Wayne County Medical Society of Southeast Michigan

January 25, 2010

Editor's Column: Before Their Research Comes Our Own
Medical Student Research Symposium Award Winners Named
Health Care Reform Update
AMA President's Blog: Where To Now?
Physicians Respond To Earthquake In Haiti
CMS Expands Payment Dispute Resolution Process
AMA Continues To Press CMS On Consultation Policy
2009 Holiday Party Contributors

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Editor's Column: Before Their Research Comes Our Own

By JOSEPH WEISS, MD
Section 1181 of the Senate Health Reform Bill-HR 3590, the Patient Protection and Affordable Care Act- would set up a Comparative Clinical Effectiveness Research Institute. The purpose of the Institute in the words of Section 1181 would be: “…. Research evaluating and comparing the health outcomes and the clinical effectiveness, risks, and benefits of 2 or more medical treatments or services ….being used in the treatment, management and diagnosis or prevention of illness or injury to individuals.”

The section goes on to define conflict of interest, establish research priorities, and set up the management of funding and conduct of research, the appointment of advisory panels, the release of research findings, and sets rules for the administration of the Institute. In addition, the section provides guidelines to keep the activities of the Institute open to public inspection.

In the release of research findings (subsection 8) the wording includes specific instructions that findings are not to be applied as “mandates for practice guidelines, coverage recommendations or to act as payment or policy recommendations.”

In their separate critiques of HR 3590 both The American Medical Association and the American College of Physicians (ACP) support the Clinical Effectiveness Research Institute. Its mandate and implementation meets their standards of what constitutes high quality research and appropriate peer review.

Critics[1],[2] say that the Institute adds further government intrusion into the marketplace. The critics contend that it is better to let the pharmaceutical companies do the research needed to learn if their new product is better than the competition. The critics further complain about the dollars to be appropriated for the Institute, $30 million, at this time. Finally, individuals opposed to the Institute claim that the Institute’s findings will not be used as information but as mandates by Medicare and health insurance companies.

Physicians can make up their own minds about the worth of the critic’s complaints. Likely each of us has an opinion on the fairness and accuracy of drug companies on presenting data on their products.

A perspective that comes out of reading summaries of the Health Reform Bill or by going to its specific sections is that much of what the Bill contains on coverage, delivery of care, cost and reimbursement for medical services and administrative simplification has merit and makes sense. Furthermore, most of the parts of the Reform Bill a physician might want to read are readily understood. We don’t need others to tell us what to think. When discussing matters of health, our own journals, colleagues and experience give us the basis for judgments on diagnosis and treatment.

We should not only ignore news columnists, talk show hosts, comedians and prominent politicians, we should prepare ourselves to counter them.

Footnotes:
1. Gottlieb, Scott: What Doctors and Patients Have to Lose Under Obama Care; The Wall Street Journal, Thursday, December 24, 2009, P A19

2. Staib, Eric: The Health-Care Tax; Fee Market v 27 no12, December 2009, p1-3. Published by the Ludwigvon Mises Institute

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Medical Student Research Symposium Award Winners Named

Twenty-nine students submitted poster and oral presentations in basic and clinical science research for the 2010 Medical Student Research Symposium Awards program at the Wayne State University School of Medicine.

“Congratulations go to all the participants for extending their medical educations to seek solutions to significant basic and clinical problems,” said Robert Pauley, PhD, associate dean of Graduate Scholars. “Special thanks go to faculty advisors who guided the research, to faculty judges of the presentations, and to Dr. Noreen Rossi and Dr. Dennis Goebel for organizing the Medical School Alumni Research Fellowships and the symposium.”

Winners in the Basic Science category, and their faculty advisors, include:

Frank Cao (2012), Robert Lasley, PhD, Wayne State University School of Medicine Department of Physiology
Yara Fardous (2012), Thomas Sanderson, PhD, Wayne State University School of Medicine Department of Physiology
Nirmal Gokarn (2012), Margaret Keil, MSN, CRNP, director of Clinical Services for Pediatric Endocrinology Interinstitute Training Program, National Institutes of Health
Sarah Lucey (2013), Scott McLean, PhD, University of Michigan School of Kinesiology
Gary Rajah (2012), Bruce Berkowitz, PhD, Wayne State University School of Medicine Departments of Anatomy and Cell Biology and Ophthalmology, and Avril Holt, PhD, Wayne State University School of Medicine Department of Anatomy and Cell Biology
Aaron Sabbota (2013), Michael Cher, MD, chair of the Wayne State University School of Medicine Department or Urology, and Daniel Bonfil, PhD, Wayne State University School of Medicine Departments of Urology and Pathology

Winners in the Clinical Science category, and their faculty advisors, include:

Duy Bui (2010), Harry Chugani, MD, Wayne State University School of Medicine Department of Neurology
Rebecca Kornas (2012), Philip Levy. MD, MPH, Wayne State University School of Medicine Department of Internal Medicine
Wen-shi Shieh (2012), Ray Bahado-Singh, MD, Wayne State University School of Medicine Department of Obstetrics and Gynecology
Timothy VandenBoom II (2012), Fazlul Sarkar, PhD, Wayne State University School of Medicine Department of Pathology
Branden Yaldou (2012), Robert Swor, DO, William Beaumont Hospital Department of Emergency Medicine
Shawn Zardouz (2013), Hamid Djalilian, MD University of California Irvine Medical Center Department of Otolaryngology

Cao, Rajah, Kornas, Shieh and VandenBoom received 2009 Medical School Alumni Research Fellowships.

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Health Care Reform Update

Editor’s Note: The following is update on the health care reform process in Washington, from the AMA published Jan. 19, 2010.

Congress and administration continue health system reform negotiations

Congressional leaders and President Obama continue to negotiate differences in health system reform legislation passed by the House and the Senate, with the goal of drafting a final package prior to the State of the Union address planned for Jan. 27. In mid January, negotiators held a marathon session which lasted an entire day and into the night, and meetings continued throughout a weekend.

It is reported that the final package is likely to include a modified version of the Senate-passed tax on high-cost insurance plans, and a health insurance exchange that is described as a hybrid between the Senate's state-based approach and the national structure adopted by the House. Lawmakers continue to negotiate many details and controversial issues, such as federal interaction in abortion services and Medicaid expansions.

Despite the progress that has been made, the outlook of a compromise bill has been clouded by today's special election in Massachusetts, which appears to threaten the Senate's 60-seat Democratic majority.

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AMA President's Blog: Where To Now?

Editor’s Note: The following is a blog entry posted Jan. 20 by AMA President James Rohack, MD, who is traveling across the country and blogging about various meetings and issues he encounters the link to the blog is http://www.ama-assn.org/ama/pub/road-doctor-rohack.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=21ae8cdf-e382-40c9-87cf-32c8561d0531&plckPostId=Blog:21ae8cdf-e382-40c9-87cf-32c8561d0531Post:335caf49-7be5-4829-ac96-a675253d6999&plckScript=blogScript&plckElementId=blogDest

With Republican senator elected in Massachusetts, now what?

As voters in Massachusetts—the only state in the Union that requires universal coverage for its citizens through a mix of an individual and employer mandate—went to the polls (recently), it was certain that the outcome of the election was going to have national implications for health system reform. As the results came in, it was equally clear that the majority of those who voted did not want to change the security of universal health care coverage that they had achieved in their state without any federal intervention.

Thus, the 49 states that do not require health care coverage for their citizens will find a federal solution more difficult due to a quirk in Senate rules not found in the US Constitution—that 60 votes are required to conduct business.

As I drove to work this morning listening to the comments being made, someone said that health system reform would raise taxes, destroy Medicare and destroy jobs. I found that curious, as that is exactly what is happening with the status quo.

Taxes are rising to pay for the Medicaid burden when patients cannot get coordinated care because of barriers that prevent physicians from coming together to share information to provide care.

Then there’s the patient I saw in my clinic on Monday who had a heart attack 13 years ago and is continuing to work his 12-hour day as a boot maker without symptoms and with an excellent functional class. He was just saddled with a $500 per month increase in his health insurance premium to a total of $1,800 per month. He is struggling as a small employer, trying to decide if he has to lay off other workers to provide health benefits for others and thus destroy jobs.

The insurer who increased the premium was not a Wall Street-traded company, highlighting that the private health insurance market problems for patients with pre-existing conditions is not limited to for-profit companies.

And the physician SGR problem continues to be an issue, despite the temporary reprieve to March 1. For those who are not on Medicare or TRICARE and have stable and secure health insurance, voting for things that do not affect them personally is an easy vote. But the reality is that physicians are more frustrated with having to keep a broken American health system together by their personal sacrifice each year. Doing nothing is not an option.

The seven critical elements the AMA outlined for health system reform are as valid now as they were when first put down on paper and refined by the AMA House of Delegates in November 2009. Regardless of the current make-up of the Senate, fixing the SGR to preserve access for patients on Medicare and TRICARE must not be kicked down the road again. A permanent fix is long overdue and needs to be done before 2012, when the baby boomers will hit Medicare.

There are some in the “budget bean-counting world” who see the deficit solution as being simple: decrease utilization by preventing access. But for the millions of Medicare and TRICARE beneficiaries who deserve the medical care they need, having the physician be the bearer of bad news that the patient can no longer be seen is an anathema to a caring physician’s core values.

The Senate should be bipartisan in dealing with this permanent repeal of the SGR now. A good step for the new senator from the Bay State would be to vote for permanent repeal of the SGR if he is true to his commitment not to have Medicare destroyed. Time will tell.

Until later...

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Physicians Respond To Earthquake In Haiti

The AMA expresses its deepest sympathy to the people in Haiti who have been impacted by the devastating and tragic earthquake two weeks ago and its subsequent aftershocks.

The AMA is working to support the U.S. government and international response efforts and has established Web pages to share medical news and developments from the field, such as emerging health needs and daily reports from the Pan American Health Organization. The Web pages include links to charitable organizations for those interested in making a financial donation to help the recovery effort.

The AMA Web site also contains an archived online training program for health responders and other health professionals that aired Jan. 16, focusing on the essential clinical and public health knowledge and skills needed to manage individuals and populations affected by the earthquake. The AMA offered the program in collaboration with the National Disaster Life Support Foundation Inc.™, the American Public Health Association, the Centers for Disease Control and Prevention Office of Injury Response, the American Nurses Association and the AMA-peer-reviewed journal Disaster Medicine and Public Health Preparedness.

In addition, articles relevant to the medical response to the earthquake that have appeared in Disaster Medicine and Public Health Preparedness are available online for all to access. The AMA also is working closely with the National Disaster Life Support Educational Consortium to develop a just-in-time educational module on the medical and public health management of earthquake casualties.

The need for medical volunteers and other health resources is still unknown at this time. As new facts emerge, the AMA will update its Web site so interested physicians can engage with the international response community.

Visit http://www.ama-assn.org/ama/pub/news/news/haiti-earthquake-response.shtml to read a statement from AMA President J. James Rohack, MD, and to view the AMA’s Web pages dedicated to the situation in Haiti.

Visit http://www.ama-assn.org/go/blog to read Dr. Rohack’s Jan. 15 blog post about the AMA’s response to the earthquake.

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CMS Expands Payment Dispute Resolution Process

Last year, CMS established a payment dispute resolution process for physicians who encountered problems in getting accurate compensation from Medicare Advantage (MA) private fee-for-service (PFFS) plans. Now, CMS has expanded the process to include non-contracted physicians and to include all MA organizations, including HMOs and PPOs, not just PFFS plans. The dispute resolution process can be used by non-contracted physicians to address problems of MA organizations paying less than regular Medicare rates as well as downcoding of claims, but not for denied claims. The contractor handling the disputed payments is First Coast Service Options, Inc. Information on how to initiate the dispute resolution process is available on at http://www.fcso.com/whatwedo/QIC/139297.asp

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AMA Continues To Press CMS On Consultation Policy

The AMA has strongly urged the Centers for Medicare and Medicaid Services (CMS) to delay for a year the implementation of its new consultations billing policy. Our efforts have included multiple discussions between Rebecca Patchin, MD, the AMA's Chair of the Board of Trustees, and Secretary Sebelius. As we previously informed the Federation, the administration informed the AMA that the General Counsel for the Department of Health and Human Services determined that CMS can not delay a single section of the final Medicare Physician Fee Schedule Rule (MPFS). Rather, CMS must either delay or move forward with the implementation of the entire rule. Consequently CMS decided to implement the final MPFS. Since CMS implemented the MPFS, the AMA has continued to press senior CMS officials to clarify the consultation policy and educate physicians. We understand that the policy is causing considerable concern and confusion. CMS has assured us that it will release some additional materials in the near future. We will alert the Federation as soon as we receive more information.

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2009 Holiday Party Contributors

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children that took place Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

Clarence H. Schultz, MD

Dr. Stephen Lemos

Robert G. Borchak, MD

Dr. & Mrs. William J. Cosgrove, Jr.

Dr. and Mrs. Mark A. Kelley

Steven A. & Deborah L. Portney

Hassan Amirikia, MD

Sheryl Wissman, MD

Dr. Adnan Munkarah

Paul & Debbie Natinsky

Dr. & Mrs. Mark Tuthill

Dr. Orlando S. Sison

Guat and Dionisia Sy, MD's

Giovanni A. Morreale, MD and Lisa J. Morreale

Dr. & Mrs. Theodore B. Jones

Dragos M. Galusca, MD

Julius V. Combs, MD

Dr. and Mrs. Charles Barone

Melvin L. Hollowell, MD

James Sunstrum, MD

Aaron Lupovitch, MD

Catherine A. Nordby, MD

Claus Petermann, MD

Dr. Amorn Manadee

Michael F. Schaldenbrand, MD

Richard J. Pollard, MD

Mary Beth Hardwicke, MD

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