Annual report fiscal year 2005 [2005]

Annual Report Fiscal Year 2005
Visit us on the web at www.medicalboard.georgia.gov

Letter from the Executive Director
During FY 2005, the Composite State Board of Medical Examiners (CSBME) accomplished several important objectives and undertook initiatives to accomplish several more during FY 2006. By achieving and implementing these goals, CSBME is poised to improve efficiency in the services it provides to the citizens of Georgia and the medical professionals who serve them. During 2005 we modernized the Board's IT infrastructure and streamlined a variety of internal processes. For example, we established a Board intranet (Confluence) for posting Board meeting materials online, thus reducing expenses in postage and supplies while simultaneously improving staff efficiency and production. In the area of licensing we have begun upgrading our computer systems to allow for the implementation of an online applications process that will shorten the application processing time and provide up-to-date status of an application for the professional; we instituted birth month renewals to assist credentialing agencies, hospitals and other state agencies in obtaining the licensure status of healthcare professionals; and we changed the renewal process for physicians from forms-based to internet-based, which gave us a 95% online renewal rate. I hope you will find the following report helpful and informative and that you will find it illustrative of CSBME's role in both improving our services to the medical professionals whom we license, and in protecting the health and safety of Georgia's healthcare consumers. LaSharn Hughes, MBA Executive Director Composite State Board of Medical Examiners
January 2006
The CSBME Mission: Protecting Georgians
Our mission statement "To protect the health of Georgians through the proper licensing of physicians and certain other members of the healing arts, and through the objective enforcement of the Medical Practice Act" is a constant reminder of our purpose. The Board fulfills its mission through three core activities:
Licensing qualified health practitioners. Enforcing rigorous quality and ethical standards in the practice of health care. Providing Georgia's health care consumers with information that enables them to make wise
choices.
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The Board
CSBME is an independent executive agency charged with the licensing and regulation of physicians, physician's assistants (PA), respiratory care professionals (RCP), acupuncturists, clinical perfusionists, and physician residents in training (residents). Pursuant to legislation passed in the 2005 legislative session, CSBME will become responsible for licensing and regulating orthotists and prosthetists in 2006, and planning was begun in fiscal year 2005 for the implementation of that mandate.
The Board itself is comprised of thirteen members, of whom twelve are practicing physicians and one is a consumer, appointed by the Governor. The Board also includes an ex-officio adviser who is a practicing physician's assistant. The PA, acupuncturist, RCP, perfusionist, and orthotist and prosthetist committees each include other volunteers from the professions they regulate. These committee members, like the Board members themselves, are unpaid volunteers who give their time and effort to the people of Georgia in order to protect your health and medical safety.
The Board is a diverse group of physicians from every region of the state, and their backgrounds reflect the rich diversity that makes our state a vibrant and growing one. Each member has a successful career that he or she sets aside for over twenty hours every month to serve Georgians.
The members of the Board are:

M. Vinayak Kamath, M.D.
President Augusta
Roland S. Summers, M.D.
Immediate Past President Savannah
Grace V. Davis, M.D., MPH
Past President Sylvester
Wm. Alan Woolery, D.O., Ph.D.
Past President Warner Robins
Linda J. Walden, M.D.
Cairo
Physician Member - Vacant
Consumer Member - Vacant

Joseph C. Finley, Sr. M.D.
Vice President Alpharetta
Eddie R. Cheeks, M.D.
Past President Augusta
Roger E. Hill, D.O.
Past President Marietta
John Grant Lewis., M.D.
Rome
T. Wayne Bloodworth, M.D.
Alpharetta
Lynette D. Stewart, M.D.
Norcross
Carolanne Redfearn, PA
Ex-Officio Member Thomasville

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Profession Physician Resp. Care Professional Physician's Assistant Resident Acupuncturist Perfusionist Volunteer in Medicine Institutional Physician Provisional Physician ALL LICENSES

Active Net Increase Licenses over FY04

27,205

1,508

4,354

256

2,301

49

1,440

418

137

19

106

7

14

-4

3

-2

4

0

36,072

2,179

Active Licenses by Profession December 31, 2005

Licensing
Through the licensure process, CSBME ensures that physicians and other CSBME-regulated professionals meet the standards of education, training, and professional conduct necessary to serve Georgia patients effectively and safely. Applicants for licensure must submit documentation of their professional education and training, details of their work history, and proof of their clinical knowledge as demonstrated by rigorous subjectbased examinations. Additionally, applicants are required to reveal any information about their medical history that could affect their ability to practice, as well as any malpractice, arrests, convictions, and actions taken against them by other licensing boards. Every two years, licensees must renew their licenses in order to continue to practice. The renewal process allows CSBME to ensure that each licensee continues to meet current training, continuing education, and professional conduct standards.

CSBME regulates eleven professions with a combined total of 36,072 actively licensed practitioners. This represents an increase of 6.4% in the number of active practitioners over FY 2004. During FY 2006, CSBME will be preparing for the licensure of orthotists and prosthetists. These professionals will be licensed in Georgia for the first time by July 1, 2006.

During FY 2005, CSBME received 3,815 applications for new licenses, an increase of 20.9% over FY 2004. The bulk of this increase was in applications for residency training permits. CSBME processed 1,133 residency training permits in FY 2005, an increase of 234%. While CSBME does not expect the growth trend in residency training applications to continue at the same pace, the issuance of licenses for the two new professions (orthotists and prosthetists) means we can anticipate receiving and processing 4,000 applications in FY 2005.

Applications 2,538 2,716 3,155 3,815

New Applications by Fiscal Year (All Professions)
4,000 3,500 3,000 2,500 2,000 1,500 1,000
500 0 FY2002 FY2003 FY2004 FY2005 Fiscal Year

CSBME continues to be a national leader in delivering value to its licensees. According to statistics published by the Federation of State Medical Boards in 2005, the cost of physician licensure in Georgia is among the nation's lowest. According to the Federation of State Medical Boards (State Medical Licensure Requirements and Statistics, 2006), the cost of obtaining and maintaining a license to practice medicine in Georgia was the fifth lowest of the 65 U.S. medical licensing boards.

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In December 2005, all active Georgia physicians' licenses are due for renewal. This biennial renewal process is a time of peak demand on the staff of CSBME, requiring coordination with external participants such as financial institutions, information technology vendors, and the Georgia Technology Authority (GTA), as well as CSBME employees and temporary staff. Effective with the December 2005 renewal season, CSBME will carry its search for greater efficiency and stakeholder value to this activity, moving from the present method of common expiration dates to staggered expiration dates based on the licensees' birthdays. This initiative will change the renewal process from a project-based one to a more routine one in which renewals are handled each month.

Medical Board 1. W isconsin 2. Nebraska 3. W ashington (Osteo) 4. South Carolina 5. Georgia 6. Utah 7. Michigan (MD and DO) 8. Alabama 9. South Dakota
10. W est Virginia (Osteo)

Application Fee 110 302 650 0 400 200 150 195 200 200

Renewal Fee, Annual
53 51 50 80 77.50 91.50 95 100 100 100

Licensing Fees over Career (25
years)
1,435.00 1,577.00 1,900.00 2,000.00 2,337.50 2,487.50 2,525.00 2,695.00 2,700.00 2,700.00

How m uch value does the G eorgia Medical Board's licensing unit deliver to physicians? The cost of obtaining and maintaining a Georgia medical license over a 25-year career is the fifth lowest of 65 U.S. licensing boards and is less than half the national average ($4,830), according to the Federation of State Medical Boards.

Note: This annual report restates the new applications figures from previous years (see graph on page 3), in order to reflect a more meaningful definition of "new application" than the 2004 annual report had used.
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2,500 2,000

Complaints Received by Year 2,154

1,500 1,000
500

1,008

1,425 1,200

1,479

1,618

FY2000 FY2001 FY2002 FY2003 FY2004 FY2005

Enforcement
The Board's responsibility extends beyond the licensing of physicians and certain other practitioners of the healing arts. CSBME is also responsible for regulating the practice of the healing arts through Georgia's Medical Practice Act and its companion laws, the Physician's Assistant Act, the Respiratory Care Practices Act, the Acupuncture Act of Georgia, and the Clinical Perfusionist Licensure Act. The Board devotes much of its time to this serious duty, investigating complaints from consumers and reviewing malpractice settlements and information from hospitals, other state medical boards, and organizations such as the National Practitioner Data Bank (NPDB).

CSBME provides a variety of avenues for ensuring that its licensees are practicing competently and professionally within the guidelines of the law. The CSBME website, www.medicalboard.georgia.gov, publishes the laws and rules practitioners must follow, and includes information and forms for filing complaints about illegal or unprofessional practice. The Board regularly receives information from the Federation of State Medical Boards (FSMB), a clearinghouse for state medical board actions, as well as from malpractice insurers, other governmental agencies, and its own investigators. And CSBME also publishes newsletters and coordinates its efforts with professional associations to educate practitioners about how to avoid the kinds of actions that could result in Board discipline. These measures are in place to help the Board guard against unprofessional conduct and protect the safety of Georgia health care consumers.

Once a complaint is received, CSBME staff members research the particulars of the allegation. This could include gathering information from medical records, malpractice settlements, statements from the respondent and complainant, and other sources. This information is then forwarded to the Board, which, through its Investigative Committee, evaluates the complaint and presents its recommendation to the full Board. The Board then decides upon the appropriate action to take, or it could return the case to the staff for further investigation or order a peer review of the complaint. Board actions can range from closing the case with no further action, issuing a letter of concern, and ordering various sanctions such as practice restrictions and/or fines. License revocation is the most severe sanction.

Public Board Orders by Year

250

200

195

150 164

119

119

100

109

82

50

FY2000 FY2001 FY2002 FY2003 FY2004 FY2005

In FY 2005, CSBME received 1,618 complaints against its licensees, a decrease of 24.9 percent over the preceding year. During the same period, the Board took 164 public disciplinary actions, ranging from fines, orders for additional medical training or education, and up to license revocation. After thorough evaluation and review, 1,618 cases were either addressed with remedies other than public discipline or involved matters outside the Board's jurisdiction.

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Investigations
When CSBME receives a complaint against a licensee or alleged unlicensed practitioner, it accords the practitioner the rights of due process. One of the pillars of due process is the presumption of innocence. CSBME Investigations, a certified law enforcement unit, helps the Board ensure that disciplinary actions are taken only after thorough investigation of the allegations.

Quality of care (30.3%) Impairment (4.9%) Discip. action - other state (12.3%) Fraud (0.7%) Unlicensed practice (7.3%) Profiles (0.1%)

26.5%

30.3%

Sexual misconduct (1.2%) Prescribing (6.7%) Felony conviction (1.1%) Violation of Board order (0.6%) Unprofessional conduct (8.2%) Malpractice (26.5%)
1.2%
4.9%

During FY 2005, CSBME received 891 allegations

0.1%

that were handled by Board

agents an increase of 5.7

percent over the FY 2004

total. Of these, malpractice

and quality of care cases

accounted for 26.5 and 30.3

percent of the total intake, respectively.

8.2%

7.3%

0.6%

1.1% 0.7%

Investigations Opened, FY2005

6.7% 12.3%

CSBME agents completed 891 investigations during the year, and at year-end, there were a total of 132 active investigations. Of these active cases, over two-thirds had been received in the preceding thirty days, continuing a trend of improving already impressive timeliness standards.

For FY 2005, the Board successfully targeted the activity of probation compliance as an opportunity for

increased efficiency. CSBME created a new Compliance Manager position in FY 2004 and filled it in FY

2005. The position was created to manage a caseload of over 250 licensees whose consent orders

required a variety of actions, such as submitting periodic reports from supervising physicians, sending

Quality of care Impairment Disc. action - other state Fraud Unprofessional conduct

Sexual misconduct Prescribing Felony conviction Unlicensed practice Malpractice

copies of prescriptions they have

written,

and

observing

restrictions on their practice

privileges.

In the past,

manpower factors had forced

CSBME to use investigators to

31%

monitor probationers, and the

40%

demands of new investigations

had severely hampered the

Board's efforts to closely

manage probation compliance.

As a result of efficiencies such

as this one, the Investigations

2% 3%

Unit completed 9.6 percent more

6%

7%

1%1% 3%

6%

cases than it did in FY 2004.

Active Caseload, July 1, 2005

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Finance and Administration
All organizations require support for their core business units to succeed items like computers, copiers, and office supplies; services such as state-of-the-art technology and support; activities such as financial administration and operational planning. The Operations Unit provides administrative support for CSBME's core functions through five primary activities: financial management, vendor management, systems administration, operations planning, and general administrative support.
During FY 2005, CSBME was faced with expanding demand for its services at a time at a time when, for the second consecutive year, its budget appropriation was being reduced by nearly 10 percent. Simultaneously, the agency's share of employee health insurance costs increased. CSBME met this challenge head-on by seeking and implementing innovative practices to increase operational efficiency while reducing operational costs. The Board implemented a private intranet to distribute Board meeting materials and information to Board members a decision that saved over 70 percent in shipping costs and led to a 55 percent reduction in regular operating costs.
CSBME also undertook actions to lay a foundation for even greater efficiency gains in the future by embarking on a project to completely upgrade its licensing and regulatory computer systems. This upgrade will enable us to implement significant enhancements, such as online application licensure and web-based certification of license standing, while simultaneously increasing staff productivity and reducing the consumption of office supplies.

FY 2005 Income Statement
Revenues:
Current Year Appropriation Application, Renewal, and other License Fees1 Fines Other Income
Total Revenues
Expenses:
Personal Services Regular Operating Travel Equipment Computer Charges Telecommunications Per Diem, Fees Contracts
Total Expenses
Net Contribution to State Treasury:

$ 2,007,495 $ 1,170,896 $ 132,150 $ 175,344
$ 3,485,885
$ 1,658,169 $ 99,819 $ 22,450 $ 9,521 $ 187,326 $ 34,966 $ 60,414 $ 62,027
$ 2,134,692
$ 1,351,193

1 Includes biennial renewal fees. During Fiscal Year 2005, no physicians' licenses expired. CSBME received $3,873,000 in physician's license renewal fees in FY2004 that will not be received again until Fiscal Year 2006. During 2005, CSBME began moving to a staggered biennial license period in which each license will expire every two years in the birth month of the licensee. Over time, this will have the effect of "smoothing out" the license renewal revenue stream.

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Our Staff
Our people are at the heart of our accomplishments. CSBME is fortunate to have dedicated, competent personnel who take their jobs and our mission seriously. Every day, these men and women perform the tasks that enable CSBME to protect the health of Georgians through our licensing and enforcement activities. They include:

LaSharn Hughes, MBA Executive Director
Jeffrey D. Lane, M.S. Director of Investigations
Deborah Owens, J.D. Legal Services Officer
Joel Greenberg, M.D. Medical Consultant
Robert Sessions, M.D. Medical Consultant
Jeriste Dorsey Financial Administrator
Karen Smith Enforcement Unit Supervisor
Gladys Henderson RCP, Acupuncture, Perfusion Licensure
Sharon Cloud Enforcement Unit
Adrienne Baker Medical Board Agent, Principal
Steve Wills Medical Board Agent, Senior
Anna Hannan Medical Board Agent, Senior
Lem Roberts Medical Board Agent, Senior
Shiela Epps Paralegal
Teri Raven Information and Referral Specialist

Jim H. McNatt, M.D., MBA Medical Director
Robert Jeffery Director of Operations
Diane Atkinson Administrative Assistant to the Executive Director
Peter Ciejek, M.D. Medical Consultant
Phyllis White Operations Analyst
Nancy Teele, M.S. Licensing Manager
Tommy Kelly Systems Administrator
Deborah Bruce Physician Licensure
Elizabeth Beavers Physician Licensure
June Dukes PA Licensure
Idrisa Smith Enforcement Unit
Nariscia Lott Enforcement Unit
Charles Kingsland Medical Board Agent, Senior
Emmalie Kirkland Medical Board Agent
Stephanie Cleary Compliance Manager

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