E-DMN - February 8, 2010

February 8, 2010

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 41^st 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).

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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:

Louis R. Zako, M.D. Says:
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.
richard henderson Says:
February 2nd, 2010 at 5:50 am
right on Joe

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