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March 15, 2010
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IN
THIS ISSUE
Editor's Column:
Aging In America
In My Opinion: The Old Model Is Gone
United Physicians President Joins DMC
New Name For St. John Health System
Dryer Foundation Gives $1M To Vision Research
At WSU, Kresge
Senate Extends Medicaid Assistance,
Delays Medicare Cut
Blues Report $257 Million In 2009 Underwriting
Losses
WSU Chief Resident Wins Poster Competition
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Editor's
Column: Aging In America
By
JOSEPH WEISS, MD
Now is not a propitious time to discuss yet another plan that includes
new taxes, further government intervention, and more regulation of
the market place. However, the idea—social insurance—needs our attention
now if we are to implement its concepts later.
The projection is that by 2016 at least 15 percent of Americans
will be age 65 or older. Experience in Germany and Japan
indicates that when a country reaches the 15 percent elderly
level, the need for services for these individuals becomes
a burden too great for families and the elderly to carry
alone.
At present, the variety of services that America provides
the elderly such as retirement communities, assisted living
apartments, retirement condominiums, community centers,
recreational clubs, visiting nurses are mainly available
to those who can afford the cost.
At the same time, the nursing home industry remains stagnant
with insufficient facilities being built or maintained
to care for the increasing numbers of elderly among us.
Furthermore, the philosophy of aging is to keep the elderly
in their homes and within the community.
The experience of Germany and Japan, two countries that have
already reached the 15 percent mark, is instructive. Both
Germany and Japan have a social insurance system funded
by a 1-2 percent tax on the incomes of all individuals.
The funds obtained are set aside separately from monies
designated for health care. The social insurance funds
pay for home and community services for elderly individuals
needing such help; a corps of doctors and nurses determines
who among the elderly are in need of assistance.
Benefits also go to family members providing assistance.
In Germany, any family member providing 14 hours or more
of care to an elderly family member is eligible for respite
care. That is, the individual giving care may take a vacation
with the state providing an interim caregiver during the
time the family member is away. A similar plan of respite
care exists in Japan.
In Japan the incidence of dementia among the elderly led
the government to set up “Alzheimer Houses.” Each home
holds nine patients. They can stay for the day, for the
night or full time. A staff paid by the state cares for
the patient while the family pays the patient’s room and
board. The time is approaching when Americans
can no longer accept that the elderly will simply slip
into oblivion. Aging brings limits, then impairments; medical
care for the elderly while necessary is not sufficient
for their well being. The social insurance now in operation
in Germany and Japan is a practical response to a problem
of care and support Americans soon will face.
Physicians should take a lead in giving
a voice to the recognition of this need for elder care
and in suggesting solutions. We can use the experience
of Germany and Japan to fashion a distinctly American model
of care.
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In
My Opinion: The Old Model Is Gone
By
ALLAN DOBZYNIAK, MD
Broadly speaking, there are limited options to reform the magnificent
entity of American health care. It is either central control with
its implicit loss of freedom for both patients and providers or free
markets. With $3 trillion in debt, $1.4 trillion in annual deficits
into the foreseeable future, job growth only in the public sector
and with 25 percent of GDP now reflecting the exponential growth
in the size of government, there is no money. Add to this
already disastrous scenario the $36 trillion underfunding of Medicare,
$16 trillion underfunding if Medicaid and now the financially perilous
state of Social Security which is already functioning in the red,
and it should be quite obvious that we are certainly broke and possibly
broken. If the cost of borrowing by the government increases only
slightly, a catastrophic outcome could occur sooner rather than later.
Default, huge tax increases and massive inflation all seemed unimaginable
but now are subjects for discussion.
The
classic reimbursement model for physicians cannot sustain.
It is not financially possible. With central control
(a single payer system) care must be rationed and provider
reimbursement reduced. Doctors should begin to understand
how wonderful the free market can be and retake control
of their financial and professional futures. Patients
acting as informed consumers in an environment permitting
appropriate competition can lead to the optimal value
(cost, quality and service) for American health care.
We will then arrive at its proper and rational percentage
of GDP. Precious capital will be allocated to the various
sectors of health care as determined by American citizens,
which is as it should be.
Not
only can fees be rationally and appropriately negotiated,
but there are myriad other opportunities. Independent
Practice Associations (IPAs) can be reformatted and strengthened.
They could negotiate and facilitate best care accountably.
IPAs functioning with the strength of numbers could negotiate
to advantage their physician members for numerous services
including the securing of medical liability insurance
through Risk Retention Groups (RRGs) and Risk Purchasing
Groups (RPGs), other insurance, banking, information
technology, investment, financial planning, real estate,
travel, car rental or even perhaps own some of these
businesses. Owning billing, regulation and compliance,
and transcription companies is certainly possible. The
collective financial strength of physicians needs to
be captured and appropriately operationalized.
It
may seem risky to take such giant steps. But defending
the status quo or looking for government solutions is
far more risky. Might I suggest that physicians rethink
their marketplace, understand and come to grips with
present financial realities. Organized medicine could
take the initiative in reshaping the future of health
care for our profession and revitalize itself in the
process.
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United
Physicians President Joins DMC
Detroit
Medical Center (DMC) has appointed Steven D. Grant, MD,
to Executive Vice President of Physician Partnerships.
In this new role, Dr. Grant will cultivate relationships
between private practice physicians and the hospital system,
report DMC officials.
Dr.
Grant has been President and CEO of United Physicians since
2000, the 1,600-member (largely Beaumont-based) group is
the largest independent physician group in the state. Dr.
Grant also serves as President and Medical Director of
Premier Physicians Network, a multi-specialty group of
850 physicians who participate in HMO risk contracts. Co-founder
of both organizations, Dr. Grant has also been a private
practice, internal medicine physician since 1979.
“I
am very excited about this opportunity,” said Dr. Grant. “I
am a private physician champion and I know that it takes
all partners, hospital and the physicians, working together
to provide the best service for our patients and this new
role will help strengthen these relationships.”
“The
health care system in this country is terribly broken,” said
Michael Duggan, President & CEO, Detroit Medical Center. “The
system needs to be re-structured so that doctors and hospitals
work together in true partnership to keep patients well.”
“We’re
not waiting for the government to reinvent the health care
system,” Duggan said. “We’re asking Dr. Grant to build
a new model where private doctors drive care decisions
with the DMC hospitals engaged as full partners. Dr. Grant
has advocated this kind of change in the health care system
for years. Now, at DMC, he’s going to get a chance to put
his ideas into practice.”
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New
Name For St. John Health System
St.
John Health System has been renamed and is now known as
St. John Providence Health System. The change is effective
March 8.
"The
names of both St. John and Providence resonate with people
in our communities. They represent the highest quality
and most compassionate care available. Together, they reflect
the totality of our health system and the breadth and scope
of the care we provide," says Janice Cosby, SJPHS
vice president of Marketing and Communications.
The
names of the hospitals and other operating units that make
up SJPHS will not change as a result of this move.
St.
John Health System and Providence merged in 1999 after
the merger of their two sponsors, the Sisters of St. Joseph
and Daughters of Charity, which created Ascension Health,
the largest Catholic health ministry in the country. Each
system had a long history of service in the community.
St. John Hospital was built in 1952 by the Sisters of St.
Joseph and Providence Hospital opened in 1910 in Detroit,
moving to Southfield in the 1960s.
St.
John Providence Health System is the largest provider of
inpatient care in southeast Michigan and one of the largest
employers in metro Detroit. St. John Providence Health
System provides comprehensive prevention, primary care
and advanced treatment programs with more than 125 medical
centers and seven hospitals spanning five counties.
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Dryer
Foundation Gives $1M To Vision Research At WSU, Kresge
The
Ligon Research Center of Vision, a multidisciplinary center
of the Kresge Eye Institute of Wayne State University,
has received a $1 million gift from the Edward T. and Ellen
K. Dryer Foundation to establish an endowed professorship.
“The
trustees of the Dryer Foundation are delighted to support
groundbreaking research into a cure for blindness by establishing
the Edward T. and Ellen K. Dryer Endowed Professorship
in Vision and Blindness Research at Wayne State University,” said
Jon B. Gandelot, a Grosse Pointe estate planning attorney
who represented the Dryers for many years and now is president
of the Dryer Foundation.
“The
professorship will be awarded to a researcher who is making
a significant contribution to artificial vision and restoring
vision to the blind,” said Gary W. Abrams, M.D., director
of the Kresge Eye Institute and the Ligon Research Center
of Vision. “This will allow for the expansion of current
research as well as the exploration of new research that
has the potential to fight eye diseases and potentially
cure blindness.”
“Supporting
research to cure blindness would have pleased Edward and
Ellen Dryer,” said Judith L. Drobot, a trustee for the
foundation.
An
executive in the banking industry, Edward Dryer and his
wife, Ellen, were lifelong residents of Detroit. While
traveling on business in New York, Mr. Dryer suddenly lost
his sight and as a result, his job. He continued to follow
the market by having his wife read to him daily from The
Wall Street Journal and other financial publications. Dryer
began investing in the stock market, and through a combination
of savvy investment strategies and a modest lifestyle,
his investments grew.
“The
Dryers would have been very happy to know that their legacy
will have a significant impact in sight-saving research,” said
foundation Trustee Elizabeth Mower Gandelot.
The
Dryers died 11 years ago, within four months of each other.
The Dryer Charitable Foundation was established in their
name through their estate plan, with a mission to aid people
who have limited sight and to fund research for the prevention
of blindness.
“We
are truly grateful for this generous gift to support blindness
research at Kresge Eye Institute and the Ligon Research
Center of Vision,” Dr. Abrams said.
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Senate
Extends Medicaid Assistance, Delays Medicare Cut
Last
week, the US Senate passed the American Workers, State
and Business Relief Act (HR 4213) that included a six-month
extension of Medicaid assistance for the states and a delay
of a scheduled Medicare physician payment cut.
The
enhanced federal medical assistance percentage (FMAP),
a program that brings federal matching dollars to states
to aid in funding state Medicaid programs, is currently
scheduled to expire Dec. 31, 2010, according to the Michigan
Health & Hospital Association (MHA). Last week's Senate
action would extend the enhanced FMAP through June 30,
2011, and bring an additional $514 million to Michigan
to support Medicaid, reported MHA. Both Gov. Granholm's
executive budget.
HR
4213 would also delay a scheduled Medicare physician payment
cut that, without congressional action, would decrease
Medicare physician reimbursement by 21 percent effective
April 1, 2010. The Senate action would delay the payment
reduction until Oct. 1, 2010. The bill passed the U.S.
Senate on a 62-36 vote, with the support of Michigan Sens.
Debbie Stabenow (D-Lansing) and Carl Levin (D-Detroit).
The U.S. House of Representatives must now act on the Senate
version of H.R. 4213 before it is sent to President Obama
for his signature.
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Blues
Report $257 Million In 2009 Underwriting Losses
Blue
Cross Blue Shield of Michigan reports underwriting losses
of $257 million in 2009, driven mostly by individual policies,
according to the company.
Blue
Cross Blue Shield of Michigan recently filed financial
statements for 2009 that show a $257 million net underwriting
loss on a SAP basis, the method of accounting required
by state regulators.
Blues
leaders stated that careful management of its investment
portfolio helped the company avoid a net income loss. Investment
returns of $241.5 million contributed to a positive net
income of $12 million.
“Blue
Cross is doing everything within our business ability to
right the ship through difficult economic times,” said
Daniel J. Loepp, BCBSM president and CEO. “We are cutting
our own costs, responsibly managing our investment portfolio
and engaging with providers to address the cost of health
care by improving quality. Our financial position in 2009
was sustained through a very determined effort to manage
our investment returns. The investment markets cannot be
expected to compensate every year for our losses on health
care products offered in a broken individual market that
desperately needs the attention of policymakers.”
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WSU
Chief Resident Wins Poster Competition
Pratik
Bhattacharya, MD, MPH, chief resident in the Wayne State
University School of Medicine’s Department of Neurology,
captured top prize in the winter meeting poster competition
of the Michigan Neurological Association.
Dr.
Bhattacharya’s abstract was titled “Prediction of outcome
in African Americans with Intracerebral Hemorrhage.”
A
2006 graduate of Tulane University and 2001 graduate of
Smt NHL Municipal Medical College in Ahmedabad, India,
Dr. Bhattacharya plans to begin a vascular neurology fellowship
at Wayne State University and the Detroit Medical Center
in July. His interests include neurocritical care and acute
stroke.
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