health care professionals to theDepartment of Health and HumanServices (HHS) Health Resources andServices Administration, Bureau ofPrimary Health Care (HRSA, BPHC) thatadministers the Program.

HHS will deem a volunteer free clinichealth care professional to be a federal

employee for the purposes of FTC cover-age for medical malpractice claims if thefree clinic and health care professionalmeet certain requirements. According toHHS, a free clinic is a health care facilityoperated by a nonprofit entity that: inproviding health care does not acceptreimbursement from any third-party payor(including reimbursement from anyinsurance policy,health plan or federal orstate health benefit program); in provid-ing health care does not impose chargeson patients to whom service is providedor imposes charges on patients accord-ing to their ability to pay; may acceptpatients’ voluntary donations for healthcare service provision; and is licensed orcertified to provide health service inaccordance with applicable law.

Volunteer free clinic health profession-als will be deemed a federal employee forthe purposes of FTC coverage for med-ical malpractice claims if the health pro-fessional: provides services to patients ata free clinic or through offsite programsor events carried out by a free clinic; issponsored by a free clinic; provides aqualifying health service without regardto whether the medical assistance isincluded in the plan submitted by the




state in which the health care practi-tioner provides the service; does notreceive compensation for provided serv-ices from patients directly or from anythird-party payor; may receive repaymentfrom a free clinic for reasonableexpenses for an incidentals such asmileage or supplies incurred in serviceprovision to patients; is licensed or certi-fied to provide health care services at thetime of service provision in accordancewith applicable law; and providespatients with written notification beforeservice provision of the extent to whichhis/her legal liability is limited pursuantto the PHS Act if his/her associated freeclinic has not already provided suchnotification.

Those services covered include: thosethat arise from services required orauthorized to be provided under TitleXIX of the Social Security Act (MedicaidProgram) regardless of whether the serv-

ice is included in the State Medicaid planin effect for the volunteer free clinichealth care professional’s work site;those that arise from the provision ofmedical, surgical, dental or related serv-ices at a free clinic site or through offsiteprograms or events carried out by thefree clinic; and occur on or after theeffective date that the HHS Secretaryapproves the deeming application sub-mitted by the free clinic on behalf of itsvolunteer.

Various program requirements havebeen instituted before HHS will deem avolunteer for purposes of FTCA coveragefor medical malpractice claims. Specificcredentialing (licensure, certification,and/or registration) must be met as wellas privileging requirements (authorizinga specific scope and content of patientcare services).

HHS will go through standard primaryand secondary verification sources todeem the applicant.

A free clinic must sponsor each volun-teer free clinic health care professionalthat participates in the Program. A free

clinic can sponsor volunteer free clinichealth care professional by submitting aFTCA deeming application to the HHSSecretary through the Free Clinics FTCAprogram. Free clinics can download thedeeming application at http://www.bphc.hrsa.gov/freeclinicsftca/applica-tion.htm

The program provides protection onlyfrom allegations of medical negligencefor volunteer free clinic health profes-sionals detailed in the program’s informa-tion notice. Other free clinic staff andthe free clinic corporation are not cov-ered under FTCA. Additionally, the pro-gram does not provide protection againstperils normally protected by generalliability and directors and officers’ insur-ance policies. Free clinics are encour-aged to consult with their insuranceagents to determine their needs for pro-tection beyond the Program.

For questions directed to theVolunteers in Health organization, con-tact Gayle Goldin at 877-844-8442, [email protected] or visit www.volunteersinhealthcare.org n


I N S U R A N C E I S S U E S

The past three years have been finan-cially treacherous for physicians buyingmedical malpractice insurance. Priceshave been very steep, availability hasbeen scarce and many insurers havefailed.Among the surviving carriers whocontinue to underwrite coverage forphysicians, some look more like RockyBalboa after the fight, rather than beforethe fight.The good news is that they arestill standing.

What are we in for in 2005? The fore-cast in a nutshell looks like clearing skiesand calmer seas, in a word,“stability.”

If you have made it through the stormof the last three years, you will likely beentering a time of relative calm and sta-bility. Rate increases should be fewer andfarther between and less severe over all.

We will not be seeing an immediatereturn to the premiums of the late nine-teen nineties. Before that happens, com-petition must strengthen in this market,underwriting results must improve andtort reform must prove its mettle at thelevel of the Ohio Supreme Court.

The rate increases taken in 2004 havebeen as follows: ProAssurance 8.6 per-cent, OHAIS 8.6 percent, The DoctorsCompany 6 percent, OHIC 17 percent,GE Medical Protective 15 percent, andAPA 9.1 percent. Most of these increaseswere moderate compared with theimmediate prior years.

At this time, I know of no planned rateincreases scheduled to take effect inOhio in 2005.

In Ohio, however, there are alwayschanges in the wind. One of the pre-dicted developments is a greatly increasedpresence of Captives, Risk RetentionGroups and new Admitted Insurers.Names such as CARE, HUG, Tri-StateMedical and hospital based captives suchas Western Reserve Assurance Companywill likely grow their policyholder count.With increased availability of reinsuranceand the dramatically increased premiumsof the past three years, these alternativerisk transfer solutions become more

viable. They believe there is enough pre-mium now to cover their risks, if they arecareful with their underwriting, or offeradvanced risk management strategies.Aword of caution to the wise before insur-ing through one of these vehicles: takecare to assess the financial wherewithaland the management structure as well asfees of the respective insurer. Most ofthese entities are not rated and deserve aclose look by informed consumers. Somewill likely succeed with flying colors,others will not. In almost all of thesevehicles that I am aware of, the premiumsare similar to those of the standard mar-ket insurers (OHIC, TDC, GE/Med Pro,ProAssurance,APA, and OHAIS).

The combination of new names in themarket place, hospital sponsored sharedrisk strategies and an improvement in theunderwriting results for the major carri-ers will all lead to more stability in Ohioin 2005. n

Malpractice Insurance Premiums:Through The Storm?

By David A. Martin, President,The Premium Group, Inc.

Notes from the First Volunteers inHealth Care Teleworkshop(Continued from page 4)


L E G I S L A T I V E R E P O R T

Ohio Supreme Court ElectionOver the last several years, perhaps no

government body in Ohio has been moreentrenched in controversial issues thanthe Ohio State Supreme Court. Oftentimes with a very split vote, the SupremeCourt has ruled on several importantmatters which affect the entire state,including issues such as tort reform andhow Ohio finances its public schools.

Due to the court’s activism on matterssuch as these, many interested partieshave weighed in on how the courtshould be structured. Historically, AMC/NOMA has supported candidates whohave the general support of the businesscommunity while unions and triallawyers have generally supported theiropposition.

Although there were several importantcontests on the November 2,2004 ballot,it is clear that the three races for a seaton the State Supreme Court were critical.AMC/NOMA, through NOMPAC, aggres-sively supported the candidates of ChiefJustice Thomas Moyer, Justice TerrenceO’Donnell and Judge Judith Lanzinger.Due in large part to the hard work ofAMC/NOMA physicians and staff, allthree candidates that we supported weresuccessful!

Business and Product Liability Tort Reform (SB 80)

While it is too early to fully compre-hend the value of a court more under-standing of our issues, significantprogress on important matters hasalready been made. Recognizing a moresupportive court, the Ohio StateLegislature recently passed a bill makingsweeping changes to Ohio’s Civil JusticeTort System. Am. Sub. S.B. 80 (Stivers-R)drastically changes how civil torts will bemanaged in this state. While the bill doesnot specifically address medical malprac-tice claims, it lays a foundation of ideol-ogy that is much more in line with ourdesire to reign in frivolous lawsuits thanany other piece of legislation taken upover the last several years. The passageof civil justice reform was a monumentaltask for this General Assembly.

The AMC/NOMA has been followingthe changes and amendments to SB 80and as a long-standing member of theOhio Alliance for Civil Justice, a broadcoalition of business, insurance and

healthcare organizations, the AMC/NOMA has been very supportive of SB 80.

Among the key provisions of Am. Sub.S.B. 80 are:

• Placing limits on the recovery ofpunitive damages – two times com-pensatory damages for large employ-ers; for small employers andindividuals, the lesser of two timescompensatory damages, 10 percentof the employer’s or individual’s networth, or $350,000

• Placing limits on the recovery of non-economic damages – the greater of$250,000 or three times the amountof economic damages up to $350,000for noncatastrophic injuries; prohibitsthe use of certain evidence in deter-mining non-economic damages forcatastrophic injuries.

• No cap on noneconomic damages for“catastrophic injuries” but judgeswould be required to review andpossibly lower large jury awardsbased on certain criteria;

• Establishing a 10-year statute ofrepose for product liability andconstruction-related claims

• Permitting the introduction of collat-eral sources of payment to plaintiffsfor damages

• Immunity from prosecution forrestaurants and food companies thatare sued by plaintiffs who blame therestaurant for making them fat orunhealthy.

• Setting limits on the successorasbestos-related liabilities

• Eliminating the consumer expecta-tion test as a stand-alone test fordesign defect causes of action.

Other pieces of legislation that passedat the end of the year of importancephysicians and the AMC/NOMA includethe following:

Chicken Pox Immunizations (HB463) – This bill requires, except in selectcircumstances, that students be immu-nized for chicken pox before beginningkindergarten. The House concurred onthe Senate’s changes and the bill nowawaits the Governor’s signature. TheAMC/NOMA strongly supported thislegislation.

Mammography Screening (HB3 3 1 ) – This legislation increases the capon reimbursement for mammographyscreening.The Senate adopted an amend-ment that creates a fee schedule bywhich health care providers and medicalrecords companies may charge for copy-ing related to medical records.

The bill changes the fees that may becharged for copies of medical recordsand establishes two fee schedules. Thefirst applies when the request is from apatient or patient’s personal representa-tive.The second applies when the requestcomes from a person or entity other thana patient or patient’s personal represen-tative.The bill provides for these sched-ules to be in effect through December31, 2008.The bill requires the Director ofHealth to adjust the fee schedules annu-ally beginning not later than January 31,2006 to reflect an increase or decrease inthe Consumer Price Index over the previ-ous 12-month period. The AMC/NOMAstrongly supports this legislation andplans to prepare a revised fact sheetr egarding medical records and pro-vide it to our members in the nextfew weeks.

Attorney Fee Data Collection (HB425) – The original intent of this legisla-tion pertained strictly to mine subsis-tence insurance, however, amendmentswere made to the bill that ask the OhioSupreme Court to adopt rules governingdata collection on contingency fees thatplaintiffs’ attorneys receive. Continuinglaw requires medical malpractice insurersto report information to the Departmentof Insurance at least annually on all mal-practice claims resulting in a final judg-ment of any amount,a final settlement,ora final disposition of the claim resultingin no indemnity payment on behalf ofthe insured. HB 425 requests the OhioSupreme Court to adopt rules of profes-sional conduct that require attorneyswho represent persons on medical mal-practice claims to file a report with theDepartment of Insurance or the Depart-ment’s designee describing the attorneyfees and expenses received for the repre-sentation, as well as any other data nec-essary for the Department to reconcilethe attorney fee and expense data withother medical malpractice closed claimdata received by the Department.

Ohio State House Report

Prepared by the AMC/NOMA and our lobbyists, Messrs. Mike Caputo and Mike Wise



L E G I S L A T I V E R E P O R T

The bill defines any information sub-mitted to the Department by an attorney,law firm, or legal professional associationpursuant to rules adopted by the OhioSupreme Court to be confidential andprivileged and not a public record.Under the bill, the information submittedis not subject to discovery or subpoenaand cannot be made public by theDepartment of Insurance or any otherperson. The Department, however, isrequired under the bill to summarize theinformation received and to include theinformation in the annual report pre-pared by the Department on closed med-ical malpractice claims. Individual claimsdata cannot be released in the annualreport. The data would be reported tothe Ohio Department of Insurance in aconfidential format, and in turn the ODIwould then issue an aggregate report tothe Ohio General Assembly. TheAMC/NOMA strongly supports thep rovisions of this legislation per-taining to reporting of attorn e yinformation.

Campaign Finance ReformAnother very important matter taken

up by this General Assembly was cam-paign finance reform. Called into a spe-cial legislative session by Governor BobTaft, the legislature made sweepingchanges to Ohio’s Campaign FinanceLaws. Among those most notable andapplicable to AMC/NOMA members are:

• Increasing caps on minimum per-sonal contributions. Current lawallows for individual contributionsof up to $2500 per election cycle percandidate. With the passage of thecampaign finance reform effort,that cap has increased to $10,000per election cycle per candidate.

• Restricting funds that may by usedfor “issue advocacy” groups.Previously unregulated, the billimposes several new forms of regu-lation on third party groups thatare formed to discuss issues, not spe-cific candidates. Under current law,corporate funds could be used tofinance activity of issue advocacygroups regardless of how close to anelection that group’s activity is. Thenew law states that corporate con-tributions to issue advocacy groupscannot be used on any activitywithin thirty days of an election for

which the group is advocating.Within that thirty-day window, onlypersonal contributions may be usedfor advocacy activity.

• Whereas issue advocacy groupswere under to obligation to reportits donors, the new law makes allfinancial activity of a group, bothdonations and expenditures,reportable to the Ohio Secretary ofState.

There were no substantivechanges made to Ohio’s limits oncontributions to Political ActionCommittees (PAC’s). Therefore, anyimpact that this bill has on theAMC/NOMA and our PAC–(NOMPAC)activities is expected to be minimal.

Leadership changes at the Statehouse

As the 126th General Assembly is set tobegin, there have been several changes tolegislative leadership. With terms limitsin effect, a new Speaker of the House andSenate President will be sworn in. JonHusted (R-Kettering) will assume the roleof Speaker of the House. In the Senate,Senator Bill Harris (R-Ashland) has wonthe support to become the next SenatePresident. Additionally, North RoyaltonSenator Bob Spada has been named tothe majority leadership team in the nextGeneral Assembly. Having a member ofmajority leadership from CuyahogaCounty will prove invaluable to thisregion as the state faces many difficulttasks ahead. Look in your mailbox for a full directory of the 126th GeneralAssembly, to come soon.

On the Horizon for thenext General Assembly

The 126th General Assembly promisesto be challenging on several fronts.Faced with a two-year deficit projectedat approximately $5 billion dollars, legis-lators will spend the first six monthscrafting an operating budget bill thatreflects Ohio’s spending capabilities. Themost likely scenario to balance thebudget will be a combination of cuts toexisting programs (Medicaid is likely toreceive significant cuts in state spending)as well as revenue enhancements(extending the 1 cent “temporary” salestax another two years is being consid-ered. The penny is projected to raiseapproximately $1.3 billion dollars peryear, cutting the projected deficit in halfif it remains). The budget process will bethe single most time consuming process

for the first half of 2005. Given the com-plexity of this budget in particular, manyother significant policy proposals willnot be taken up until budget delibera-tions conclude in June. In addition to thestate budget, legislators are expected totake up comprehensive tax reform.

Although the budget and tax reformare certainly going to take up a signifi-cant amount of time as those issues aredebated, the legislature will review sev-eral other important policy matters.AMC/NOMA has submitted a proposalthat will create a nonbinding mandatoryarbitration for medical malpracticeclaims. We have reviewed our proposalwith legislative leadership and havereceived positive feedback on our plan.Furthermore, State Senator KevinCoughlin (R-Cuyahoga Falls), has agreedto serve as the primary sponsor for ourproposal. Senator Coughlin’s office iscurrently drafting the bill and we expectit to be introduced early in the nextGeneral Assembly.

Due to the nature of the bill,we expecta great deal of opposition, primarily fromtrial lawyers. We will keep our membersfully apprised of developments as theyarise, however, our active support bothfor the bill and Senator Coughlin will benecessary as this bill progresses throughthe legislative process.

The next session of the GeneralAssembly promises to be exciting andchallenging. AMC/NOMA will be thedriving force behind what will probablybe the most organized effort to mitigatethe medical malpractice crisis in Ohioover the next two years. AMC/NOMAmembers will be asked to play a key rolein this effort. Please do not take thisrequest lightly, as your involvement willbe critical. You will receive updates on the status of our proposal in themonths to come. It will be equallyimportant that our members continue tocontribute to NOMPAC. In the mean-time, please do not hesitate to contactElayne R. Biddlestone at the AMC/NOMAat (216) 520-1000 ext. 321 or e-mail [email protected] with anyspecific question or comment that youmay have. n

Ohio State House Report(Continued from page 6)

P A T I E N T W E L L N E S S


Cleveland hasbeen a paceset-ter in acutestroke care sincei n t r a v e n o u stissue plasmino-gen activator (IV tPA) receivedFDA approval in1996. Early com-munity efforts instroke includedthe Academy of

Medicine of Cleveland/Northern OhioMedical Association brain attack guide-lines and the Cleveland Health QualityChoice project. Building on this founda-tion, Operation Stroke and AmericanStroke Association’s (ASA) national initia-tives were piloted in five U.S. cities in1998. Cleveland joined 21 additionalpilot cities in 1999. Currently, there are more than 100 cities participatingincluding six in Ohio (Akron/Canton,Youngstown,Toledo, Columbus, Cincin-nati, Cleveland).

Each year there are more than 5,000acute strokes admitted to Cleveland areahospitals. Of those cases, only 2 percentreceive IV tPA within three hours ofonset, the only FDA-approved treatmentfor acute stroke. Our reports show morethan 1,000 stroke-related deaths occur inCuyahoga County each year. The objec-tives of the Cuyahoga County OperationStoke were: to increase public awarenessof stroke warning symptoms by 25 per-cent; to increase the number of patientsreaching an ED within 3 hours of strokeonset to 25 percent; to increase the useof IV tPA to 5 percent; to increase thenumber of patients presented to anEmergency Department within six hoursto 33 percent. To accomplish these goalsCuyahoga County Operation Strokerequired participating hospitals to: beinvolved in stroke CME; to develop stan-dardized dataforms for stroke patients;and, most importantly, to collect out-comes performance data.

The creation of the Cuyahoga CountyOperation Stroke initiative was not easyand required extensive trust buildingamong the Cuyahoga County physiciansand hospitals. Eventually, virtually all

Cuyahoga County hospitals becamemembers of Operation Stroke. Thisunique cooperation was achieved by cre-ating four committees (Education,Marketing, EMS, Medical) which identi-fied issues, suggested participatory solu-tions and nurtured the development ofthe initiative in Cuyahoga County. Arehabilitation subcommittee was addedlast year. Significant accomplishmentsincluded: the standardization of EMS fieldprotocols for acute stroke withinCuyahoga County, the development ofstandardized stroke orders and algo-rithms for all Emergency Departments,the development of a “Stroke SurvivorGuide” for patients and the creation of acommunity, doctor-friendly, stroke out-comes dataform.The latter was a uniqueaccomplishment of Cuyahoga CountyOperation Stroke and was overseen byIrene Katzan with the support fromgrants by Astra Zeneca and Genentech.The initial outcomes data pilot was devel-oped with Gary Hauser and the StrokeGroup of Denver, Colorado. Eventually,the data and outcomes effort migrated tothe ASA’s “Get with the Guidelines” proj-ect, linked with the Paul CoverdellNational Stroke Registry,which Ohio wasone of five pilot states. The CuyahogaCounty effort has led to two northeastOhio “State of Stroke” CME programseach with more than 200 participantsand a 2003 Ohio Stroke Summit held inColumbus. In a related effort, theCleveland Clinic Health System receivedthe 2003 JCAHO Codman Award for sys-tems approaches to the use of IV tPA inacute stroke.

This year the major focus of CuyahogaCounty Operation Stroke is to assist localhospitals to become JCAHO-certifiedPrimary Stroke Centers. The goal is tohelp all Cuyahoga County hospitals withactive Emergency Departments tobecome Primary Stroke Centers over thenext two years. Already MetroHealthMedical Center, Lakewood Hospital andUniversity Hospitals have all been certi-fied. The Cleveland Clinic has an antici-pated certification date of early 2005.Many of the other hospitals involvedwith Cuyahoga County’s OperationStroke have indicated they will apply for

JCAHO review in 2005 and the organiza-tion will be assisting those efforts. Therehave been preliminary discussions withCleveland EMS about triaging acutestroke patients to JCAHO-certifiedPrimary Stroke Centers.

Cuyahoga County Operation Strokerepresents a multidisciplinary community-wide effort which demonstrates hospi-tals can overcome local politics and worktogether to improve the care of patientswith stroke. Our success has dependedon the efforts of many individuals whomI cannot name all. However, I want toacknowledge Annette DiRosa and WendeMiller of ASA, Dr. Ronald Savrin whoserves as liaison with the AMC/NOMAand those who have served as committeechairs: Michael Waggoner (Medical), Dr.Dennis Landis (Medical), Cathy Sila(Medical), Chief Christopher Flynn(EMS), John Kubincanek (EMS), GaryClark (Rehabilitation), Michael Merk(Education),Diane Conaway (Marketing).From its 1999 inception, due to theirefforts as well as the entire community’scooperative spirit, Cuyahoga CountyOperation Stroke has developed into anational role model of regionalized andsystematic approaches to stroke care.This “Cleveland experience” was high-lighted at the second National Institutesof Health symposium on stroke care in2002 and has been presented in peerreviewed publications. Our communityand our stroke patients should be veryproud of these accomplishments.

Alberts MJ, Hademenos G, Latchaw etal. Recommendations for the establish-ment of primary stroke centers. JAMA2000;283:3102-3109

Katzan IL. Graber TM. Furlan AJ.Sundararajan S. Sila CA. Houser G. LandisDM. Cuyahoga County Operation Stroke.Cuyahoga County Operation Strokespeed of emergency department evalua-tion and compliance with NationalInstitutes of Neurological Disorders andStroke time targets. Stroke. 34(4):994-8,2003 Apr.

Editor’s Note: AMC/NOMA staffattends regular meetings and is activelyinvolved in Operation Stroke’s initia-tives. n

Cuyahoga County Operation Stroke: From Politics to Patient Care

Anthony J. Furlan, M.D.Chairman Cuyahoga County Operation StrokeHead Section of Stroke and Neurocritical CareDepartment of NeurologyCleveland Clinic Foundation

P U B L I C H E A L T H I S S U E S


Collaborative Efforts Improve Regional Emergency Preparedness

Lisa AndersonVice President, Member Services,The Center for Health Affairs

The events of September 11, 2001,caused an enormous shift in how wedefine emergency preparedness.That daybrought the realization that the responsesystems in place at the time could easilybe overwhelmed by an incident of suchmagnitude. As a result, communitiesacross the nation, including here inNortheast Ohio, initiated a concertedeffort to ensure they would be prepared.

In our region, hospitals began workingwith public health, public safety, emer-gency management and other officials todevelop a coordinated regional responseplan.While hospitals have long had well-developed and frequently tested proce-dures for responding internally toemergency events, over the last twoyears, work has focused on building col-laborative arrangements and protocolsamong hospitals and other communityagencies.

This preparedness effort has been sup-ported by a funding stream that wasappropriated by Congress beginningwith federal fiscal year 2002.The fundinghas been designated specifically forbioterrorism preparedness efforts, with aportion earmarked for hospitals. Themonies are available in the form of grantsmade by the Health Resources andServices Administration (HRSA), a divi-sion of the U.S. Department of Healthand Human Services.A total of just over$2 million in federal funding has been

made available to Northeast Ohio hospi-tals to date.The distribution of this fund-ing to hospitals is currently underway.

The grant dollars have enabled hospi-tals to purchase equipment and providetraining to their staffs. The Center forHealth Affairs (CHA) is the NortheastOhio regional coordinator and has facili-tated the planning process and the flowof federal funding to 28 hospitals in thefive counties that comprise the region:Cuyahoga, Lorain, Lake, Geauga andAshtabula. In order to be eligible for thefunding, hospitals have been required tospecify how they intend to utilize thegrant dollars, and must be consistentwith broad guidelines developed at theregional level and approved by the state.

Some outcomes specifically related tothe grant funding include the acquisitionof personal protective equipment by hos-pitals; the development of an emergencypreparedness operating procedures man-ual,which was distributed to hospitals byCHA; the acquisition by hospitals of aradio system that can be used for com-munication during a disaster; and thetraining of hospital staff in the HospitalEmergency Incident Command System(HEICS), which is a system all hospitalshave been encouraged to implementinternally for responding to an emer-gency situation.

Besides developing procedures andpurchasing necessary equipment and

training, this endeavor has been valuableto hospitals because it has created asense of cohesion across the region andhas strengthened relationships with pub-lic health, public safety and emergencymanagement personnel. For example,hospitals have developed an agreementfor sharing supplies and equipment inthe event of a disaster.Also, over the lasttwo years, hospitals, along with theseother entities, have participated in tworegional table-top exercises to test andimprove the coordinated regionalresponse to a biological event. In addi-tion, at the state level efforts are cur-rently underway to develop a system forquickly and easily verifying the creden-tials of healthcare professionals whomight arrive at a facility, other thanwhere they have privileges or areemployed, in order to volunteer theirservices during a mass casualty event.

At least one more year of federal fund-ing is anticipated to support the continu-ation of emergency preparednessinitiatives.These funds will be useful infurthering the preparedness efforts, butalready it is clear that hospitals are moreprepared now than they have ever beento meet the needs of the community inthe event of a widescale emergency.

Editor’s Note:AMC/NOMA is an activeparticipant with CHA in assistinghospital and physician preparednessefforts. n

The Regional Medical Advisory Committee:Closing the Gap Between Medicine and Public Health

The profound impact that 9/11 had onour society has been well documentedand cannot be overstated. A phase shiftin the profile and range of responsibili-ties of the national public health systemoccurred in the aftermath. The tradi-tional role of public health has centeredon the recognition, evaluation andresponse to naturally occurring, focusedoutbreaks of infectious disease. Fordecades, that work has taken place inde-pendent of institutionally-based medicalcare, to the detriment of both profes-sions. With the reemergence of smallpoxnow viewed as a potential agent ofbioterrorism, the anthrax scares near the


Anna Mandalakas, MD, MS, FAAPAssistant Professor of Pediatrics, RB&C and CWRUMedical Director, Cuyahoga County Board of Health

Terry Allan, MPHHealth Commissioner,Cuyahoga County Board of Health


Medical Acupuncture More Accepted by Physicians and Patients

Robert B. Kelly, M.D., M.S., A.B.F.M., A.A.M.A.


What’s All theExcitementAbout?

Public aware-ness and use ofa c u p u n c t u r eincreased in theUnited States fol-lowing PresidentNixon’s visit toChina in 1972and New YorkTimes reporter

James Reston’s account of Beijing physi-cians easing his post-surgery abdominalpain with needles. In the United Statesthere are more than 10,000 acupuncturespecialists of whom approximately 30percent are physicians. In 1993, the FDAreported that Americans were spending$500 million per year and making 9 to 12million visits for acupuncture treatments.This has increased considerably over thelast decade.

What is Medical Acupuncture? Is it Diffe rent from OrdinaryAcupuncture?

Acupuncture is a very old medical art,and there are many approaches to learn-ing and practicing it. Medical acupunc-ture is the term used to describeacupuncture performed by a physiciantrained and licensed in Western medicinewho has also had thorough training inacupuncture as a specialty practice. Aphysician acupuncturist can use one orthe other approach, or a combination ofboth as the need arises, to treat an illness.

How Can Physicians Learn Medical Acupuncture?

The best resource for information onoptions for training is the AmericanAcademy of Medical Acupuncture(AAMA, www.medicalacupuncture.org).The AAMA offers a certification processthrough the American Board of MedicalAcupuncture. Certification involves aminimum of 300 hours of approved CMEtraining in acupuncture, successful com-pletion of a written examination, and aminimum experience of two years ofacupuncture clinical practice (at least500 treatments).The majority of UnitedStates physicians who perform acupunc-ture have received some of their trainingthrough UCLA School of Medicine’sHelms Medical Institute (HMI, www.

HMIacupuncture.com). HMI offers a“Medical Acupuncture for Physicians”course twice a year.The course has “pri-mary care” and “pain management”tracks, with about an 80 percent overlapin the content of the two tracks.

What is the Scope of Medical Acupuncture?

Medical acupuncture is a system,which can influence three areas ofhealth care:

• promotion of health and well-being,• prevention of illness,• treatment of various medical condi-

tions.While acupuncture is often associated

with pain control, in the hands of a well-trained practitioner it has much broaderapplications. Acupuncture can be effec-tive as the only treatment used, or as thesupport or adjunct to other medicaltreatment forms in many medical andsurgical disorders.

The World Health Organization recog-nizes the uses of acupuncture in thetreatment of a wide range of medicalproblems, including:

• Digestive disorders: gastritis andhyper-acidity, spastic colon, constipa-tion, diarrhea.

• Respiratory disorders: sinusitis, sorethroat, bronchitis, asthma, recurrentchest infections.

• Neurological and muscular disorders:headaches, facial tics, neck pain,intercostal neuritis, frozen shoulder,tennis elbow, various forms of ten-donitis, low back pain, sciatica,osteoarthritis.

• Urinary, menstrual, and reproductiveproblems.

• Physical problems related to tensionand stress and emotional conditions;insomnia.

In 1997 a consensus panel convenedby the National Institutes of Health con-cluded that there was clear evidence ofacupuncture’s effectiveness for postop-erative and chemotherapy-induced nau-sea and vomiting, nausea of pregnancy,and post-operative dental pain. For otherconditions, the NIH panel concluded thatacupuncture may be effective as anadjunct or alternative therapy.These con-ditions include addiction, stroke rehabili-tation, headache, menstrual cramps,tennis elbow, fibromyalgia, low backpain, carpal tunnel syndrome, and

asthma. For chronic conditions, patientswill usually need a series of treatmentsand some require long-term maintenancetreatments to maintain gains in symptomcontrol they have achieved.

In clinical practice, acupuncture prac-titioners often individualize therapy foreach patient, and patients may respond(or not respond) to similar or differenttreatment approaches used by differentpractitioners. Research on acupuncture’seffectiveness has been hampered by thedifficulty of efforts to create a “control”treatment, and by attempts to standard-ize what is, in practice, a more artisticthan standardized therapy.The future ofresearch into acupuncture’s effective-ness probably lies with comparisonsbetween results of acupuncture and stan-dard allopathic or osteopathic therapy,rather than placebo-controlled trials.

One Physician’s Path to UsingMedical Acupuncture

Having decided in 2003 that I wantedto learn how to incorporate acupunctureinto my clinical practice of FamilyMedicine, I enrolled in the HMI MedicalAcupuncture Course in the Spring of2004. I began to use acupuncture when Ireturned from the first intensive six-daysegment of the course. I was quicklyencouraged to continue by the excellentresponses that many patients had to myacupuncture input. Over the next sixmonths, I treated more than 50 people,performing about 170 treatments, whilecompleting the home-study segment ofthe course. I then took the final 10-day“clinical unit” in late 2004, whichcemented and expanded my knowledgeand skills.While still a relative novice, Iam confident that I can help most of thepeople who come to me seeking helpfrom acupuncture as a stand-alone oradjunctive therapy. I am planning to pur-sue further training in the future and tocomplete the Board Certificationprocess.

Editor’s Note: AMC/NOMA membersare encouraged to submit articles forinclusion. There are six ClevelandPhysician issues published in: Jan./Feb.;March/April; May/June; July/Aug.;Sept./Oct.; Nov./Dec. The editorial dead-line falls the 15th of the month prior tothe issue date. Please call (216) 520-1000 ext. 320. n



Greater Cleveland is moving towardachieving clean (smokefree) indoor air inall public places, including restaurants,bars, and all other public venues. Strongjustification for this movement existsfrom a public health perspective.

Overwhelming evidence has emergedthat secondhand smoke (frequentlyreferred to as ETS or environmentaltobacco smoke) is not just an annoyance,but a major health hazard. As early as1975, there was abundant evidence inthe scientific literature that ETS is a causeof cardiac and respiratory disease. In1986 the Surgeon General and theNational Academy of Sciences concludedthat secondhand smoke causes lung can-cer. A pioneering study published in thejournal Circulation in 1991 concludedthat ETS is the third leading cause of pre-ventable death, killing 53,000 nonsmok-ers in the U.S. each year.1 This numberexceeds those killed in highway acci-dents. This study went on to concludethat for every eight smokers the tobaccoindustry kills through direct use of itsproducts, it kills one nonsmoker throughsecondhand smoke.

Separate smoking and nonsmokingsections in restaurants and other indoorenvironments cannot eliminate an indi-vidual’s exposure to the toxins from sec-ondhand smoke, according to the Centerfor Disease Control.Ventilation systemsare designed to efficiently circulate airwithin an enclosed environment, not tofilter and clean it. It is virtually impossi-ble to have a truly smoke-free section ina restaurant.

Today, the leading arguments againstmaking all public venues smokefreecome from portions of the hospitalityindustry and fall into one of two cate-gories — economic or ideological. Theeconomic arguments assert that makingcertain establishments smokefree, suchas restaurants, bars and bowling alleys,will hurt businesses. These argumentsecho the dire (and unfounded) predic-tions made before airlines, theatres, gro-cery stores, and a host of otherbusinesses went smokefree. Researchersstudying this issue reviewed 97 studieson the economic impact of smokefreepolicies in the hospitality industry. Theyfound that all of the best designedstudies — those not affiliated or funded

by the tobacco industry — reported thatsmokefree regulations had no impact ora actually had a positive impact on salesor employment.

Ideological arguments maintainAmerica is a free country and eliminatingsmoking in public places is a step towardlosing our freedoms. These argumentsignore that one of the major and mostbasic functions of government is to pro-vide for the public’s safety. If govern-ment can issue regulations to ensure thatfood is properly prepared and safe to eat,and that drinking water is free of danger-ous contaminants, why is it an erosion ofour freedoms to ensure that the airbreathed by patrons and workers in a baror restaurant is also free of the 53 car-cinogens and 4,000 other chemical com-pounds contained in smoky air?

Throughout the nation and globally,the movement for clean indoor air isgaining momentum. Minnesota is likelyto become the nation’s eighth smokefreeworkplace state, joining California,Delaware, New York, Connecticut, Maine,Massachusetts, and Rhode Island.Numerous cities across the nation havealso enacted such bans, including NewYork City, and Columbus and Toledo inOhio. Entire nations have eliminatedsmoking in public places — Ireland,Norway, Sweden, New Zealand, andBhutan have all passed national smoke-free legislation.

The Cleveland Clean Indoor AirCampaign officially kicked off inNovember, 2003. Its goal is to achieve100 percent smokefree air throughoutthe greater Cleveland area. Initial goalsare to achieve smokefree public places inCleveland, Lakewood, and ShakerHeights. Progress is being made in all ofthese areas. Cleveland is a particularchallenge for a variety of reasons — itseconomic problems, the large size of itsCity Council (21 members), and its com-plex political landscape. But this pastsummer, a special governmental AdvisoryCommittee — which included represen-tatives of the hospitality industry —made strong recommendations thatCleveland’s City Council enact such leg-islation, and Mayor Campbell hasendorsed clean indoor air. Lakewoodseems to be moving rapidly and is draft-ing legislation at this time. Beachwood

also is moving swiftly toward enacting aclean indoor air ordinance and it desiresto encourage all of its adjacent suburbsto go smokefree as well, includingHighland Hills, Lyndhurst, Orange Village,Pepper Pike, South Euclid, and ShakerHeights. If successful, this move couldneutralize the frequently cited (and erro-neous) assertion that patrons will flee toadjacent municipalities if they are notallowed to smoke in their home neigh-borhoods.

More than 11,000 individuals and morethan 90 organizations including theAMC/NOMA have endorsed theCleveland Clean Indoor Air Campaignand its goals.

To join or learn more about theCleveland Clean Indoor Air Campaign,please visit www.smokefreeohio.org. orcontact the AMC/NOMA for more infor-mation.

References1. Glantz SA, Parmley, W. Passive

Smoking and Heart Disease:Epidemiology, Physiology, andBiochemistry. Circulation. 1991:83(1):1-12;

2. Scoll M, Lal,A, Hyland A, Glantz, SA.Review of the quality of studies onthe economic effects of smoke-freepolicies on the hospitality industry.Tobacco Control. 2003:12:13-20.

Editor’s Note:Dr.DeNelsky has chairedthe Cuyahoga County Tobacco ControlCoalition since 1995. The AMC/NOMAstaff attends regular Cleveland CleanIndoor Air Campaign committee meet-ings.For more information contact LindaHale at (216) 520-1000 ext. 309. n

The Pursuit of Smokefree Indoor Air

Garland Y. (Gary) DeNelsky, Ph.D., Chair,Cuyahoga County Tobacco Control Coalition


P R A C T I C E M A N A G E M E N T

The Academy of Medicine of Cleveland/Northern OhioMedical Association (AMC/NOMA) is pleased to partner withCuyahoga Community College’s (Tri-C) Center for HealthIndustry Solutions to offer Certification Courses and ContinuingEducation Unit Seminars at discount prices for AMC/NOMAmembers and staff.

Earn Certification and CEUS through Cuyahoga CommunityCollege’s Medical Practice Management Seminars. Day pro-grams are taught by Practice Management Institute (PMI) andfocus specifically on medical practice needs. CEUs are offeredfrom PMI,AAPC, and AAMA.

• Master Collection Through Insurance Processing by PMI (.3 CEU) Jan. 26 1:00-4:00 pm East 2 Room TBD Price $111

• Documentation and Guidelines by PMI (.3 CEU)Jan. 26 9:00 am-12:00 pm East 2 Room TBD Price $111

• Compliance Officer Training Clinic by PMI (1.2 CEU)Jan. 27, 28 8:30 am-3:30 pm AMC/NOMA Boardroom Price $371

• ICD-9-CM Coding Workshop by PMI (.6 CEU)Feb. 9 8:00 am-3:30 pm East 2 Room TBD Price $187

• Certified Medical Office Manager by PMI (2.4 CEU)Feb. 10, 18 8:30 am-3:30 pm AMC/NOMA Boardroom Price $639

• CPT Coding Workshop by PMI (.4 CEU)Feb. 16 8:30 am-3:30 pm East 2 Room TBD Price $187

EVENING COURSES (6:00 to 9:00 p.m.) – Receive Certificatesof Completion for accelerated medical practice courses taughtby local instructors

• Medical Te rminology/Anatomy & Physiology (2.4 CEU)Price $216 East – Jan. 19-Feb. 21 (Monday & Wednesday)

Westlake – Jan. 25-Feb. 24 (Tuesday & Thursday)East – April 4-May 4 (Monday & Wednesday)

• Medical Coding and Ancillary Services (4.8 CEU)Price $507 East – Feb. 22-April 14 (Tuesday & Thursday)

West – Feb. 28-April 20 (Monday & Wednesday)

• Surgical Coding/Modifiers/HCPCS Coding (4.8 CEU)Price $507 West – May 2-June 29 (Monday & Wednesday)

East – May 3-Jun 30 (Tuesday & Thursday)

• Medical Insurance Billing for the Medical Practice (1.2 CEU)Price $262 East – March 2-April 20 (Wednesday)

• Customer Service Workshop for Health Care (.3 CEU)Price $74 East – March 14 (Monday)

Watch your mail for additional class listings. Members and/ortheir staff will need an exclusive AMC/NOMA course numberto register and obtain the discount. For course numbers, callLinda Hale of AMC/NOMA at (216) 520-1000, ext. 309, or [email protected]. n

Discounted Tri-C Class List

Ohio KePRO to Promote Electronic Records

Alice Stollenwerk Petrulis, M.D., Medical Director, Ohio KePRO

President Bush has stated that Elec-tronic Medical Records (EMRs) would beavailable to all Americans in 10 years.David Brailer, M.D., has been nationallyappointed to take the lead on this project.

The Center for Medicare and MedicaidServices (CMS) has contracted with theQuality Improvement Organizations(QIOs) in each state to promote informa-tion technology (IT) in physician officepractices and to work with physicians toimprove rates on seven quality measures.The quality measures will focus on:

• Immunization• Diabetes• Screening mammography• Colorectal screening• Hypertension• Heart failure • Coronary heart diseaseMore and more practices are either

considering, or have actually taken theimportant steps to implement theseincreasingly critical tools. They see thevalue of an EMR as:

• Improved access to patient informa-tion

• Reduction of errors and improve-ment in quality of care

• Creation of a more efficient office• Improvement in billing accuracy• Reduction in transcription costsA national pilot is already underway in

four states as part of this national initia-tive, which is also called the Doctors’Office Quality-Information Technology(DOQ-IT) Project. Software vendors havealready been recruited to assist in thisendeavor.

National support has been obtainedfrom physician organizations such as theAmerican Academy of Family Practiceand several subspecialties.

The end result of this project will likelybe Pay-for-Performance contracts withreimbursement tied to electronic report-ing of data. In addition, physician publicreporting of quality measures, similar towhat is seen on www.medicare.gov fornursing homes, home health agenciesand soon-to-be-reported hospitals mayfollow.

Ohio KePRO is the QIO for Medicare in

Ohio. Many physicians throughout thestate have already collaborated with uson our ambulatory projects in the lastfew years and will continue to do so aswe move forward in assisting physicianoffices in the implementation of (EMRs).Physician stakeholder groups, such as theOhio chapter of the American College ofPhysicians, have likewise endorsed ourefforts on this project.

To prepare for this initiative, OhioKePRO has added staff from healthcaresoftware companies who have years ofexperience in the installation of EMRs.The staff is ready to offer consultativeservices to physician offices at no cost.Ohio KePRO will be able to assist in theselection of an EMR, and offer guidancein implementation to achieve office effi-ciency.

For those practices that are thinkingabout, or have recently installed an EMR,and would like further information aboutthis initiative, please contact the QualityImprovement staff at Ohio KePRO at(800) 385-5080. n


G O V E R N M E N T R E L A T I O N S

According to the Center for Medicareand Medicaid Services (CMS), effectiveNov. 12, 2004, the interest rate forMedicare overpayments and underpay-ments will be 12 percent. And beginningthis month, physician payment ratesincrease by 1.5 percent. Below CMSoffers a few ways to boost your bottomline including:

• “Welcome to Medicare”physical: youcan bill for the electrocardiograms inaddition to the payment for the phys-ical. They’ve also allowed you to billfor a more extensive office visit pro-vided at the same time,as long as youcan show medical necessity.

• Vaccinations and injections: increasedcoverage means influenza vaccinepayments increase from $8 to $18 —even when the injections are per-formed on the same day as otherMedicare-covered services.

• Expanded access: new coverage forcardiovascular disease and fordiabetes.

• Pay restrictions removed: New fund-ing will target low osmolar contrastmediums and clinical costs in certainstudies of life-saving investigationaldevices.

• In-office drug administration: drugsadministered in a doctor’s office and

services related to the use of thosedrugs will be reimbursed at ratesmore than 120 percent higher thanin 2003. The adoption of 18 newcodes allows more chances to bill forthese services.

• Part B Drugs: New payment rates willbe set at 106 percent of the averagesales price based on the most quar-terly data from manufacturers.

• Physician “scarcity” areas: A 5 per-cent quarterly incentive payment to doctors practicing in “physicianscarcity areas” listed on the CMS Web site at www.cms.hhs.gov/providers/bonuspayment n

CMS Sets Rates for Physicians

Results Mixed on Liability Reform Ballot InitiativesVoters in four closely watched states

considered ballot measures to ease themedical liability crisis and strengthentheir access to health care:

• In Florida, voters passed Amendment3, entitling patients in medical liabil-ity cases to no less than 70 percent ofthe first $250,000 awarded, and 90percent of any damage award inexcess of $250,000. However,Amend-ments 7 and 8,backed by a trial attor-neys’ group, also passed, including a“three strikes and your licensed isrevoked” rule. Those amendmentsrequire action by the Legislaturebefore implementation and will beopposed by the Florida MedicalAssociation.

• In a decisive victory, Nevada voterspassed Ballot Question 3, placing a hard cap of $350,000 on non-economic damages in medical liabil-ity cases, installing a periodic pay-ment plan for damages totaling morethan $500,000 and limiting attorneycontingency fees. Physicians thereare now also only financially respon-sible for their percentage of fault in amedical liability lawsuit.

• There was a setback for patients inOregon, where Ballot Measure 35 didnot receive enough “yes” votes.Ballot Measure 35 would havereinstated a $500,000 cap on non-economic damage awards in medical

liability cases, with an annualConsumer Price Index adjustment.

• Results were mixed in Wyoming.Voters passed Amendment C, whichallows the Legislature to set up med-ical review panels to weed out frivo-lous lawsuits, while allowing oneswith merit to proceed to court. Butamid a vigorous campaign funded bya group of personal injury attorneys,Amendment D came up short. Thatmeasure would have allowed theLegislature to consider limits on non-economic damages in medical liabil-ity cases. n

SOURCE: AMA Federation News

Privacy Rule Complaint StatisticsThe HIPAA Privacy Rule provides a

mechanism for registering a complaintwith DHHS via mail, fax or e-mail. DHHSeven provides a Health InformationPrivacy Complaint Form on its Web siteat www.hhs.gov/ocr/privacyhowtofile.htm to facilitate the complaint process.A complaint may be made by anyonewho wants to report a HIPAA violation,

whether or not the released informationrelated to such individual.

As of April 14, 2004 — one year aftermost entities were required to be in com-pliance with the Privacy Rule — theOffice for Civil Rights closed nearly2,700 complaint cases. Nearly two-thirdsof the complaints were found not to fall

within the scope of the Privacy Rulebecause they either involved accusationsof actions that were not prohibited bythe regulation, involved entities thatwere not “covered entities” as defined bythe Privacy Rule or involved actions thatoccurred before covered entities wererequired to be compliant. n

G O V E R N M E N T R E L A T I O N S

OIG Advisory Opinion Permits Hospital Subsidy of Obstetricians’Malpractice Insurance Premium

The DHHS Office of the InspectorGeneral found that a proposal by a med-ical center to subsidize the malpracticeinsurance premium of four obstetricians

that provide services in a health careshortage area contained sufficient safe-guards to mitigate the risk of violatingthe fraud and abuse statute. To read the

Advisory Opinion No. 04-11, go towww.healthlawyers.org/docs/ask2004/AO_0411.pdf n

OIG Releases Work Plan Detailing Priorities for Fiscal Year 2005Each year the Department of Health

and Human Services (DHHS) Office ofInspector General (OIG) publishes awork plan announcing where it willfocus its resources. Among OIG’s agendaitems for 2005 are plans to:

• Review the relationship betweenbilling companies and physicians todetermine the impact of billing com-pany arrangements on physicianbilling.

• Examine patterns of physician cod-ing of evaluation and managementservices to determine whether theseservices were coded accurately;

• Examine Medicare Part A and Part Bclaims with overlapping services forskilled nursing facility patients todetermine whether duplicate pay-ments are being made to the physi-cians and the nursing homes for thesame patient services;

• Review pathology services per-formed in physician offices to deter-mine the relationship betweenphysicians who furnish pathologyservices in their offices and outsidepathology companies.

To read the OIG’s “Work Plan FiscalYear 2005” go to www.healthlawyers.org/doc/ask2004/OIG_2005_workplan.pdf n

Joint Commission’s Newly Enhanced Quality Check® Helps Americans Choose Health Care Services

The Joint Commission on Accreditationof Healthcare Organizations launched onJuly 15, 2004 a new generation of report-ing health care information about thequality and safety of care provided in itsaccredited health care organizationsacross the country.

The Joint Commission’s QualityCheck® will provide clear, objective datato individuals that will permit them tocompare local hospitals, home care agen-cies, nursing homes, laboratories, andambulatory care organizations with oth-ers on state and national basis. Further,the Joint Commission will, for the firsttime, provide hospital-specific informa-tion about clinical performance in thecare of patients with four major condi-tions. These include heart attack, heartfailure, pneumonia, and pregnancy andrelated conditions.

Individuals will also be able to deter-mine how health care organizations com-pare with others in meeting nationalrequirements that help them preventdevastating medical accidents. Therequirements specifically seek to avoidmisidentification of patients, surgery onthe wrong body part, miscommunicationamong caregivers, unsafe use of infusion

pumps, medication mix-ups, problemswith equipment alarm systems,and infec-tions acquired in the health care setting.

Consumers can access Quality Checkat www.qualitycheck.org and search forhealth care organizations by name, type,and/or location. Interactive links to infor-mation are designed to help individualsbetter understand how to use and inter-pret the information presented. Individu-als are encouraged to talk with theirdoctors about the information presentedon Quality Check.

Quality Check uses symbols, such aschecks, pluses and minuses to make iteasy for consumers to compare healthcare organizations.Quality Check reportsinclude:

• The organization’s accreditationdecision and effective date

• Health care services provided bythe organization that are accred-ited by the Joint Commission

• National Quality ImprovementGoals, which portray the perform-ance of hospitals in caring forpatients with heart attack, heart fail-ure, pneumonia, and pregnancy andrelated conditions. These currentlyapply only to hospitals.

• National Patient Safety Goals,which display the performance ofhealth care organizations in takingspecific steps to prevent serious acci-dents in health care. The Goals andtheir related discrete requirementsare specific to different types ofhealth care settings accredited by theJoint Commission (for example, hos-pitals, ambulatory care organizations,clinical laboratories).

• Special quality awards and otherdistinctions, such as MagnetHospital recognition and/or partici-pation in the Hospital VoluntaryPublic Reporting Initiative

• Commentary about the QualityCheck report , if the organizationchooses to submit one for inclusion

• Requirements for improvement,if applicable

The Joint Commission offers a freeseries of Helping You Choose brochuresat www.jcaho.org, or (630) 792-5800.Historical Performance Reports will con-tinue to be available at the Quality CheckWeb site, www.qualitycheck.org. Forconsumers unable to access QualityCheck online,call the Joint Commission’sCustomer Service Center at (630) 792-5800,8:30 a.m.to 5 p.m.CT,during week-days. n



To speak with someone aboutyour loved one’s needs call

800-862-5253or visit on the web atwww.hospiceohio.org

Hospice and Palliative Care Partners of Ohio is a new name that blends 100 yearsof Visiting Nurse Association knowledge and expertise with a brand new visionand direction for Hospice care in Ohio.

Our wonderful staff, like Kathy Stahl, attend to your end of life care needs withcompassion and skill. Services include medical and nursing care, pain andsymptom control, counseling and a host of care options with 24-hour availability.

In the home, hospital or extended care facility, Hospice and Palliative CarePartners of Ohio is your hospice of CHOICE.

THE NEW NAMEIN HOSPICE CARE

Formerly VNA Hospice. An Agency of the Visiting Nurse Association.

Kathy Stahl, CHPN, RNCertified Hospice Nurse



included conditions and exceptions thatwould apply to the extended reportingendorsements applicable to physicianswho retire. The suggested draft indicatesthat retirement shall mean the completecessation from the practice of clinicalmedicine for a period of at least fiveyears except:

i. Physicians may engage in medicalresearch that does not involvepatients.

ii. Physicians may teach in a non-clinical (nonpatient care) setting,e.g., classroom.

iii. Physicians may engage in claimreview for the state or federalgovernment for private or other

“public”health insurer.iv. Physicians may engage in such

activities as:1. JCAHO Survey (for the JCAHO

or for a private organization)2. Any other form of consultation

or employment that involvesthe use of their medical knowl-edge but does not include anyform of patient care.

v. Physicians may provide clinicalservices for government spon-sored and independent freeclinics so long as:1. Professional Liability coverage

is afforded to physician by thatentity.

2. Any income derived from thisactivity is de minimus (lessthan $100,000/year).

vi. Physicians may provide clinical

services in the form of supervis-ing physicians-in-training (interns,residents, and fellows) so long asthey Professional Liability cover-age is afforded by the organiza-tion or institution that providesthe setting for the intern, residentor fellow training.

There is no assurance that ODI willconsider requesting that medical liabilitycompanies in Ohio adopt this modeldraft policy, however, the AMC/NOMAleadership plans to meet with theDirector of ODI to pursue this issue. Wewill keep our membership apprised ofany developments. (Questions? Contactthe AMC/NOMA executive vice president/CEO at (216) 520-1000, ext. 321 formore information on this issue.)

(For related story on Volunteer inHealth Care Teleworkshop see pg 4.) n

AMC/NOMA Leadership’s VoiceHeard Locally and at the State Level(Continued from page 3)

P U B L I C H E A L T H I S S U E S

The Regional Medical AdvisoryCommittee: Closing the GapBetween Medicine and Public Health(Continued from page 9)

The design of the prescreening processfor potential vaccinees coordinated bythis committee was critical to minimizingadverse events related to the administra-tion of the smallpox vaccine, includingissues surrounding HIV exposure, preg-nancy status and previous Smallpoxvaccination.

An educational conference designed toorient medical workers and safety forcesabout the vaccination campaign wasvery successful. Committee physicianswere also actively involved in vaccina-tion clinic logistics to assure safe and effi-cient distribution of vaccine to recipientsand provided 24/7 coverage for consulta-tion on vaccination-related issues in theweeks following vaccination. All of theseissues have implications for pandemicinfluenza planning and the entire processhas forged strong partnerships betweenmedicine and public health that willserve both professions well into thefuture.

The emergence of SARS raised con-cerns about nosocomial transmissionthrough an unrecognized case. TheMedical Advisory Committee convenedon a number of occasions to discuss theneed for increased surveillance in all hos-pital ICU’s for patients with respiratorysymptoms. In response to these con-cerns, a conference was planned forDecember 11,2003. “SARS 2004: Bracingfor Its Return, Regional Preparedness”,which provided an opportunity for pro-fessionals across multiple disciplines toincrease their public health and patient

management skills based on lessonslearned from the SARS 2003 outbreak.These discussions about SARS broughtabout further concerns regarding thelimitation on movement to contain andcontrol an infectious disease outbreak,resulting in a community plan to addressissues related to quarantine.

Most recently, the committee discussedthe issues surrounding the currentinfluenza season, including challengesaround the shortage of vaccine. It wasagreed that a unified message on illnessprevention will be important when flucases start to increase. Promotingmessages on “Cough Etiquette,“How toStay Healthy” and “When to See YourPhysician” will be very importantaddressing hospital surge capacity issuesthis winter.

The technical knowledge and insightof this group has served Northeast Ohiowell in confronting the emerging chal-lenges of medicine and public health. Tooptimize the impact of this valuableresource, highlights of the MedicalAdvisory Committee’s work will beincluded in a future Cleveland Physicianmagazine.

For additional information about theMedical Advisory Committee or otherpublic health issues, please contact theCuyahoga County Board of Health’sRebecca Hysing at (216) 201-2001 ext.1602, rhysing@ ccbh.net or visit www.ccbh.net as well as AMC/NOMA (216)520-1000 ext. 321 or e-mail [email protected] n

end of 2001 and the emergence of globalepidemic potentials related to West NileVirus,SARS,and Avian Influenza, the needto close the gap between the independ-ent and often parallel paths of medicineand public health was long overdue.These events served as a catalyst forrapid local change in meeting this need.

In November of 2001, the local healthdepartments in Cuyahoga County, incoordination with community medicaland academic partners from the Cleve-land Clinic Foundation, UniversityHospitals of Cleveland, MetroHealthMedical Center, the Academy of Medicineof Cleveland/Northern Ohio MedicalAssociation, the Center for Health Affairs,the Cuyahoga County Coroner and CaseSchool of Medicine formed the CuyahogaCounty Medical Advisory Committee.This committee, comprised of publichealth and medical experts, has becomea forum for discussing a range of topicsrelated to infectious disease control andis now recognized as the RegionalMedical Advisory Committee on Bio-terrorism Preparedness.

Some of the initial work of this com-mittee involved the planning of theSmallpox Vaccination Campaign for areapublic health and medical response staffwhich included discussion on the impli-cations of a mass vaccination campaign.

M E M B E R S H I P M A T T E R S

Thinking About Retiring?

If you are considering retiring fromyour practice we need to hear from you.Why? Your benefits!

As a retired member you will continueto receive many of the benefits of mem-bership, including dues-exempt member-ship at a “retired” status, access to staff,access to the AMC/NOMA Web site(www.amcnoma.org), eligibility forAMC/NOMA 50 year award, and yourname in the AMC/NOMA physician direc-tory so you can stay in contact with yourcolleagues.

Here are some helpful hints:• We can provide you with informa-

tion that will be beneficial to youwhether you are selling or closing amedical practice.

• It would also be very helpful for theAMC/NOMA to know where your

patient records are. We get manyphone calls from patients trying tolocate their medical records from aretired physician and can handlethese inquiries for you.

Here are the options for retired mem-bership:

• Your AMC/NOMA dues must be cur-rent.

• If you retire before May 1, 2005, youpay no 2005 dues. You will have“retired”status.

• If you retire after May 1, 2005, youwill need to pay your 2005 dues, thenyou will be dues exempt in 2006.

For more information about closing apractice or to change your membershipstatus, contact Linda Hale in theMembership Department at (216) 520-1000 ext. 309. n

Not Quite RetiredBut Cutting Backon Hours

AMC/NOMA offers part-time

membership to physicians 66+

years of age working less than

20 hours per week and/or less

than 40 hours per week.

Contact membership at (216)

520-1000 for information. n

New Group Members Add to Regional Presence

Increasingly more physicians are real-izing in the struggle for medical liabilityreform, increased reimbursements andpatients’ access to care, strength lies innumbers and if today’s doctors want tosee real change transpire, all doctors —regardless of their affiliation — mustband together.

In 1999, the separation of the Academyof Medicine of Cleveland/Northern OhioMedical Association (AMC/NOMA)(founded in 1824) from the state medicalassociation, allowed for a strong workingrelationship on state legislative issuesbetween the Ohio Podiatric MedicalAssociation and the AMC/NOMA.

Last October 1, 2004, 90 active mem-bers from the Northeastern OhioPodiatric Academy joined more than4,000 MD/DO members of theAMC/NOMA as group members.

William H. Seitz, Jr., MD, orthopedicsurgeon and President of the AMC/NOMA, said the decision to add podia-trists to the county’s medical society waspart of other major changes in theAcademy of Medicine Cleveland’s mem-bership structure. He explained, thischange made it possible to disengagefrom the state medical society in 1999and become an independent medicalsociety. He said the AMC/NOMA leader-ship decided to do this because it’s a“membership-driven”association and theCleveland physicians wanted group

membership to better reflect the prac-tice of medicine in the 21st century.Then, he explained, the AMC/ NOMAleadership created a new group member-ship category for hospital medical staffsand medical group practices. Allowingpodiatrists to join was a direct result ofthe AMC/NOMA leadership workingwith Cleveland’s hospital medical staffs.He explained since podiatrists are fullmembers of these hospital medical staffs,with all the rights and privileges ofMD/DO physicians, it made sense toallow podiatrists membership in theAMC/NOMA.

The measure of success Dr. Seitz hopesto realize, within a year of admitting theAMC/NOMA’s newest membershipgroup, is active involvement, not justdues-paying members. For example, he’dlike to see the group become active oncommittees, in programs and in CMEseminars. He said he’s already workedclosely with the Ohio Podiatrist MedicalAssociation (OPMA) in the past on legis-lation. His hope is the AMC/NOMA’sinvolvement of podiatrists becomes anational model for other county medicalsocieties.

He said,“We are facing the same prob-lems, the same issues…malpracticeincreases, fee decreases, patients losingaccess to doctors, we are all colleaguesfacing the same threats to all of ourpatients. All doctors have one thing incommon. We are all just taking care ofour patients.” n

“As long as we all put ourpatients interests first,

we are all working together.”– William H. Seitz, Jr., M.D.


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MEDICAL OFFICE SPACE for rent or lease. 4861Broadview Rd. If interested please call (440) 526-0272.

Developing New Directives to Address Medical Liability and Patient Safety in Northern Ohio

FRIDAY, MARCH 4TH, 2005EMBASSY SUITES, INDEPENDENCE, OHIO

JOINTLY SPONSORED BY: THE ACADEMY OF MEDICINE OF CLEVELAND/NORTHERN OHIO MEDICAL ASSOCIATION, (AMC/NOMA),THE ACADEMY OF MEDICINE EDUCATION FOUNDATION (AMEF),THE CLEVELAND ACADEMY OF OSTEOPATHIC MEDICINE (CAOM),

AND SAINT VINCENT CHARITY HOSPITAL.


PROGRAM FORMAT:

9:00 a.m. – 9:15 a.m. – Opening RemarksWilliam H. Seitz, Jr., M.D.,President,Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA), and

George Thomas, D.O.,President of the American Osteopathic Association.

Program Moderator: Dr. William H. Seitz, Jr., AMC/NOMA President and AMEF Board Member.

9:15 a.m. – 10:00 a.m. Medical Liability Insurance UpdateMs. Ann Womer-Benjamin, J.D.,

Director of the Ohio Department of Insurance, • Update on the Ohio Department of Insurance initiatives —

update on current liability insurance market and finalreport of the Ohio Medical Malpractice Commission.

10:00 a.m. – 10:45 a.m. Legislative Advocacy Initiatives –State Legislative Update (Panel)Mr. Michael Wise, J.D.

McDonald, Hopkins Burke and Haber, andMr. Michael Caputo

AMC/NOMA lobbyistsWhat is going on in Columbus relative to medical liability issues

• Update on legislation of importance to physicians• Discussion on how physicians can work with politicians to

advocate for their issues

The Honorable Kevin Coughlin – Ohio Senate • Overview and purpose of proposed alternative dispute

resolution legislation in Ohio

10:45 – 11:00 a.m. – BREAK

11: 00 a.m. – 12 noon – Advantages of Alternative Methods to LitigationGeorge F. Lee, M.D. CEO and President,Physicians Reimbursement Fund (RRG),California Pacific Medical Center, San Francisco, CA

12:00 noon – 12:45 p.m. LUNCH

12:45 – 1:45 p.m. Bridging Medical Liability and Patient SafetyWilliam Sage, M.D., J.D, Professor of Law,Columbia University, New York, NY

1:45 – 2:45 p.m. The How and When of Communicating Unexpected OutcomesGerald Hickson, M.D.Associate Dean for Clinical Affairs,Director,Vanderbilt Center for Patient and Professional Advocacy

2:45 p.m. – 3:00 p.m. - BREAK

3:00 – 4:00 p.m. The Potential of Health InformationTechnology to Reduce Errors and Reduce PremiumsBarry Chaiken, M.D.Chief Medical Officer, American Board of Quality Assurance Utilization Review Physicians – Boston, MA

4:00 – 4:30 p.m. - National Health Policy Update Patient Safety and Tort Reform Initiatives at the FederalLevel — What Can We Expect from the 109th Congress?The Honorable William Frist, M.D.United States Senate (INVITED)

The Honorable Steven LaTouretteUnited States House of Representatives (INVITED)

4:30 – 5:00 p.m. CLOSING REMARKS – WRAP-UP What Needs to be Done and Where Do We Go From Here?William H. Seitz, Jr., M.D.President, Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA), and

George Thomas, D.O.President of the American Osteopathic Association.


St.Vincent Charity Hospital designates this educational activity for a maximum of 6.5 Category 1 credits towards the AMAPhysician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the educationalactivity. The cost for residents is $25, AMC/NOMA or CAOM members is $50 and nonmembers and other healthcareprofessionals is $75. See the enclosed brochure in this edition of Cleveland Physician to register.

NOMANorthern Ohio Medical Association

THE ACADEMY OF MEDICINECLEVELAND

P R A C T I C E M A N A G E M E N T


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Medical Mutual of Ohio discussed theimportance of provider-to-provider relation-ships by offering attendees the opportunityfor Medical Mutual of Ohio representatives tocome to their office to meet with staff mem-bers, answer any question, and provide train-ing regarding billing issues. The ProfessionalProvider Manual is now offered on disk,which should make it easier and quicker forproviders to find information. Medical MutualCurrent Topicsincluded, modifierupdates, globalsurgery rules,reimbursement forblood draws andmany other topics.

The OhioDepartment of Jobs and FamilyService’s brieflyshared informationregarding theirnew InteractiveVoice ResponseSystem, designed to access clientinformation, claim status, payment status andother valuable information. For more infor-mation contact Taunya Rock at AMC/NOMA(216) 520-1000. n

AMC/NOMA “Solving the Third-Party Payor Puzzle”2004 SeminarThe annual AMC/NOMA “ Solving the Third-

Party Payor Puzzle” Seminar was held onNovember 10, 2004. Speakers were fromorganizations such as:Athem Blue Cross andBlue Shield, Palmetto GBA, Medical Mutual ofOhio, the Bureau of Health Plan at the OhioDepartment of Jobs and Family Services.

Presenters provided information on theDirect Deposit plan that is now available.Applications were provided along withinformative packets, which also addressedimportant phone numbers and Web sites.Our insurance representative also explained

that due to identitytheft, IdentificationCards wouldchange. Anthemhas a ClinicalAccount Pharma-cists on staff that iswilling to meetwith providers todiscuss new med-ication and ways to increase patientcompliance. Alsodiscussed was anew companycalled CAQH.CAQH is aUniversal

Credentialing DataSource. CAQHprovides an easierway to credentialphysicians.“Onephysician, Oneapplication, OneSource”, is thecompany’s motto.

Palmetto GBAcovered commondenials and rea-sons, as well assolutions to theseproblems. Palmettoalso offers federalincentives forproviders that prac-tice in underserved areas.The Health Professional Shortage Areas(HPSAs) incentive provides a 10 percentbonus payment paid quarterly to the physi-cian in this area.Another incentive programcalled Physician Scarcity Areas (PSAs) providea 5 percent bonus payment for servicesrendered by physicians in PSA-designated geo-graphical areas. The government representa-tive also covered the new Medicare DrugProgram.The Palmetto representative reviewedthe telephone appeals process line as well asvarious training programs for their providers.

From left: Medical Mutualof Ohio’s provider servicerepresentatives, DianaIrvin and Melissa Stary,used the AMC/NOMA’sNov. 10 seminar to relayinformation regarding theplan’s modifier updates,global surgery rules, reim-bursements for blooddraws as well as casemanagement. From left: Michael F.

Galloway and CherylDonahue, both withAnthem Blue Cross andBlue Shield, shared withseminar attendees rele-vant information regard-ing the company’s directdeposit plan and creden-tialing services.

From left: Kathy Mooreand Dottie Justice, bothombudsmen of bureauhealth plans with the OhioDepartment of Jobs andFamily Services, found theAMC/NOMA’s recent ThirdParty Payor seminar agood opportunity to pres-ent the Bureau’s basicbilling training manual toattendees.

From left: Dr. JohnBastulli, AMC/NOMAvice president of legisla-tive affairs, poses withLakewood Hospital’sChief of Staff, Dr.MarvinShie III, prior to his

Nov.11 presentation to medical staff.

Dr. James Lane, (right)immediate past presidentof AMC/NOMA, outlinesto Huron Hospital med-ical staff members theAMC/NOMA’s efforts topromote medical liability

reform and the organization’s instrumental rolein the 2004 Ohio Supreme Court outcome whileDr.Raja Shekar, (left) chief of staff, looks on.

M E M B E R S H I P M A T T E R S


Mark Your Calendar• Mark your calendar for Sunday, Jan

3 0 for a Wine Tasting at Club Isabellafrom 5 to 7 p.m. RSVP by Jan. 21required to Linda Hale at (216) 520-1000 ext. 309. Member and spousecost is $20 per person, residents andmedical students cost is $15 per per-son. Hor d’oeuvres, a fine selectionof wines and dialogue with a localwine connoisseur included with fee.

• Mark your calendar for Friday,March 4, 2005 for a full-day seminartitled,“Developing New Directives toAddress Medical Liability and PatientSafety in Northern Ohio.” The semi-nar will take place at Embassy Suitesin Independence.

• Mark your calendar for Friday,Apri l 29, 2005 for the nextAMC/NOMA Annual Meeting. OhioSupreme Court Chief Justice ThomasJ. Moyer will be the keynote speaker.The event is schedule to begin at 7p.m. at the Ritz-Carlton Hotel inCleveland. More information tocome in subsequent issues of theCleveland Physician.

• Mark your calendar for Monday,August 8, 2005 for the 2nd AnnualMarissa Rose Biddlestone MemorialGolf Outing. n

AMC/NOMA LeadershipContinues to Meet withMedical Staff Aroundthe Region

Colleague’s Corner

Recognizing outstanding AMC/NOMA members for their honors, awards andachievements, in addition to their work to spread health and wellness messages tothe community.

Dr. Kodish Takes Clinic PostAMC/NOMA member, Dr. Eric Kodish of Rainbow Babies and Children’s Hospital

is the new chairman of the Cleveland Clinic’s department of bioethics in clinicalresearch division. Kodish is the first physician to lead the department. He started inOctober 2004 after three years as founding director of the Rainbow Center forPediatric Ethics and more than a decade as an attending physician inhematology/oncology at Rainbow, part of University Hospitals of Cleveland. Kodish isa professor of bioethics,pediatrics and oncology at the Cleveland Clinic Lerner Collegeof Medicine of Case Western Reserve University.

Dr. Thomas Creates New Center for Space MedicineLast October,AMC/NOMA member, Dr. James D. Thomas, M.D., section head of

The Cleveland Clinic’s Cardiovascular Imaging, created The Center for Space Medicinein conjunction with Peter R. Cavanagh, Ph.D.Sc., chairman of the Clinic’s Departmentof Biomedical Engineering. The Center for Space Medicine researches medical prob-lems experienced by humans during long-term space flight. The center works closelywith engineers and scientists at Cleveland’s NASA Glenn Research Center. n

Dr. Bastulli Represents AMC/NOMA on WCPN’sRadio Program Titled:“Scales vs. Scalpels”

Dr. John Bastulli, VP of legislativeaffairs for the AMC/NOMA, recentlydebated J. Michael Monteleone, per-sonal injury attorney at the Clevelandlaw firm of Jeffries, Kube, Forrest &Monteleone Co., L.P.A. on WCPN’s(90.3 FM noncommercial public radio)program hosted by Dave Pignanelli.

The topic: “Scales vs. Scalpels”focused on the state’s medical liabilitycrisis and asked who’s to blame: triallawyers, doctors or insurance compa-nies? Some of the questions posed tothe interviewees by Mr. Pignanelliincluded: Where is Ohio as far as itsversion of tort reform? When capswere placed did insurance companiesfreeze their rates for doctors? What isthe dollar amount awarded by a jurythat’s deemed excessive and requires ajudge to step in?

Dr. Bastulli did an excellent job in representing the AMC/NOMA andexplaining to the listening audiencethat states which have enacted “mean-ingful tort reform” have medical liabil-

ity rates that are one-third less thanCuyahoga County’s current rates. Hedeflected the common notion thatinsurance companies are increasingtheir rates to compensate for poorfinancial investments in the late 1990sby explaining the insurance industry isheavily regulated and, by law, is onlyable to invest a small percentage intohigh-risk funds.

He said while the insurance industrysaw financial losses, as many investorsdid in the late 1990s, they were mod-est. He said the reason doctors havenot seen substantial decreases in med-ical liability rates yet is because thelegislation needs to mature and “mean-ingful tort reform”needs to be enactedin the state.

Dr. Bastulli deciphered for the audi-ence the difference between “tortreform” and “meaningful tort reform”by explaining we need caps on painand suffering, limits on attorney con-tingency fees, expert hearing panelsand to establish a mediation system. n

volume 90 no

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