House of Delegates; June

Cover the Uninsured Week highlights need for solutions in Detroit, Wayne County
A diverse coalition of more than 400 organizations and faith leaders last month launched Cover the Uninsured Week at a news conference featuring Michigan Surgeon General Kimberlydawn Wisdom, MD, Detroit Mayor Kwame Kilpatrick, Gail Warden, Wayne County Executive Michael A. Ficano, Oakland County Executive L. Brooks Patterson, Macomb County Commissioner Nancy White, and DeFannie Davis, spokesperson for the uninsured.
In a study released May 10 the Kaiser Commission on Medicaid and the Uninsured estimated that the United States will spend $41 billion for uncompensated care for the uninsured in 2004. Federal, state and local governments will incur as much as 85 percent of these costs, according to the study, which notes that even with uncompensated care, people who are uninsured for the entire year "can expect to receive about half as much care as people who are fully insured." This study comes on the heels of new research from The Robert Wood Johnson Foundation, the national sponsor of Cover the Uninsured Week, which found that 20 million working adults in the US are uninsured, including 500,000 in Michigan. Both reports have been released to coincide with Cover the Uninsured Week, the largest national educational effort on the issue of health coverage and the uninsured.

"What this report tells us is that while we spend significantly on health care in this country millions of Americans still don't get the health care they need because they are uninsured. Many of them live here in Michigan," said Gail Warden, President Emeritus, Henry Ford Health System and trustee of  The Robert Wood Johnson Foundation. "This should be a wake-up call for all of us. Solving this problem will not only mean better health care access for those who are currently uninsured, but also economic benefits for our entire country. From a practical perspective and a moral perspective, we need to solve this problem once and for all."

More than 400 organizations, including United Way, Blue Cross Blue Shield of Michigan, all major health systems, the Detroit Regional Chamber, Greater Detroit Area Health Council, AFL-CIO, and more as well as more than 100 area faith leaders from all denominations were involved in organizing Cover the Uninsured Week in southeast Michigan. More than 1,700 activities took place nationwide during the Week, with more  than 25 events throughout Wayne, Oakland and Macomb counties.

During the kick-off event held at University of Detroit-Mercy, Michigan Surgeon General Dr. Kimberlydawn Wisdom presented a proclamation signed by Gov. Jennifer Granholm proclaiming Cover The Uninsured Week in Michigan. Detroit's Mayor Kwame Kilpatrick also presented a proclamation declaring Cover The Uninsured Week in Detroit. They also heard from Defannie Davis, an uninsured mother and sole caregiver for her chronically ill husband, who described how living without health insurance has affected her life. Speakers at the news conference in addition to those already mentioned included: David Morse, Vice President, Communications, The  Robert Wood Johnson Foundation; Spencer Johnson, President, Michigan Health & Hospital Association; and, Cynthia Holste Pepper, Chairperson, Small Business Association of Michigan.

"Being uninsured means living with fear every day," said DeFannie Davis. "I fear getting sick and not being able to work, I fear an injury that will leave me with bills I am unable to pay and I fear getting a regular check-up that results in finding something that needs further treatment. I am here today, because I fear this problem will not be solved unless more people speak out, tell their stories and demand this issue receive the attention it deserves."

The May 10 event followed the national launch of Cover the Uninsured Week on May 5, which featured US Senate Majority Leader Bill Frist (R-TN), US Senator Jay Rockefeller (D-WV), and Noah Wyle, star of television's "ER," who serves as the campaign's national spokesperson. Cover the Uninsured Week is the largest mobilization in history on behalf of uninsured men, women and children in America. Former presidents Gerald Ford and Jimmy Carter are the honorary co-chairs.

According to the most recent information from the Census Bureau, there are nearly 44 million Americans living without health coverage-including 8.5 million children. In 2002, the number of people without health care coverage increased by more than 2 million, the largest one-year increase in a decade. In Michigan, 1.2 million are estimated to be uninsured.

"This issue is about all of us and that is why so many of us are here representing diverse organizations that are calling for the same thing - health care coverage for every man, woman and child in America," said Warden.

Cover the Uninsured Week, working with Families USA, a national health care consumer advocacy organization, developed a resource guide in English and Spanish that details what help may be available to residents of Michigan who do not have health coverage. The guide contains information on free or low-cost health insurance programs, community health centers, free clinics and pharmaceutical assistance programs. The guide will be available at the health and enrollment fairs taking place as part of Cover the Uninsured Week, and at www.CoverTheUninsuredWeek.org. In addition, the guide can be obtained by calling a toll-free telephone number (888) 538-4371. The toll-free number is funded in part by Pfizer Inc, and offers help in both English and Spanish.

Cover the Uninsured Week in Detroit is funded in part by The Robert Wood Johnson Foundation, the nation's largest philanthropy dedicated exclusively to improving the health and health care of all Americans. The California Endowment and the W.K. Kellogg Foundation also are providing significant funds for events throughout the nation.

To view the research reports released as part of Cover the Uninsured Week log on to www.CoverTheUninsuredWeek.org.

Letter: WCMS urges city, county to approve health authority
The following is a letter dated May 4 from WCMS President Edward Jankowski, MD, and Executive Director Adam Jablonowski to the Detroit City Council and the Wayne County Commission

We are writing this letter to urge you to approve the Detroit City Wayne County Health Authority (DWCHA).

The health status of Detroit and Wayne County’s citizens already ranks among the worst in the nation and things are not going to get better left on their own. The status quo will only lead to worsening health status, further fragmentation of the delivery system, and loss of services in the community. We have already seen so many doors close and resources dry up.

In light of this burgeoning health crisis, Gov. Jennifer Granholm challenged us to find workable solutions. Since then, we, a group of 80 or more volunteers, have devoted hundreds of hours of our time, expertise and resources to put forth our best recommendations. It has been an honor and pleasure for us to weave these ideas together into the development of the Detroit Wayne County Health Authority (DWCHA).

It is clear that no single organization or unit of government, health care system, physician or clinic, provider or advocate has the resources to get the job done.

With our combined experience and expertise, we have designed and recommended an integrated model of health care services that will provide or arrange for a safe, effective, timely, efficient, equitable, and patient-centered continuum of care, which includes preventive health, disease management, primary care services and a care management medical home for all enrollees. An estimated 695,000 Detroit and Wayne County citizens will be eligible to benefit from DWCHA services.

We have been able to identify $50 million additional federal Medicaid dollars for the region. Moreover, we have been able to secure a $500,000 Congressional earmark and more than $1 million in grants to begin DWCHA operations.

No new county or city funds are required. There are no new obligations to the city or county. No authority oversight is relinquished by any governmental unit.

The DWCHA is not a political entity. Nor is it another level of bureacracy. Rather, the DWCHA will serve as a focal point of expertise that can maximize current state, federal and local resources that cannot be obtained individually. The DWCHA will work collaboratively with existing organizations so that the safety net of health care services can be restored for the community.

You control the final steps: ratification of the Interlocal Agreement  (ILA), the legal document that provides the foundation for the DWCHA, by the Detroit City Council and Wayne County Commission. Without the ratification of this document most of these efforts will be lost. Without the DWCHA it will be harder for the community to maximize its federal reimbursement. The grants and congressional earmark will be lost. The individual organizations will be left to face a snowballing health crisis on their own and continue to struggle as they have in the past. The uninsured and under-insured individuals and families of Detroit and Wayne County will continue to get piecemeal services, if any. The status quo may be preserved - if we’re lucky enough to hold on to what’s left.

As volunteers who came together willingly for the greater good of our community, we ask you to act NOW. We have other jobs and responsibilities, and so, we will move on. Unfortunately, Detroit and Wayne County will not.

Detroit is recognized nationally for its serious health care predicament. We have tried to help. Now it is your turn. Please don’t lose this opportunity to make a difference. Again, we urge the Detroit City Council and the Wayne County Commission to move forward and ratify the ILA.

Editorial: Network And Need
By JOSEPH WEISS, MD
Editor
Richard Smith, MD, was inaugurated May 15 at the Detroit Institute of Art as the next president of the WCMS. Guests enjoyed dinner in the Great Hall, the world famous mural by Diego Rivera surrounded and encompassed us. The setting was not lost on Dr. Smith, whose inaugural remarks made reference to the congruence between art in the DIA and the "art" of medicine.

However, the setting provided more than an elegant ambiance. The importance of the evening came from the guests. They included MaryAnn Mahaffey, President of the Detroit City Council, Congresswoman Carolyn Cheeks Kilpratick, representatives from Congressman John Conyers’ office, leaders of the ministry in Detroit, and Marc Shulman (R) Chair of the Appropriations Committee in the Michigan House of Representatives. More Democratic party noteables would have been present except the evening was also the date of the the state Democratic Jefferson-Jackson Day dinner.
Representatives from the Michgan State Medical Society were in attendance including President Elect  Alan Mindlin, MD. Staff and chiefs from Ford hospital and the DMC were represented. The guests, numbering more than 175, were not just at the DIA to honor the office of WCMS President; these people knew Dr. Smith personally.

Among the guests, there was sufficient political power and finesse to take the Gordian Knot that is now the Wayne County Detroit Authority and untie it.

Dr. Smith brings an extensive political network begun by chance in childhood but woven by him with skill as an adult. At the same time, we have before us the need for those skills: The task is to resolve the political dilemma now upon the Wayne County Detroit Health Authority. This problem threatens not only the Authority's implementation but its existence.

Of course, the WCMS cannot broker a compromise that would give the Health Authority the legal recognition vital to it now.  But with Dr. Smith, the WCMS has the contact to nurture that resolution.
The May 15 inaugural revealed the potential that the WCMS brings to the medical community. This year provides an opportunity to turn this possible energy into real gain.

Special communication from Thomas Simmer, MD, BCBSM Chief Medical Officer
You've heard a lot about the new health benefits that are being implemented for hourly auto workers following the collective bargaining agreements last fall.  The changes to the benefit programs are complex and vary from one manufacturer to another.  I will briefly summarize the information that is most important to physicians.  There are three major changes:

· Transfer from the Traditional network and fees to the TRUST network and fees
· Mandate of mail order pharmacies for maintenance medications
· Coverage for office visits at 100 percent co-payment by the patient
Under the new collectively bargained benefit plan, patients must seek services from physicians contracted with the TRUST network or pay an out-of-network sanction. For hourly workers at Daimler-Chrysler, this was implemented on April 1, 2004.  Ford hourly will begin on July 1, and the date for General Motors has not yet been established.  Most physician fees are five percent lower under the TRUST contract than they are under Traditional. 

When prescribed medications for long-term use, patients may fill the initial three months through retail pharmacies and then must switch to mail order pharmacies for continued coverage.  Physicians are often asked by patients to write two sets of prescriptions, one for each type of pharmacy. 

Office visits have never been covered for auto workers enrolled in the Traditional program.  Under the new agreements, such visits are described as "covered benefits" with a 100 percent member co-payment.  For Daimler-Chrysler a catastrophic deductible of $5,000 applies to office visits.  Under the TRUST agreement, physicians are limited to collecting the established fee screen for covered services.  Physicians may demand payment in full from the patient at the time of service.

The agreement also directs BCBSM to examine ways to improve the performance and cost-effectiveness of the Blue Preferred Plus network, which serves about 160,000 members in Michigan.  This may include a reduction in the number of facility and professional providers in the network.  The impact of this directive has not yet been determined.

Governor signs pesticide notification law for schools, day care centers
Gov. Jennifer Granholm recenlty signed into law Public Act 24 of 2004, legislation strengthening parental notification requirements prior to the application of pesticides in schools and day care settings.
"Encouraging parents and others to limit childhood exposure to harmful environmental toxins represents one of the top public policy priorities of the Michigan Junior Leagues," says Linda Kingston, Chair, of the State Public Affairs Committee of the Michigan State Council of Junior Leagues. "This new law will increase parents awareness of the dangers pesticides pose to their child's healthy development, and promote the use of less toxic alternatives around young children."

House Bill 5154, sponsored by Rep. Ed Gaffney (R-Grosse Pointe), provides for universal notification of all parents prior to the application of pesticides, except in emergency situations, in schools and day care settings.  The bill also encourages alternative control techniques to minimize pesticide use.

While current Michigan law requires schools to notify parents at the beginning of the school year that they have the right to be notified prior to the application of a pesticide in the school, Junior League members found that not all parents were aware of this requirement and not all schools were in compliance.

This final action culminates years of study, planning and collaboration by Junior League members with other concerned child health organizations such Local Motion and the Michigan Environmental Council. Junior League leaders credit this collaborative effort with the unanimous support the bill received in both the House of Representatives and the Senate, and the support of the governor.
Children are especially vulnerable to toxic substances. Pound for pound, they eat more food, drink more water, and breathe more air than adults, all of which dramatically  increases their exposure to chemicals.  There is growing evidence that chemicals in the environment, including some pesticides, may be contributing to some illnesses. For example:

-Over just the past 20 years, children's brain cancer has increased 35 percent, cancers of the testicles are up by 66 percent and certain lymphomas in teenagers have doubled;
-Asthma too, has more than doubled over the past 20 years and is the leading cause of school absenteeism;
-Children living in homes where the yards are treated with pesticides have four times the risk of soft-tissue sarcoma; and
-Children exposed to pesticides used in the home and garden are three to six times more likely to develop leukemia than children who are not exposed.

Although improved detection may figure in, environmental causes may account for more than half of all cancers, says the American Cancer Society.

"The vast majority of all pesticides registered for use by the US Environmental Protection Agency (EPA) have never been fully tested for the full range of potential human health effects." Over the last two years, the Junior Leagues of Michigan have been educating their members and other parents about the dangers of environmental toxins in the home and suggesting healthy alternatives.

The Junior Leagues represent women from across the state dedicated to promoting voluntarism, developing the potential of women, and improving communities through the effective action and the leadership of trained volunteers.

HOD Resolutions
RESOLUTION 79-04A

Title: Reappointments to the Medical Staff.  Approved.
Introduced by:  Robert J. Jackson, MD, for the Organized Medical Staff Section
Supported by the Wayne County Delegation
Original Author:  Narinder K. Sherma, MD

 RESOLVED:  That the Michigan Delegation to the AMA ask the AMA to work with the Joint Commission on Accreditation of Healthcare Organizations to change the requirement for reappointments to medical staffs to every four years.

RESOLUTION 86-04A

Title: Limit Availability of Soda Pop in Schools.  Referred to the Board for Study.
Introduced by:  Ronald M. Davis, MD, Wayne County
Original Author:  David A. Share, MD

RESOLVED:  That MSMS support legislation that seeks to limit the availability of soda pop in schools by prohibiting the sale of soft drinks to students on school premises while school is in session.

RATIONALE:  Although the Reference Committee unanimously agreed with the importance of a healthy diet and with the high caloric content of sugared soda pop, it felt that the resolution oversimplified the causes and solutions of obesity and did not take into account other beverages that include high fructose corn syrup - including some fruit drinks.  The Committee also is aware that many school districts rely on soda pop sales for additional funding.

RESOLUTION 87-04A

Title: Michigan Pharmaceutical Produce List.  Substitute Resolution (in lieu of Resolutions 29-04A and 87-04A). See Resolution 29-04A.
Introduced by:  Edward G. Jankowski, MD, for the Wayne County Delegation
Original Author:  George J. Murakawa, MD

RESOLUTION 88-04A

Title: Bargaining With Managed Care: Putting Quality of Care Where it
Belongs.  Approved.
Introduced by:  Narinder K. Sherma, MD, for the Wayne County Delegation

RESOLVED:  That MSMS study state action doctrine legislation as passed in other states and consider preparing such legislation for introduction in the Michigan legislature.

RESOLUTION 89-04A

Title: Targeting Obesity.  Adopted as Amended.
Introduced by:  Federico G. Mariona, MD, for the Wayne County Delegation

RESOLVED:  That MSMS join with health care organizations, academic centers, community agencies, local health departments and the state of Michigan to aggressively promote effective interventions to deal with obesity as an increasing and pervasive public health concern; and be it further

RESOLVED:  That MSMS join with health care organizations, academic centers, community agencies, local health departments and the state of Michigan to promote preventive health educational programs based on making better dietary choices, increasing physical activity, informing medical practitioners about practical and effective ways to counsel patients on the dangers of excessive body mass, and informing the public about ways and means to help themselves become thinner and healthier.

RATIONALE:  The Michigan Department of Community Health, led by the State Surgeon General, is developing a coalition of health care organizations, academic centers, community agencies and local health departments to address this issue.  The Committee wanted to include the state of Michigan in this initiative to reflect their interest and commitment to public health. 

RESOLUTION 90-04A

Title: Fees for Copies of Records.  Referred to the Board for Study.
Introduced by:  Narinder K. Sherma, MD, for the Wayne County Delegation

RESOLVED:  The MSMS seek clear legislation allowing physician charges for copies of medical records and materials and that these fees be annually adjusted for inflation.

RATIONALE:  There are current legislative efforts that potentially address many of the concerns expressed in this resolution.  Further study is necessary to adequately address the intent of this resolution.

RESOLUTION 91-04A

Title: Alternative/Complementary Medicine.  Disapproved.
Introduced by:  Martin H. Daitch, MD, for the Wayne County Delegation

RESOLVED:   That the Michigan Delegation to the AMA ask the AMA to work with appropriate organizations to require that information regarding alternative or complementary medicines, including drug interactions similar to that found in the PDR, be available with the cost borne by manufacturers.

RATIONALE:  The Committee recommends disapproval of the resolution because no significant testimony was provided to clarify the intent of the resolution.  The manner of how the information is to be collected and which alternative medicines should be included was not specified. 

RESOLUTION 92-04A

Title: Physician Representation on Hospital Boards of Trustees.  Referred to the Board for Study.
Introduced by:  Narinder K. Sherma, MD, for the Wayne County Delegation

RESOLVED:  That MSMS seek legislation to mandate an adequate number of actively practicing physicians (elected by medical staffs) on hospital boards of trustees.

RATIONALE:  The Committee did not believe that this resolution would accomplish the author's intent to provide greater physician input in disputes between the hospital administration and medical staffs.  Hospital board members are fiduciaries of the institution and not necessarily able to advocate for the interests of their colleagues.  Additionally, the resolution asks that MSMS seek legislation to mandate an adequate number of actively practicing physicians on the hospital board.  Hospital boards are not uniformly sized and the term "adequate" is not defined, and would therefore be difficult to implement in legislation.

RESOLUTION 93-04A

Title: Increasing State Tobacco Taxes.  Substitute Resolution (in lieu of Resolutions 34-04A and 93-04A)  See Resolution 34-04A.
Introduced by:  Ronald M. Davis, MD, for the Wayne County Delegation

RESOLUTION 34-04A

Title: Increasing State Tobacco Taxes.  Adopted as Amended.  Substitute Resolution (in lieu of Resolutions 34-04A and 94-04A)
Introduced by:  Rajesh B. Makim, MD, for the St. Clair County Delegation
 
 RESOLVED: That MSMS strongly support an increase of a minimum of 75 cents per pack in Michigan's cigarette excise tax increase (and comparable increases in taxes on other tobacco products); and be it further

 RESOLVED:  That MSMS support the Governor's proposal to allocate all of the revenue generated from this tax increase to health care and public health programs, with the first $30 million being dedicated to public health programs including tobacco prevention and cessation, chronic disease prevention and control, and maternal and child health, and with the remainder being dedicated to Medicaid services.
RATIONALE: The Committee recognizes the importance of MSMS supporting the tobacco tax legislation.  The Committee would like to commend the bipartisan efforts of Governor Jennifer Granholm and Representative Larry Julian to give proper support to the Michigan Medicaid program and for sending a strong message to the People of Michigan on the effects of tobacco use.  If physicians want more information, please visit www.mitobaccotax.org and support House Bill 5632. 

RESOLUTION 94-04A

Title: Billing the Uninsured for Hospital Services.  Adopted as Amended.
Introduced by:  Edward G. Jankowski, MD, for the Wayne County Delegation
Supported by the Organized Medical Staff Section

 RESOLVED:  That MSMS support federal and state regulatory reforms that do not preclude hospitals from billing uninsured patients on a means-tested sliding scale: and be it further
 RESOLVED:  That the Michigan Delegation to the AMA ask the AMA to support federal and state regulatory reforms that do not preclude hospitals from billing uninsured patients on a means-tested sliding scale.

RATIONALE:  The Committee agrees that the current regulatory environment has created a situation that adversely affects low-income patients without insurance.  However, the Committee did not wish to further jeopardize the already narrow financial margins of hospitals by mandating billing and collection procedures.  Therefore, the Committee recommends adopting a resolution that provides adequate flexibility for hospitals to accommodate lower income patients without fear of violating any state or federal regulations.

RESOLUTION 95-04A

Title: Affordable Health Insurance Coverage for All.  No Action.
Introduced by:  Edward G. Jankowski, MD, for the Wayne County Delegation
Original Author: H. Richard Henderson, MD

RESOLVED:  That the Michigan Delegation to the AMA ask the AMA in 2004 and for as long as necessary make as its number one priority affordable health insurance coverage for all Americans; and be it further

RESOLVED:  That the Michigan Delegation to the AMA ask the AMA to allocate the financial resources equivalent to that allocated to physician advocacy issues to addressing the issue of affordable health insurance for all Americans.

RATIONALE:  The AMA delegation advisors indicated that the content of this resolution is already policy of the AMA and that work on this issue continues.

RESOLUTION 96-04A

Title: Blue Cross Blue Shield of Michigan Reform.  Approved.
Introduced by:  Federico G. Mariona, MD, for the Wayne County Delegation

RESOLVED:  That MSMS vigorously pursue any and all remedies (legislative, judicial) at any and all levels (state, federal) to ensure that Blue Cross Blue Shield of Michigan reimburse physicians with both timely payment and timely notice of any changes in coding.

RESOLUTION 97-04A

Title: Clean Up Physician Health Plan Contracting.  Disapproved.
Introduced by:  Edward G. Jankowski, MD, for the Wayne County Delegation

 RESOLVED:  That MSMS seek legislation that would cause all health plans to deliver to physicians, on request and within 30 days, a copy of their current contract with all changes highlighted and dated since the original contract was signed.

RATIONALE:  There was no  testimony in support of this resolution at the Committee.  Furthermore, it was the sentiment of the Committee that this issue should be addressed in the contract with the health plan as opposed to creating legislation.

RESOLUTION 98-04A

Title: Prescription Refill Cycle.  Adopted as Amended.
Introduced by:  Martin H. Daitch, MD, for the Wayne County Delegation

 RESOLVED:  That MSMS work with the appropriate Michigan government entities and pharmaceutical benefit managers to change the coverage rules to allow prescriptions for chronic illnesses and non-narcotic drugs written and filled for up to a 90-day supply so that patients will avoid additional co-pays.

RATIONALE: The Committee amended the resolution in order to adequately address the full scope of this problem for patients and physicians.  The Committee agrees with the intent of the resolution to provide greater access, convenience, and lower costs for patients.

RESOLUTION 99-04A

Title: State Audit of Mental and Physical Health Funds to Counties.  Adopted as Amended.
Introduced by:  Edward G. Jankowski, MD, for the Wayne County Delegation

RESOLVED:  That MSMS encourage the state to require an annual independent statute audit, reported by county, of Medicaid and other state and federal funds provided through the state for mental and physical health services; and be it further;

 RESOLVED:  That an annual independent state audit, reported by county, of Medicaid and other state and federal funds provided through the state for mental and physical health services be made widely available to all citizens of Michigan.

RATIONALE: The Committee amended the resolution in order to provide a greater number of options in obtaining the information that is requested by the author.  This could include legislation, but could also be accomplished by a request to the Department of Community Health, and FOIA request, or other means.  The Committee was aware of the perceived lack of financial accountability and the inability of patients to access care within the mental health system in Michigan, and was supportive of the intent of this resolution.