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February 8, 2010
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IN
THIS ISSUE
Editor's Column:
What Congress Has Put Together, Let No Tea Party Tear
Asunder
President Schedules Health Reform Summit
For Feb. 25
Obama Invites Republicans to Share
Ideas At Televised Reform Summit
Clinton Reform Veterans Helping Obama
With Overhaul Effort
Physicians Needed To Support Haiti
Relief Efforts
New Medical School Moves Forward Another
Step
St. John Gets Anonymous $3 Million
Grant For Cardio Lab
WSU Physician Group Doctor Earns Grant
To Decode Diseases
Last
Week's With Comments - Editor's Column: Another
Inconvenient Truth

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Editor's
Column: What Congress Has Put Together, Let No Tea
Party Tear Asunder
By
JOSEPH WEISS, MD
The medical profession should not look with indifference on the present
declivitous course of the health reform bill. If no bill or a weak
one emerges from Congress, physicians will find that ultimately their
medical way of life will change in ways greater than if a bill had
passed.
First,
an impasse will end the chance to end the Sustainable Growth
Rate formula; we will again face income stagnation. Congress
will repeat its habit of granting a last-minute “reprieve” of
1 percent or even one-half of 1 percent increase in reimbursement.
At the same time we can expect an upturn of 5 percent or
more in expenses. Our real income will continue to drop.
Second,
we will find ourselves subject to more regulation. We are
victims of the magical thinking by insurers and government
that somehow more rules on physicians will mean less cost
for patients. The new regulations on what constitutes “meaningful” electronic
medical records is representative of this fantastical notion.
Third,
the failure to pass a multifaceted, health reform bill
will likely accelerate the passage of medical practice
from small groups to large HMOs. Without cost controls
included in the reform bill, the expense of health insurance
will increase such that more people will accept the restrictions
of choice and care placed upon them by the HMO approach
to medical care. This restriction of choice for the patient
will lead to restricted practice options for the physician.
Fourth,
fragmentation between primary and specialty care will both
continue and increase. Failure of the health reform bill
will mean little redistribution of income to primary care.
The specialties that make the most money will retain their
appeal and increase as greater incomes allow more intense
lobbying to protect those big incomes. Family practice
will keep its position as poorly paid, poorly looked upon
and overly scrutinized by regulators.
At
this time, our best hope to salvage reform is to support
the AMA. It has demonstrated an understanding of the importance
of reform for both patient and physician (see the letter
to membership from AMA President James Rohack, MD, printed
in the DMN e-edition Jan. 25. http://www.wcmssm.org/dmn/2k10/e-edition/dmnjanuary252010.htm .
The ills that afflict the health reform bill call for attentive
care by all physicians working as a group through their
individual societies.
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President
Schedules Health Reform Summit For Feb. 25
By
PAUL NATINSKY
President Obama has planned a half-day summit with key legislative
leaders on both sides of the aisle to publicly and “systematically” debate
health care reform issues, using the existing House and Senate bills
as a starting point, reported the New York Times this morning.
Obama
announced the summit during an interview with CBS newswoman
Katie Couric on a Super Bowl pregame show.
The
move comes fast on the heels of newly minted Massachusetts
Sen. Scott Brown’s swearing in to the seat previously held
for decades by Edward Kennedy. After decisively winning
election in one of the Bluest states in the nation, Brown
declared himself the 41st vote against the health
care reform bills. The Brown victory is widely interpreted
as troublesome for Democrats as mid-term elections approach.
According
the Times article, some are speculating that the summit
is an attempt to expose Republicans as naysayers and political
opportunists and to debunk some widely spread interpretations
of the bills that the legislation’s supporters deem as
false and politically motivated.
Whether
the summit is an honest attempt to reinvigorate the health
care reform legislative process or a political stunt, it
surely means one thing. Health care reform is not dead…yet.
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Obama
Invites Republicans To Share Ideas At Televised Health
Reform Summit
The
New York Times reports that the President's
invitation is for a half-day televised summit February
25. It is "a high-profile gambit that will
allow Americans to watch as Democrats and Republicans
try to break their political impasse." The move
is seen as a way for Obama to force Republicans to
help govern and to "put more scrutiny on Republican
initiatives" on health care. There remains, however,
a split among lawmakers – even among Democrats – on
what should be in health reform legislation with even
House and Senate Democrats differing on several key
tenets, including inclusion or exclusion of a tax on high
cost insurance policies (Zeleny, 2/7).
The
Washington Post: Republican leaders on Sunday
welcomed "the outreach" but maintained their
position that lawmakers must start over on the health
reform effort to win Republican cooperation. Meanwhile,
Democratic leaders seem to welcome the step. "'As
we continue our work to fix our broken health care system,
Senate Democrats will not relent on our commitment to
protecting consumers from insurance company abuses, reducing
health care costs, saving Medicare and cutting the deficit,'
Senate Majority Leader Harry M. Reid (D-Nev.) said in
a statement shortly after the interview." House
Speaker Nancy Pelosi and Reid are trying to "negotiate
fixes to the Senate bill that the Senate could approve
under special budget rules to protect the package from
a GOP filibuster. Then the House could pass the fixes,
along with the Senate bill." Many have called that
process too partisan, however (Shear, 2/8).
Politico: "Obama
said he wants to 'look at the Republican ideas that are
out there. … If we can go, step by step, through a series
of these issues and arrive at some agreements, then, procedurally,
there's no reason why we can't do it a lot faster the process
took last year,' he said. … Speaking to [CBS' Katie] Couric,
Obama acknowledged public unhappiness with all the special
deals in the legislation. 'What we have to do is just make
sure that it is a much more clear and transparent process,'
he said. 'I've got to push Congress on that'" (Budoff
Brown and Allen, 2/7).
Bloomberg: "Senate
Republican Leader Mitch McConnell of Kentucky, responding
to Obama's idea, said legislation should start from scratch
if Obama wants a measure that can get support from both
parties. 'If we are to reach a bipartisan consensus, the
White House can start by shelving the current health-spending
bill,' McConnell said in an e-mailed statement. 'There
are a number of issues with bipartisan support that we
can start with when the 2,700-page bill is put on the shelf'" (Anderson
Brower, 2/8).
Roll
Call quotes a statement from Pelosi: "The
House-passed health insurance reform legislation included
a number of Republican amendments — added as the bill
worked its way through three committees. In the last
Congress, we worked with President Bush in a bipartisan
way to pass initial economic recovery legislation, a
bill to deal with the financial crisis and historic energy
legislation that increased our nation's fuel efficiency
standards for the first time in more than 30 years. We
remain hopeful that the Republican leadership will work
in a bipartisan fashion on the great challenges the American
people face" (Pierce, 2/7).
The
Wall Street Journal: But from others in the
Democratic party, "[t]here was immediate skepticism
... that the forum would break the impasse. House
Majority Leader Steny Hoyer (D., Md.) said he had reached
out to Republicans 'on several occasions' last year to
seek their ideas and feedback. 'I was, however, disappointed
that these meetings did not result in any serious follow-through
to work together in a bipartisan fashion,' he said" (Reddy
and Meckler, 2/7).
Los
Angeles Times: "The summit invitation
serves two political purposes. For months, the president
has endured criticism that he reneged on a promise to
televise healthcare negotiations on C-SPAN. By opening
up the summit to the cameras, Obama can argue he is making
good on that commitment at a crucial point in the process.
Also, the summit gives the president a chance to paint
Republicans as obstructionists who refuse offers of compromise.
If that's how the event is perceived, it could pay off
for Democrats in the November midterm elections" (Nicholas,
2/8).
Kaiser
Health News provides highlights of the weekend's
headlines and highlights of health policy news, including President
Obama's speech to the Democratic National
Committee and Sunday's
week-ahead reports.
This
is part of Kaiser Health News' Daily Report - a summary
of health policy coverage from more than 300 news organizations.
The full summary of the day's news can be found here and
you can sign up for e-mail subscriptions to the Daily
Report here.
In addition, our staff of reporters and correspondents
file original stories each day, which you can find on
our home
page.
This
information was reprinted from kaiserhealthnews.org with
permission from the Henry J. Kaiser Family Foundation.
You can view the entire Kaiser
Daily Health Policy Report, search the archives
and sign
up for email delivery. © Henry J. Kaiser Family
Foundation. All rights reserved.
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Clinton
Reform Veterans Helping With Obama Overhaul Effort
The
Associated Press reports that aides who
helped with President Bill Clinton's health care reform
effort are pushing to help President Barack Obama
pass his health system overhaul this year.
The aides "are adamant that the Democrats can't afford another
health care disaster. But they're divided on whether scaling down
Obama's plan would be an acceptable solution. … 'If Bill Clinton
couldn't get it done, and Barack Obama can't do it, no Democrat will
ever try again,' said economist Len Nichols, health policy director
at the New America Foundation. A Clinton White House health budget
aide, Nichols has been operating as an unofficial adviser to lawmakers
and administration officials wrestling with details of the current
legislation. ... The mere mention of settling for less is causing
consternation among former Clinton aides. Obama's health care plan — denounced
as a government power grab by critics — is already scaled back from
the ambition of the Clinton years." Some of the plans scaled
back this time by Democrats include the amount any employer – even
small ones – are required to contribute to their employees' health
insurance. The Clinton plan would have required even small business
employers to provide insurance coverage, Obama's plan does not (Alonso-Zaldivar,
2/8).
This
is part of Kaiser Health News' Daily Report - a summary
of health policy coverage from more than 300 news organizations.
The full summary of the day's news can be found here and
you can sign up for e-mail subscriptions to the Daily
Report here.
In addition, our staff of reporters and correspondents
file original stories each day, which you can find on
our home
page.
This
information was reprinted from kaiserhealthnews.org with
permission from the Henry J. Kaiser Family Foundation.
You can view the entire Kaiser
Daily Health Policy Report, search the archives
and sign
up for email delivery. © Henry J. Kaiser Family
Foundation. All rights reserved.
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Physicians
Needed To Support Haiti Relief Efforts
Practicing
physicians interested in supporting the earthquake relief
effort in Haiti are invited to register through the AMA/NDLS™ Disaster
Volunteer Physician Registry. The AMA is using the registry
to facilitate and coordinate the deployment of physicians
who are willing to volunteer with federal and private sector
response organizations to respond to the earthquake. Given
the physically challenging, austere, resource-constrained
environment in Haiti right now, volunteers must be self-sufficient
and able to work independently.
Visit www.ama-assn.org/go/haiti-volunteer to
register today.
Visit www.ama-assn.org/go/haiti to
view AMA Web pages dedicated to information related to
the earthquake and the relief effort.
Visit http://www.ama-assn.org/go/blog to
view a Jan. 27 blog post from AMA President J. James Rohack,
MD, about the registry and the AMA’s support of the relief
effort.
Visit http://www.ama-assn.org/ama/pub/news/news/physician-volunteers-haiti.shtml to
view an AMA news release about the registry.
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New
Medical School Moves Forward Another Step
According
to a report appearing in the Detroit Free Press last week,
the Oakland University William Beaumont School of Medicine
took another step toward existence.
The
Liaison Committee on Medical Education, the panel that
accredits medical schools, has awarded preliminary accreditation
to the school after a LCME survey team visited the school
in November, according to OU officials. OU plans to begin
classes in the fall of 2011.
The
Free Press also reported that Central Michigan University
is considered an applicant with the LCME and will break
ground on Feb. 18 for a $24-million addition to its health
professions building which will house the medical school.
Meanwhile,
Western Michigan University is weighing a medical school
as well and representatives from the university and its
health care partners, Borgess Health and Bronson Healthcare
Group, met with LCME staff last month to discuss their
plans, according to a university spokeswoman.
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St.
John Gets Anonymous $3 Million Grant For Cardio Lab
According
to a report in Crain’s Detroit Business (http://www.crainsdetroit.com/article/20100204/FREE/100209914)
an anonymous donor has made a $3 million gift to St. John
Hospital and Medical Center to fund a new cardiovascular
hybrid surgical laboratory.
The
program is expected to cost more than $5 million and will
be used to perform non-surgical and minimally invasive
heart procedures.
The
lab will also be equipped for traditional cardiac surgery
and have the capability to perform sophisticated diagnostic
tests and a full range of invasive and non-invasive therapeutic
procedures including angioplasty and the implantation of
pacemakers and internal defibrillators, according t Crain’s.
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WSU
Physician Group Doctor Earns Grant To Decode Disease
Process
A
Wayne State University Physician Group doctor has received
two federal stimulus grants totaling more than $775,000
to investigate the potential role of polychlorinated biphenyls
in the progression of breast cancer and to delineate the
role of a liver enzyme in the development of metabolic
diseases such as heart disease, abnormal cholesterol metabolism
and insulin-resistant type II diabetes.
Melissa
Runge-Morris, MD, professor and acting director of the
Institute of Environmental Health Sciences at Wayne State
University and professor of the Division of Hematology/Oncology
in the Wayne State University School of Medicine’s Department
of Internal Medicine, received $418,000 from the National
Institutes of Health. Her research group is investigating
the effect of PCBs accumulated in breast tissue, beginning
in the very early stages of development.
“We’re
trying to understand if normal levels of PCBs that one
might be exposed to in the environment accelerate breast
cancer progression,” said Dr. Runge-Morris, a member of
the Malignant Hematology Multi-Disciplinary Team for the
Karmanos Cancer Institute.
PCBs
are a class of chemical compound that for many years was
used in hundreds of industrial and commercial applications,
including electrical, heat transfer and hydraulic processes.
Although no longer commercially produced in the United
States, PCBs may be present in products and materials produced
before the 1979 ban. PCBs do not readily break down, tending
instead to persist in the environment, cycling among air,
water and soil for long periods of time. They are not easily
detoxified from the human body, instead accumulating and
persisting in fatty tissue over extended periods of time.
Research has provided conclusive data that PCBs cause cancer
in animals, with studies in humans supporting their potential
carcinogenicity.
Dr.
Runge-Morris will study the effects of PCBs in normal human
breast epithelial cells and in those that are more progressed
toward cancer. She will use cell culture techniques and
will transplant or “xenograft” cells into immunodeficient
mice. Her studies are designed to determine whether PCBs
activate key estrogen-responsive or reactive oxygen pathways
implicated in breast carcinogenesis.
The
cell culture and xenograft model for human breast cancer
progression that is used by Dr. Runge-Morris’ research
team was developed by WSU investigators at the former
Michigan
Cancer Foundation. She said one of the advantages of this
model is that it facilitates the exploration of the earliest
stages of breast cancer development.
“Many
of the breast cancer cell lines that are currently studied
represent more advanced stages of cancer,” she said. “Our
model, on the other hand, uses human breast epithelial
cells that are practically normal to determine if exposure
to PCBs or other environmental contaminants tips the balance
toward cancer progression. It also takes advantage of the
limited mouse lifespan, allowing us to determine if cancer
develops at an accelerated rate.”
Dr.
Runge-Morris received a second stimulus grant for $357,461
to investigate the function of a liver enzyme that plays
a central role in lipid metabolism. Disturbances in lipid
metabolism set the stage for the emergence of metabolic
diseases such as heart disease, liver dysfunction and insulin
resistant type II diabetes.
The
enzyme hydroxysteroid sulfotransferase, or SULT2A1, is
known to metabolize hormones and detoxify drugs, chemicals
in the environment and carcinogens. Recent studies, however,
suggest that SULT2A1 is also capable of metabolizing oxysterol
intermediates of cholesterol metabolism.
Dr.
Runge-Morris’ lab uses primary cultured human hepatocytes
and molecular biology approaches to characterize the enzyme’s
integrated role in a vast lipid metabolism network. “We
want to understand exactly what controls the gene that
encodes SULT2A1 because it may explain the diversity of
responses that characterize drug, chemical, hormone and
cholesterol metabolism in humans.”
Results
of the study will shed new light on diseases that occur
as a function of disordered lipid metabolism.
“Not
everyone who is obese, for example, develops type II diabetes,” Dr.
Runge-Morris said. “We suspect this could be due to critical
inter-individual differences in lipid metabolism. A better
understanding of the molecular events that regulate the
major players in lipid metabolism like SULT2A1 will provide
us with the tools to recognize and prevent the development
of serious metabolic diseases in humans.”
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Editor's
Column: Another Inconvenient Truth
By
JOSEPH WEISS, MD
The December 9 issue of the Journal of the American Medical Association
(JAMA) included a 6-page article equal in importance to the 2,073
page bill now before Congress.
The JAMA article carries the title: Relationship
of Primary Care Physicians’ Caseload With Measurement
of Quality and Cost Performance. (Nyweide David J.
et al: JAMA, December 9, 2009; Vol 302, No.22, pp2444-2450).
The authors asked if practitioners caring for Medicare
patients see sufficient numbers of outpatients to assess
individual physician performance in a statistically valid
manner. Nyweide et al found:
· The majority of primary care physicians work in small or
solo practices with no one physician seeing sufficient
Medicare patients to permit performance evaluation
· No practices of under six physicians had sufficient
numbers of patients to detect a 10 percent difference in
cost or quality with any other physician group
· To make comparisons of cost or quality consistently required
a group of 50 or more primary care physicians. At present,
groups that size represent 0.2 percent of primary physician
groups in America
· No primary care group, no matter what size, could generate
sufficient caseloads to detect a difference between physician
groups of preventable hospitalization or less than 30-day
re-admission.
The authors point out that their findings cast doubt on the
validity of Pay-for- Performance and the Physician Quality
Reporting Measures as means of rewarding superior performance.
The patients that physicians report on, are too small in
number to qualify for a reward for superior care.
The implication for physicians is that at some point insurance
companies, and that includes Medicare, will put an end
to physicians working in solo or small group practice.
The insurers will mandate that physicians work in groups
large enough to generate performance comparison statistics.
Furthermore, those of us who now participate in Pay for Performance
or Quality Reporting should realize we are involved in
an undertaking that is both a sham and a scam. Nyweide
et al reveals that what we report is false as a measure
of quality; that is the sham. Once having read Nyweide
et al, we know we are taking the money under false pretenses;
that is the scam.
Comments:
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February 1st, 2010 at 1:33 pm
Once again, Joe Weiss is right on!
Does anyone remember Second Surgical Opinion?
Does anyone not know about Pre-authorization?
Has anyone heard the health insurance companies protesting, “We are not practicing medicine”?
Now they want to Pay for Performance (translation: always pick the cheapest alternative.
February 2nd, 2010 at 5:50 am
right on Joe