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ACAAI / AAAAI Joint Statement on Singulair
HOUSE OF DELEGATES
RULES OF ORDER
MEETING REPORT
November 4, 2005
The meeting of the ACAAI House of Delegates was held on Nov. 4 at the 2005 Annual Meeting in Anaheim. The meeting was called to order by Speaker Rose Marie Young, MD.
President’s Report
ACAAI President Myron Zitt, MD, reviewed the role of the House of Delegates and the importance of the feedback that it provides to the Board of Regents. He thanked the Speaker for her work in bringing a “town hall” forum structure to the meeting and encouraged ACAAI members to use the House of Delegates page on the ACAAI Web site.
He reviewed the positive resolution of the immunotherapy issue with New York Empire Blue Cross/Blue Shield. He stated that this was an example of the House of Delegates bringing an issue to the Board of Regents.
In addition, he discussed the issue of the AAFA Seal of Approval that has been awarded to ionizer products. He said that AAFA had informed him that ionizers would no longer be endorsed after Jan. 1.
President-Elect’s Report
ACAAI President-Elect William Dolen, MD, also emphasized the importance of the House of Delegates and encouraged members to e-mail him with any issues or concerns any time in the coming year.
JCAAI Report
JCAAI President Stanley Fineman, MD, reviewed several issues on which the Joint Council has been working: congressional lobbying, coding, Medicare compliance, syringe safety, sterile compounding, follow-up lab test results and five-year review of physician work. He encouraged members of the House of Delegates to be JCAAI members and make regular use of the JCAAI Web site.
Empire BC/BS and Immunotherapy
Linda Cox, MD, addressed the issue of a three-year limitation on immuotherapy therapy imposed by Empire Blue Cross/Blue Shield and how it was favorably resolved. She stressed that scientific data were used to arrive at a conclusion. The JCAAI immunotherapy forms will be accepted by Empire BC/BS.
Resolution
Kevin McGrath, MD, representing the Connecticut Allergy Society, introduced a resolution that was amended and approved by the delegates:
BE IT RESOLVED that the House of Delegates recommends that the JCAAI, as well as the ACAAI, address the issue of high co-pays for allergy immunotherapy. Many of our members have experienced patients having co-pays that are nearly equal to or even higher than the fee charged for administration of 95115/95117 code. As a co-pay was originally defined as a partial payment of services, it is unreasonable that insurers are charging such high co-pays for allergy immunotherapy. We feel this issue needs to be addressed both by the ACAAI and the Joint Council immediately in a position statement in a timely fashion.
Allergy and Asthma Proceedings Journal
Joseph Bellanti, MD, and Russ Settipane, MD, presented a report on the Allergy and Asthma Proceedings Journal and discussed several new additions to the journal.
World Allergy Organization
Constance Katelaris, MBBS, PhD, treasurer of the World Allergy Organization, presented a report on the organization’s Global Recommendations in Allergy (GLORIA) program in the United States. GLORIA, co-sponsored by the World Health Organization, develops and disseminates at the international level best practice guidelines on health care for allergic disease.
Election of Officers
Speaker Young presented a slate of candidates for office which was unanimously elected by the delegates:
James Mallette, Jr., Speaker
Kevin McGrath, Vice-Speaker
Christopher Randolph, Secretary
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UPDATE
September 15, 2005
Just think of all the hassles that we, as physicians, must face everyday. From “Big Brother” in the form of governmental regulations (OSHA, HIPPA, CLIA) to all the numerous insurance plans that plague our lives including Medicare and Medicaid, we still plow through and take care of our patients.
We tell our family members and friends, if we had to do it over again, we would have done something different. Some of us are even thinking of early retirement.
But who are we kidding? When Katrina came crashing through, destroying homes/land that will cost billions to rebuild, killing hundreds and displacing thousands of lives, physicians were there to hold the fort caring for the sick until the cavalry showed. Others that had planes were flying the homeless to prospective new lives. And still many others are volunteering their services in every state to provide care wherever it will be needed.
If one wasn’t physically able to go to where help is needed, donations in all forms are being sent instead. The ACAAI is donating $50,000 towards relief for the victims of Katrina and Mike Zitt (our president of ACAAI) has challenged us to donate at least $500 as well to help. I know that many if not all of our members will take up that gauntlet and meet the challenge
So don’t let anyone tell you that docs are only in it for the money, don’t care about patients but only about the almighty buck or in league with the “Devil.” If that were true, we would be in big business or politics. It takes disasters such as Katrina that show our true selves and why we went into medicine (allergy or pediatrics, etc.). So despite all the grumbling, we love our profession and what we do. We just need the strength to keep doing it despite all odds and remembering why.
I know that many of us need more information on how else can we continue to help. So here are important Web sites that can provide it.
Rose Marie Young, M.D.
Speaker of the HOD
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UPDATE
June 22, 2005
VICTORY!! David has knocked out Goliath.
Thanks to the support and assistance from various parties – ACAAI, JCAAI, Medical Society of the State of New York, AAAAI’s Immunotherapy and Allergy Diagnostics/Practice Diagnostic and Therapeutics Committee – we have accomplished the unthinkable. The Long Island and New York State allergy societies were persistent and succeeded in getting Blue Cross/Blue Shield to revise its policy on immunotherapy and in the future will defer to the allergist for advice on policies involving allergy. I am hoping that this will set a precedent in handling similar problems or issues for other states.
Thanks to the team that accomplished this great feat: Dan Mayer, MD (Past president, LIAAS/NYSSAAI), Robert Corriel, MD (President, LIAAS), Jim Pollowitz, MD (President, NYSSAAI), Andy Green, MD (Past President, NYSSAAI), Robert Scher, MD(President, MSSNY), Myron Zitt,MD (President , ACAAI), Michael Schatz, MD (President, AAAAI), Stan Fineman, MD (President, JCAAI), Linda Cox, MD (Chair , AAAAI Immunotherapy and Allergy Diagnostics Committee), John Cohn, MD (Chair, AAAAI Practice Diagnostic and Therapeutics Committee) and the Texas and Florida allergy societies.
As individuals, many times we feel powerless when dealing with bureaucracy, but if we learn to work as a team, we can offer solutions to diverse problems which can affect all of us – regardless from which state we hail. We are the experts in our field, yes we can consider ourselves experts. Remember we did an additional 2-3 years of training to learn our specialty and, as delegates, are board certified. So who better qualified to know what is best for our patients when it comes to allergies – us or an insurance company? Many of us have gone on to do clinical studies to provide evidence-based results to back up our clinical decisions. Essentially, we are setting the standards on how to practice allergy.
So if our standards are questioned again in the future, we need to rally immediately, gather all our resources and fight for these standards. I would like to have more discussion on this and similar topics at our next House of Delegates meeting in Anaheim.
Let me know what you think.
Rose Marie Young, M.D.
Speaker of the HOD
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UPDATE
April 5, 2005
I. New York was hit with another blow by the insurance companies. GHI has decreased allergy reimbursement by 25% starting next month. Is this a national trend? If more and more insurance companies follow suit, it may cost the allergist money just to treat these patients. Here is a question for the delegates. Do you know of anyone or have you thought of other alternatives to running your practice? (Such as having patients set up medical accounts.) I do know of two internists in my area who have resigned from all insurance companies and charged annual fee to their patients for unlimited medical services.
II. I was at the AAAAI meeting in San Antonio and it was estimated that > 8,000 registrates were there. Definitely a larger group than the number of registrates we had at the Boston meeting.
For the President and Officers of the local societies: If you know any members of your society who are NOT members of the ACAAI could you ask them these two questions: a) Why haven't they joined?
b) What could the ACAAI do to get them to join?
Please send in your comments. I would like the delegates all over the country to discuss what is happening in their state, so that by sharing ideals we may be able to deal with these obstacles.
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UPDATE
March 15, 2005
I. Update on Resolution #2 LIAAS vs BC/BS (or David vs Goliath).
The battle with Empire BC/BS is still ongoing. NY state medical society (MSSNY) was also outraged that an insurance company is playing doctor and dictating what is appropriate or inappropriate medical care. Three letters have been sent to Empire BC/BS: one letter from signed by JCAAI, ACAAI, and AAAAI, one from ACAAI ‘s attorneys, and one from MSSNY – all in agreement that this policy is INAPPROPRIATE. Officers from LIAAS and NYSSAI will be meeting in San Antonio to formulate strategic arguments to use when a formal meeting with BC/BS is arranged.
II. BC/BS has decreased reimbursement for venom therapy by 50% in NY. This will not even cover cost of venom extract.
III. Anthem is limiting immunotherapy visits and increasing co-pays in Connecticut.
We would like to hear from other delegates or members from across the nation if this is a trend. Definitely, when insurance companies hear of success in decreasing services or reimbursements as practicing “good medicine,” we can assure you that the word is rapidly spread among the different companies to copy this success. We need to stay on top of these attempts which challenge us as physicians and not just as business people.
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UPDATE
February 28, 2005
The Long Island Allergy, Asthma Society presented its case to the Medical Society of the State of New York. The state medical society agreed to also write a letter to Blue Cross/Blue Shield denouncing the mandate of not reimbursing immunotherapy greater than three years because it is “inappropriate medicine.” The state society also agreed that the insurance company is trying to practice medicine, and the letter will demand a retraction of this “inappropriate policy.”
This letter will be sent at the same time as the ACAAI/AAAAI/JCAAI letter also denouncing this policy.
I will keep the HOD members informed of further developments. Suggestions or any other strategic recommendations from the members will be gladly welcome.
If you have an issue or problem ongoing in your state, please let me know so I can broadcast it to the rest of the delegates for their input.
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UPDATE
February 28, 2005
The following action was taken by the ACAAI House of Delegates at its meeting in November 2004:
RESOLUTION #2
Introduced by the Long Island Allergy Asthma Society and New York State Allergy Society
New York Empire Blue Cross/Blue Shield
We request that since the ACAAI, our leading national organization and definitive expert which constantly strives to promote excellence in the practice of the subspecialty of Allergy and Immunology whereby representing us, the practicing allergist: To Denounce and Refute the NY Empire BC/BS policy on Immunotherapy which in essence states that physicians who do not follow this policy are practicing inappropriate medicine. Although Empire BC/BS offers a medical policy disclaimer – this policy does not state that the HMO will not pay for more than 3 years of Immunotherapy which is a business issue, but rather it is MEDICALLY INAPPROPRIATE to treat for longer than stated policy that pertains to Hymenoptera sensitivity, Allergic extrinsic asthma, perennial rhinitis, etc. . . . We consider this a medical-legal statement giving the right of an HMO to practice INAPPROPRIATE medicine even when the scientific studies, the FDA's statement on immunotherapy and the practice parameters dictate otherwise. Though this is a local issue, as we have seen with “prior authorization of antihistamines,” once this is accepted or ignored by the medical profession, it will snowball across the nation setting precedence for OTHER or NEW practice guidelines determined not by us but by the HMOs.
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