LEE COUNTY MEDICAL SOCIETY VOLUME 20, NO. 3

MAY GENERAL MEMBERSHIP MEETING

ROYAL PALM YACHT CLUB 6 :3 0 p.m. - Social Time

1:00 \>,m. • Dinner

PROGRAM: "HEY, What's a physician doing in the

Florida Legislature?"

SPEAKER: Donald C. Sullivan, M.D.

Florida St.1tc Senator, 22nd District

Dr. Sullivan is an Orthopedic Surgeon who has an active practice in Sc. Petersburg. He began his political involvement with a run for the Florida Senate in 1990. With the help of FLAMPAC and Florida physicians he was elected with his second run in 1992 and re-elected in I 994.

He will bring us up-co-date on what hap• pened in the 1996 Florida Legislative Ses• sion and how you the physician can make a difference. •

IN MEMORIAL SIGMUND R. GREENBERG, M.D.

1930-1996 Dr. Greenberg joined the Lee County

Medical Society in 1988. He came from Abington, PA, where he was Chief of Endo­crinology at Abington Hospital, to join the staff of the VA Outpatient Clinic. He helped establish the Florida Endocrine Society, serv• ing as Secretary-Treasurer, President-Elect and President. He was involved at the local. state and national level of his professional organizations and was Board Certified by the American Board of Internal Medicine and American Board of Endocrinology and Me­tabolism.

He had many articles on the subject of his specialty, Endocrinology, published in the American Journal of Medical Science, An• nals of Internal Medicine and the New En­gland Journal of Medicine.

Dr. Greenberg's death was due to a sud­den heart attack. He was talking on the phone at the VA Outpatient Clinic when this misfortune occurred.

He was always ready co serve the Medical Society and served on our Grievance Com­mittee. We will miss his presence in our medical community. •

VACATION TIME!! NO

SOCIETY MEETINGS JUNE • JULY • AUGUST

SEE YOU IN SEPTEMBER!

THE VOICE OF LEE COUNTY MEDICINE Fort Myers, Florida

Daniel R. Schwartz, M.D., Editor

PRESIDENT'S MESSAGE "LEGISLATIVE HU RRICANE SEASON"

This is the t ime of year when we all have the most to fear:· the Florida Legislature is in session. Those of you who arc newcomers to our state will find that it's open season on common sense. Physicians arc always a favor# ice t.irge~ and often find themselves in the eye of the storm. Just like in hurricane season•· if it isn't bolted down you may lose it!

This is also the time when I can look each of you straight in the eye and answer the question •· "what has the medi­cal society done for me lately?" The FMA is doing battle in Tallahassee to protect your interests! Weekly reports arc sent to the county medical societies updating them on each and every bill of interest co us. The members of our county legislative committee receive legislative faxes nearly every day asking us to contact our key legislators

ALAND. SIEGEL, M.D. about bills under consideration. Some of the bills are al-most too ridiculous to believe while others just plain make

you mad. I'm going to discuss both kinds of bills in the paragraphs that follow. One bill proposes to require rwo members of the Board of Medicine be physicians who

use nontraditional medical treatments in a significant portion of their practice. The same bill would prohibit the discipline of physicians solely for the use of experimenta l or nontra• ditiona l therapy or procedures in their practice. Sound scary to you? How about a bill to create a Board of Oriental Medicine to license and regulate the practice of acupuncture and other 11oricntal therapies."

The 253 foreign-licensed physicians who haven't been able to pass the FLEX exam after three tries have again passed a bill out of committee to grant them licensure by decree. You may recall that after much pressure the governor supported the FMA by vetoing a similar bill in the last session. Politics makes strange bedfellows; it seems the Miami legislative contingent feels so strongly about th is that they have threatened to hold up the rest of the Republican legislative agenda if they don't get their way. T he fact that every other interna• tional medical graduate has passed the FLEX or similar exams doesn't matter•· these phy­sicians can't pass and its easier to make a law than to reach them how to pass the exam.

Equally erroneous is a companion bill that mandates designated internship positions for foreign-licensed physicians at the Universities of Florida, Miami, and South Florida. Th is sets a dangerous precedent. I'm confident that soon we'll have designated positions for other ethn ic groups, sexua l orien tations, and disadvantaged minorities. Eventually we,'ll have to open the profession to imbeciles and politicians as well.

The battle con tinues to rage over mandated continuing medical education credits. The FMA understands that no issue so directly touches our membership as this one. Unfortu• natcly the legislators sec this issue as an opportunity to grandstand for their constituents -• who could possibly be against stopping domestic violence, avoiding malpractice, and combating A IDS? TI1e good news is that three hours of geriatrics were nearly mandated and we were successful at amending thar out of the bill. Hopefully we'll be able to reduce risk management, domestic vio lence, and AIDS to one credit each •· I'm sorry co say that we probably don't have the support to do more than that.

Several groups of healthcare providers again d id battle with the FM A this session. A RN P's want to prescribe controlled substances without physician approval. They want to be able to sign up with Medica id HM O's as independent providers in the same way that physicians do. Optometrists have a bill banning any hospital or managed care entity from "discrimi• nating" against chem on the basis of train ing •· or lack thereof.

The trial lawyers arc up to their usual tricks. We defeated a change in the wrongful death

C ontinued on Page Two

9n qhis 9ssue ... _______ ~ Membership Activity .. ................. .... 2 FMA Annual Meeting •.........•....•....• 2 FMA Board of Governors ................ 2 Sports Physicals ...... ... ..........•....•..... 2 D emographics of SW Florida ..........• 2 Lee County Medical Society

A lliance/Foundation News ••...••••..• 2 The P atient Is Your Boss ....•........ .... 2 Classified ............................... ..... .... 2

Managed Care Musings .................... 3 Lee County Legislative

Delegation Votes .............••............ 3 FMA EVP • D esignate N amed ......... 3 Board of Medicine

Meeting Schedule .......................... 3 Antitrust Cautions . .•.•.................•... 4 Florida Medical Foundation ............. 4 Leukemia Society ....•..•.............•...... 4

May, 1996

AS I RECALL. .. ROGER D. SCOTT, M.D .

"THE BLACK BAG" It was a time before plastic and disposable

medical supplies - a time of house calls - of emergency roadside assistance - and the doctor was recognized by h is stethoscope or his black bag. My Black Bag has been put away for probably 29 or 30 years. I recently uncovered it and inventoried it and the fol­lowing is the list of the contents. It is sur­prising that so much could be packed in such a small space. MISCELLANEOUS EQU IPMENT:

Alcohol sponges in glass jar, snake bite kit, ruler, I petrified roach, scissors, blood pres­sure cuff, cubex syringe, mu ltiple bandages, compresses, tape, tongue blades, pen light, thermomcrer, sterile sutures, glass syringes, cyccare kit, package of small instruments, ammonia inhalers, tourniquet. TABLETS AND CAPSULES:

Tuinal, H istaclopane, Pen. G-50,000 U (exp. 4/1/53), Crystodigin, Seconal, Zactrin, Nembutal, Medrol, Codeine, NTG, Mor­phine, Equanil. V IALS AND AMPOULES:

Histadyl, Crystodigin , Mepcrgan, Sterile Saline, Phenergan , Xylocainc 2%, Probanthine, Aueromycin IV 100 mg (exp. I 1/52), Aminophyllin IV and IM (different ampoules). Nembutal, Epinephrine, Caf­feine and Na Benzoace, Ephedrine, Epineph­r ine in oil, CaG!ucona tc Metrazol, Coramine, Octin, ampoule file, Seconal Sod ium , Demerol, Morphine Tarrate Syret tes, Achromycin I M (exp. 1/66), Chloromycetin, IV, IM, orSubq (exp. 8/64), Sterile \Vaccr, Dramamine, Sparine, Wyamine, Chlor Trimeto n, Ko nakion, Trilafon.

Sec how many of these drugs you recog­nize today and their usage plus dosage. Ex­piration dates on medicat ion was just com~ ing into vogue.

Most physicians made house calls and so did I but only for possible surgical problems o r postoperative visits. Most of the drugs in my bag were for use in the event of any emer­gency, and were rarely used. Some of the new physicians have said they're making a few house calls now so maybe the Black Bag will reappear. •

When finished with this issue . ..

TO: INITIALS:

PAGE TWO

LEE COUNTY MEDICAL SOCIETY BULLETIN

P.O. BOX 60041 Fort Myers, Florida 33906-004 I

Phone (941) 936-1645 FAX (941) 936.0533

The Lee County Medical Society Bulletin is published monthly with the June and August Editions omitted. CO-EDITORS

Mary C. Blue, M.D. John W. Snead, M.D. Daniel R. Schwartz, M.D.

EDITORIAL BOARD PRESIDENT

Alan D. Siegel, M.D. PRESIDENT-ELECT

George C. Kalemeris, M.D. SECRETARY

David M. Reardon, M.D. TREASURER

Bruce). Lipschutz, 0.0. PAST PRESIDENT

Ronald J. Delans, M.D. MEMBERS-AT-LARGE

David M. Shapiro, M.D. Thomas E. Kowalsky, M.O. Richard G. Kilfoyle..M.D. Lee D. Litvinas, M.O. James H. Rubenstein, M.D. Marilyn S. Young, M.D.

MANAGING EDITOR Ann Wilke, 936-1645 Internet: willce0660I@MedONE.ORG

The Editon welcome contributioru liom the members. Opinions cxprcued In the BULLETIN ,m, those of the individual authon and do not nccouarlly reflect policies of the Society.

MEMBERSHIP ACTIVITY Moved from the Area:

Barry Zarenky, M.D. Luis A. Aponte, M.D.

Resigned: Edward L. Davis, D.O. Fraida Ghoghawala, M.D. Lakshmi Krishnan, M.D. Ramiah Krishnan, M.D. C. Nonon Sims, M.D. Paul Wozney, M.D.

Deceased: Sigmund R. Greenberg, M.D.

Retired/Disability (retained Membership) J. Steward Hagen, lll, M.D.

MAKE YOUR RESERVATIONS FOR

THEFMA'S ANNUAL~E.TING,

MAY 15 - MAY 19 The FMA Annual Meeting will be held at

the Marriott's Orlando World Center. from Wednesday, May 15, through Sunday, May 19.

In addition to an extensive array of scien­tific programs beginning on Wednesday, May 15, the FMA Annual Meeting is the setting for the FMA House of Delegates and the FMA Alliance Annual Meeting. For reset• vations and a detailed schedule, please call the Medical Society.

If you are not a Delegate or Alternate and are going to be at The Annual Meeting for other reasons, please let us know so we can include you in our activities, 936-1645. •

FMA BOARD OF GOVERNORS

REPRESENTATIVE If you have any questions or wish to share

any comments with the FMA, your repre• sentative for District "E" is:

KENNETH C. KIEHL, M.D. 1830 South Osprey Avenue, Suite 104

Sarasota, FL 34239 Dr. Kiehl will talce your concerns and issues

to the FMA Board for consideration. •

THE BULLETIN OF THE LEE COUNTY MEDICAL SOCIETY

HIGH SCHOOL SPORTS PHYSICALS VOLUNTEER PHYSICIANS NEEDED

FRIDAY, JUNE 14, 1996 6:00 - 9:00 P.M.

LEE MEMORIAL HOSPITAL CAMPUS 6:00 - 8:00 P.M.

CAPE CORAL HIGH SCHOOL Physicians and Physician's Assistants who would like to volunteer to help with this years

school sports physicals please call the Society Office at 936-1645 or Tammy Cox at 432-0500. A total of 587 exams were done last year. The more help we get, the faster we finish. •

President's Message ••• Continued from Page One statute that would have allowed nondependent children to sue for malpractice. Unfortu• nately we are going to see some extension in the statute of limitations for birth Injury •· lawyers will probably be able to bring suit until the child is eight years old! Undecided at this time of this writing is whether physicians will still be able to "go bare" or be required to have insurance •· another gift for the trial attorneys that we may not have to clout to defeat.

You might ask if we support anything of our own or do we just try to defeat the opposi• tion? We continue to push for a separate Department of Health that would be run by physicians instead of the oppressive reign of Doug Cook and the Agency for Healthcare Administration. We have a managed care bill with numerous provisions including anti• trust relief and regulation of HMO's. We want· to guiraritee-paym.ent.for·emergencyser• vices provided to patients even when approval from'a managed care organization cannot be obtained.

What is the take home message? Organized medicine is doing something for its member• ship even if you never read a mailing, send a letter, or call a legislator. What is your mini• mum obligation? Send in your dues and encourage your fellow physicians to join the county medical society, the FMA, and the AMA. Join our political action committees•· AMPAC, FLAMPAC, and LeePAC. This is the best investment you can make for yourself on the political scene. Legislation, like hurricanes, are a yearly fact of life. The odds are you'll be around for the battle next season. •

•-· DEMOGRAPHICS OF SOUTHWEST FLORIDA

POPULATION TOTALS

'90-'95 AVG. '94-'95 ANNUAL PROJECTIONS

COUNTY April 1, 1994 April 1, 1995 %CHG. %CHG. 2000 2005 Charlotte 124,883 130,397 4.4% 3.3% 153,601 176,197

Collier 180,540 187,599 3.9 4.3 222,199 256,000

DeSoto 26,260 26,301 0.2 2.0 28,500 30,698

Glades 8,366 8,598 2.8 2.5 9,498 10,297

Hardee 22,454 22,299 -0.7 2.8 23,101 23,798

Hendry 28,686 29,300 2.1 2.6 32,502 35,498

Highlands 75,860 76,503 0.9 2.3 85,399 94,002

Lee 367,410 376,603 2.5 2.4 428,101 478,005

Manatee 228,283 232,7~02 ).9 1.9 257,404 . 281,100

Sarasota 296,002 301,202 1.8 1.6 329,799 357,002

Southwest 1,358,744 1,391,504 2.4% 2.5% 1,570,104 1,742,597

% of State 9.8% 9.9% N/M N/M 10.2% 10.4%

Florida 13,878,905 14,109,602 1.7% 1.8% 15,449,100 16,741,839

POPULATION TOTALS

(On July 1, 1995) COUNTY 0-14 15-19 20-39 40-64 65+ TOTAL Charlotte 17,567 4,990 23,251 38,307 46,541 130,656

Collier 34.425 8,899 45,982 54,688 45,573 189,567

DeSoto 5,518 1,506 7,516 7,274 5,270 27,084

Glades 1,759 565 2,046 2,559 1,706 8,635

Hardee 5,361 1,71! 6,698 5,531 3,462 22,763

Hendry 8,129 2,133 8,925 7,264 3,246 29,697

Highlands 12,879 3,921 14,624 20,553 26,333 78,310

Lee 66,830 18,181 90,972 108,807 95,667 380,457

Manatee 40,650 11,255 53,905 63,756 65,249 234,815

Sarasota 42,059 12,620 62,149 89,916 96,538 303,282

Southwest 235,177 65,781 316,068 398,655 389,585 1,405,266

% of State 8.5% 8.2% 8.0% 9.9% 14.6% 9.9%

Florida 2,771,182 806,544 3,965,790 4,023,716 2,662,837 14,230,069

May, 1996

LEE COUNTY MEDICAL SOCIETY ALLIANCE/ FOUNDATION NEWS

Respectfully submitted by Nancy Barrow, Corresponding Secretary

1996 CHARITY BALL Now is the time to send in your reserva•

tion to attend the Magical Golden Anniver• sary Ball on May 25th, at the Ritz-Carlton, Naples. Invitations have all been mailed. If you have not received an invitation please contact Sue Backstrand at 278-0088.

Also, remember to make reservations for the Golf and Tennis Tournaments being held on Saturday, May 25th. There will be many prizes and those who participate are sure to have a great time. The cost of the Golf Tour• nament is $75 per person and the Tennis is $50 per person. Space is limited so reserve early.

Lastly, raffle tickets are now on sale! Any• one interested in purchasing tickets in ad­vance should contact Sue Backstrand at 278-0088. You need not attend the Bal\ to pur­chase raffle tickets. . . . . . . . . •

7'.ti===- ·-

THE-PATIENT IS YOUR BOSS

-ii

• The patient is the most important person. • The patient is not dependent on you • you

are dependent on the patient. You work f2I: the patient.

• The patient is not an interruptjon of your work. The patient is the ~ of your work.

• The patient does you a favor by being in your office. You are not doing the patient a filxor by caring for them.

• The patient is as much a pan of your busi• ness as anything else, including inventory, employees and your facility.

• The patient is not a cold statistic. The patient is a person with feelings and emo­tions, just like you Treat the patient bet• ter than you want to be treated.

• The patient is not someone to argue with or match wits with.

• It is your job to satisfy the needs, wants and expectations of all patients, and, whenever possible, resolve their fears and complaints.

• The patient deserves the most attentive, courteous and professional treatment you can provide.- · · ·

• The patient is the lifeblood of your busi­ness. Always remember that without pa• tients, you would not have a business. You work for the patient. •

Reprint With Permission Lee Knapp Consultants, Inc.

. . NEUROLOGIST: : Full-time or Part•ti~e Board Eligible · or Board Ce~tified Neurologist··

:needed for consultativ_~. ouq,atient . .services at The VA Outpatient Clinic, Fort.Myers;:FL. I>leasecon•.

. , ~ct Freci W~nnan, M~D.:· Chief · Medlcai Offi~, ae(94.1) 939~3939/ .~OE.

May, 1996 THE BULLETIN PAGE THREE OF T HE LEE COUNTY MEDICAL SOCIETY

MANAGED CARE MUSINGS by Brent M. Schillinger, M.D.

Without a doubt, the single most popular medical catch phrase of chc mid-nineties is managed care. Popular, chat is, in terms of the number of times and places the phrase is used. Popular you might say from a quantitative point of view.

For physicians, the popularity of managed care is mixed at best. The mere mention of the term incites major agica. We have enough of a challenge fighting disease and other natural forces that arc often out of control. Along comes managed care, a seemingly our-of-our• control-yet-man-made-force that has the potential for changing the entire way we practice medicine. This disturbance of the status quo has led some physicians to prefer the more descriptive references of mangled care or perhaps managed cost.

For those of you who aren't big fans, I've got some bad news: managed care is here to stay. But, like the dynamic cycles of life itself, it will go through an evolutionary process. This is where we physicians can still play an active role. And that's good news.

In theory, managed care could set a very positive agenda. In reality, there is a big problem when we try to figure out who is managing the managers. For the most part, no one is managing the managers. This spells out trouble because of several natural forces at work: corporate greed and capitalism coupled with a public that demands the best of everything without paying an extra dime for the privilege.

Getting back to evolution, (assuming you believe in that theory in some form), managed care is not a fixed entity. The picture is changing.

Managed care was originally concocted to provide optimum healthcnrc at a fixed low cost. Gullible people, at first, believed it would work. Most doctors knew better. We real• \Zed, in order to tru\y fix costs, one would have to cut corners :ind lim it c~rc. The public didn't want to believe this and the insurance companies didn't want to admit char.ration~ ing was part of their master plan. Well, they couldn't hide it forever.

ln che lase several months, the media has shifted into high gear for managed care bash­ing. (I muse say ic is a pleasant change from their usual favorite of basic doctor bashing.) In mid-January, Time published a front page managed care expose on the HMO gag rules. Shortly thereafrcr, Donahue and Maury Pov itch devoted entire shows to poor souls whose lives were ruined by greedy managed care companies. Last week, ABC's 20/20 did a nicely biased segment on one mid-western HMO that repeatedly practiced malpractice while simultaneously pocketing a hefty prone.

At the conclusion of the 20/20 story, the program cut back to the studio for some staged spontaneous discussion. Although Barbara Walters seemed to lack full grasp of the issues, she did read some timely advice off the teleprompter. Appearing as sincere as possible, she warned viewers to steer clear of managed care plans that restrict one's choice of physicians and out-of-panel second opinions. She clearly implied that there arc serious flaws in the current system, especially lack of industry regulation.

Now that the country has heard it from Barbara \Xlaltcrs, I believe it's safe to say the public's perception of managed care is changing. That, in cum, opens che door for a change in the industry. As consumers express cheir frustrations, physicians can play a key role in guiding the direction of this change.

Last year In Tallahassee, partisan policies blocked the passage of any meaningful healthcare legislation. This year, public opinion about managed care can override the politics.

As physicians, we have pledged this season to team up with the attorneys (talk about changes) to co-lobby for legislat ion that would hold managed care plans accountable for medically necessary services they deny. We arc also working jointly on a bill that would prohibit a health plan from dropping a doctor without cause.

Then there is the issue of patient choice, an important area for consumers and doctors alike. Patient choice has taken the form of a proposed constitutional amendment, of which the Palm Beach County Medical Society has come out strongly in favor. Herc is where getting petition signatures from your patients would make a world of difference.

\Vhile some doctors n.ctivcly involved in milnngcd care programs initially saw patient choice as a r.hrcar ro their practices, in reality it protects their practices and protects their patient/physician relationships. As the law currently stands, a plan can drop a doctor with thirty days' notice, forcing patients to find a new 11providcr11 and leaving their old 11pro .. vidcr" witho ut a practice.

Looking further down the road, many leaders (including Representative Ben Graber) have predic ted that as managed care continues to evolve, insurance companies will no longer be involved. Instead, the system will be entirely physician directed. Certainly an interesting prediction, but doctors must be present to guide the changes for this to happen.

Today the quantity of managed care is a reality. Only by actively working together can we ensure that the healthcare industry evolves in a direction where qualicy is the reality. •

EDITOR'S NOTE: Dr. Schillinger is Vice C hair of FMA Council on Public Relations, Communications and Membership.

DIAGNOSTIC ACCESS IMAGING, INC. "The OPEN MRI of Southwest Florida '.'

- Neuroradiologist on Staff - Great for Claustrophobics

1=;=::;=::::;::::::;:::::::;:::::::i - Very Quiet Procedure - Obese Patients (425 lbs) II

- Sedation Rarely Needed

12995 South Cleveland Avenue Suite 182 Fort Myers, Florida 33907 (941) 936-3332

LEE COUNTY LEGISLATIVE DELEGATION VOTES As of April 20, 1996, this is how Lee County Legislators have voted on our priority

issues. Check marks indicate the actual votes cast. As you can see, Representative Arnold and Senator Dudley have d,e most 2nb'. due to ihc fact chat they sit on the committees where our issues have been referred and heard. ( +) signifies support of FMA positions. REPRESENTATIVE ARNOLD REPRESENTATIVE PEEPLES ✓ + FMG + OOH ✓ + Statute of Limitations + Clinical Lab

(subcommittee & full committee) FMG ✓ + CME • C ME ✓ + Wrongful Death • Managed Care Package ✓ + Clinical Lab (* Needs Contact) ✓ + Opromctry REPRESENTATIVE DUDLEY ✓ + Fraud Amendment ✓ + Section 16 Repeal (Sponsor)

REPRESENTATIVE GAY ✓ + Managed Care Package ✓ + FMG ✓ + CME ✓ - Optometry SENATOR ROSSIN

+ CME ✓ + Optometry + Clinical Lab + CME

Managed Care Package + Managed Care Package (needs contact) + Clinical Lab

+ OOH FMG (needs contact) REPRESENTATIVE LIVINGSTON

+ FMG + C ME + C linical Lab + OOH + Managed Care Package

• Caryn M. Craddick, Director

FMA \"i/csr Central Field Office

FMA EVP ~ DESIGNATE NAMED Mr. Charles S. Amorosino, Jr., has been chosen Executive Vice President-designate of

the FMA. Mr. Amorosino has 15 years experience with the Massachusetts Medical Society (MMS) where he served as associate executive secretary and later as executive sccrcrnry. As MMS executive secretary, Mr. Amorosi no was responsible for the day-to-day operation of the 16,000-mcmber state medical society, including membership and specialty society services, regional office support, and membership recruitment activities. Mr. Amorosino holds a master's degree in international administration. •

Meeting Date: June 7 • 9 July 13 · 14 August 2 • 4 October 'I • 6 December 6 • 8

BATSON

CARNAHAN

D ovLE

BOARD OF MEDICINE 1996 MEETING SCHEDULE

Location: Agenda Deadline: Eden Roe/Miami May 16th The Viney/Sc. Pete Hyatt Orlando Airport Sheraton/W. Palm Beach Tampa Airport Marriott

June 21st July 11th September 12th November 14th

Have a Great Summe:r . ..

Sec You In the Fall/

The Staff at the

Lee County Medical Society Office

& CO., P.A.

Business Operational Review

Revenue/Management Cont rols

Procedure Cost A nalysis

Personnel and Policy Manuals

P ractice Start-Up CERnFIED PUB UC ACCOUNTANTS

Member of r,,,·olionnl CPA llcohh Care

Ad\11,on Auocialion

Collections/ Reimbursemen t Evaluations

8211 COLLEGE PARKWAY • FORT M YERS, FLORIDA 33919 • 482-5522

PAGE FOUR THE BULLETIN May, 1996 OF THE LEE COUNTY MEDICAL SOCIETY

ANTITRUST CAUTIONS As the health care market becomes more competitive, physicians need to increase their

awareness of antitrust law. Though the market may force physicians to work together as a "group," there are stiff criminal and civil penalties for doing so unless the physicians ad­here to strict guidelines.

The Sherman Act is a key federal law which is comprised of two sections: Section 1, prohibits concerted action which reasonably restra ins competition; and Sectio n 2, gcncr• ally prohibits monopolies.

For there to be a violation of Section l , there must be an ,.agreement" and it must unrca .. sonably restrain competition. For there to be an agreement, there must be more than one "economic unit" involved. That is, there can be no such agreement by one economic unit with itself. For example, generally speaking, shareho lders in the same .corporation arc, for an titrust purposes, legally incapable of engaging in illegal concerted action together if they share substantial economic risk. They arc generally considered to be part of a single eco­nomic unit. Conversely, members to two or more competing economic units, separate pro .. fcssional corporations, for example, may not agree to a whole host of things, because suc h agreements would violate one or more antitrust laws.

Some agreements are considered to be so egregious that they need not even restrain competition. The mere fact that such an agreement has occurred is enough , and there is no defense. Some of the "per se" violations of the antit rust laws include: agreement among two or more independent physicians to charge a particular amount for a particular service ('price fix ing"); agreemen t among two or more independent physicians not to contract with a particular HMO ("boycotting"); agreement among two or more independent physi­cians regnrding their hours of operation, the services they will offer, or the geographic areas they will serve ("market allocation"). This is by no means a complete list or a complete description of the antitrust laws, but describes some types of activities that will violate an ti trust laws.

Illustration: A payer approaches you and several of your colleagues, who arc competi• tors. The payer gives you a contract and fee schedule, which you review with your col­leagues. Though the payer recogn izes that you arc not a physician group practice, it would like to deal with just one of you for contracting purposes. Yo u choose o ne of you to "rcprc• sent" the group of you, and seek changes in the contract, including the fee schedule.

Impression: The Sherman Ac t has been violated. S ince you and your colleagues arc competitors and arc not members of a single professional corporation thro ugh which you conduct all or substantially all of your professional practices, you may not d iscuss fees among yourselves, and you may not appoint someone to act as the voice of the "group." In addi­tion to the price fixing described above, if you decided together not to contract with the payer, you would have engaged in a group boycott. •

An MRI with Something Special . . .

STARVIEW* MRI Patient Entertainment System

Patients can watch a movie of their choice during their MRI exam!

Two convenienl locatio11s with complimen1a1y /ra11spor1a1io11 =l !il H E A L T H I M A G E S, I N C.

HEALTH IMAGES OF CAPE CORAL 941/574-9333

HEALTH IMAGES OF FORT MYERS 941 / 482-3338 • 800/ 443-6802

•Parenr Pe11di11g

FLORIDA MEDICAL FOUNDATION Section 170 Plan, a tax deductible charitable gift annuity, is a method for you to save for

your reti rement, college for your children, disability or to pass assets to survivors. The Florida Medical Foundation (FMF) has established a gift annuity program which allows

the f-MF to receive funds which arc mostly tax deductible for the donor and the donor receives a future stream of income, part of which is tax free. In addition to fully funding the annuity obligation, FMF will purchase life insurance on the contributor from an A+ Superior rated company by A.M. Best which will provide its' future endowment benefit.

You and your chosen second income beneficiary will receive a retirement income for life, funded through an annuity, starting on the date chosen by you. Then, at your death, The Florida Medical Foundation will receive nn endowment in your name. The funds you deposit to the Section 170 Plan is mostly tax deductible (I.R.S. Sec. 501 c#) and the amount of retire­ment income will depend on the total amount of funds you contribute to the plan.

BENEFIT SUMMARY • Set Aside Dollars Monthly For Future Use• No Limits • Receive a Current Year Tax Deduc­tion • EACH YEAR You Contribute • Florida Medical Foundation Matches Your Retirement Benefits 50% • Guaranteed Income For The Life of Two People • No 10% Federal Penalty for Early Distribution • SECURITY: G ift Annuity Agreement (Legal Contract) • Docs Not Con• flict With Any Current Qualified Plan You Have • May Not Be Attachable in the Event of a Lawsuit (Malpractice) • No Administrative Fees or Expenses • Plan Allows Total Flexibility For The Physician's Decisions • Supports FMF Programs Such as Continuing Medical Educa­tion, Scholarships, Research etc. and Creates an Endowment in Your Name

USES • Rctircment/)ncome • Office Plan • College Plan • Estate Planning INFORMATION 1-800-423-1409 • FAX (904) 632-1420 • (904) 354-5 l 15 •

LEUKEMIA SOCIETY SEEKING ADVISORY

BOARD MEMBERS The Fort Myers Advisory Board to The Leu­

kemia Society of America is currently seek­ing individuals to sit as members on ics advi• sory board. The Leukemia Society's Suncoast Chapter formed the Fort Myers Advisory Board in the fall of 1992 to further the goals of the Society in the Lee County area.

The Leukemia Society is a national, vol­untary, not-for-profi t health organization dedicated to eradicating leukemia and its related cancers and to .improving the lives of patients and their families.

A primary function of the Advisory Board is to educate patien ts, the public and health care community abou t t h e Leukemia Society's program of research, community service, public and professional educatio n , and patient aid. The Advisory Board also assists the Leukemia Society through special events to raise additional funds for the Society's programs.

Individuals interested in sitting on the advisory board may contact Jeff Hild at 334-4121 or Kurt Streyffeler at 656-4484. •

LEE COUNTY MEDICAL SOCIETY P.O. Box 60041 Bulk Rate

U.S. Postage PAID

Fort Myers, Florida 33906-0041 Ft. Myers, FL

Permit No. 534