March 16, 2004

Delegate Body and Executive Council
meet, discuss resolutions
The following resolutions were considered by the Executive Committee at its recent meeting. Four previous resolutions (see DMN, March 1, 2004) were discussed at the last meeting.

Title: Clean Up Physician Health Plan Contracting
Submitted by: Edward Jankowski, MD
Whereas: most physicians are not able to keep track of old health plan contracts and many physician contracts have changed remarkably over time, and
Whereas: most contract changes are unilaterally dictated by the insurer,
and
Whereas: all physicians should review all of their health plan contracts on a regular basis in order to make judicious business decisions, therefore be it
RESOLVED: that the Michigan State Medical Society have legislation introduced 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.
Fiscal note: none

Title: Denial of Claim Legislation
Submitted by: Edward Jankowski, MD
Whereas: denial of a claim is frustrating and costly for the physician and patient, and
Whereas: ascertaining the rationale for the denial can be extremely difficult, and
Whereas: resolving disputed claims would be easier if the person who denied the claim is identified in the returned claim, therefore be it
RESOLVED: that the Michigan State Medical Society support the effort of Rep. Shelley Taub to sponsor legislation requiring the person who reviews the claim to identify him/herself on the returned claim, and be it further
RESOLVED: that the Michigan State Medical Society support making it mandatory that the person who reviews the claim is identified and can be directly contacted to discuss the rejected claim.

Alternative/Complementary Medicine
Submitted by Martin Daitch, MD
Whereas, alternative or complementary medicines are utilized by millions
of patients, both with and without physician approval;
Whereas, there are no national or state organizations ensuring quality
control of the safety and potency of these agents;
Whereas, there are no patient information materials containing indications,
side effects, contraindications or potential incompatibilities;
Whereas, there is a similar lack of information on medical equipment such
as prostheses and air filters; be it therefore
RESOLVED: that MSMS work with appropriate organizations to require that information regarding alternative or complementary medicine,
similar to that found in the PDR, be available.

Michigan Pharmaceutical Product List
Submitted by George J. Murakawa, MD, PhD
Whereas: in February 2002, Michigan created the Medicaid formulary, Michigan Pharmaceutical Product List (MPPL)
Whereas: this formulary was created to save the state money by restricting medication access and to maximize generic medication usage
Whereas: this formulary is highly restrictive in that only 61 of the top 100 oral medications prescribed in Michigan are on the formulary
Whereas: Medicaid HMOs are not required to adhere to this formulary
Whereas: Medicaid HMOs have a more restrictive formulary and do not provide the same medications
RESOLVED: that MSMS work with appropriate Michigan government officials to require that one formulary (MPPL) apply to all Medicaid patients, fee-for-service and managed care.

Medicaid, Blues, liability top MSMS agenda
As part of the MSMS Strategic Plan, MSMS annually sets forth an agenda of state legislative goals to accomplish. Following is the agenda for 2004:
Medicaid
-Uniting health care interests to achieve the goal of appropriate funding and responsible regulation of the Medicaid program in Michigan;
-Reimbursement parity with Medicare;
-Improved regulatory oversight of Medicaid health plans;
-Streamlined administrative processes;
-Protect health care safety net;
-Providing coverage for the uninsured.
Public Act 350
-Advocating for the interests of our patients, by making Blue Cross Blue Shield more responsive, effective, and efficient;
-Would require Blue Cross Blue Shield to have an alternative method for processing claims that are unable to be processed by their automated system;
-Would require Blue Cross Blue Shield to adopt a policy that procedures for coding and submission of claims be written in unambiguous language;
-Would require Blue Cross Blue Shield to provide reasonable advance written notice for changes to policies related to the coding and submission of claims;
-Would establish penalties should Blue Cross Blue Shield fail to meet the criteria established by the proposed legislation
Administrative Simplification
-Working with the health care and business communities to build consensus about reducing unnecessary administrative expenses.
Mental Health Parity
-Preventing discrimination in health coverage against those in need of mental health care;
-Spousal Non-Liability - Closing the loophole that currently affords individuals legal protections if they refuse to pay medical expenses incurred by their spouse;
-Surgical Assistants - Changing the Public Health Code to reflect the current environment with respect to the use of Certified Surgical Assistants.

Certificate of Need Reform
-Putting patients first by improving access to necessary medical services.

Physician Apology Legislation
-Fostering open communication between physicians and patients by making admissions of sympathy to a patient inadmissible during any subsequent court proceedings.

Medical Liability
-Protecting the liability climate in Michigan by opposing legislative attempts to roll back the clock on tort reforms.

Scope of Practice
-Protecting the health of Michigan's citizens by opposing legislation that would expand the scope of practice of for allied and alternative health professionals, and ensuring that scope of practice continues to be based on education and training:
-Optometric Scope of Practice Expansion
-Advance Practice Nurse Scope of Practice Expansion
-Certified Registered Nurse Anesthetist Scope of Practice Expansion
-Chiropractic Scope of Practice Expansion
-Physical Therapist Scope of Practice Expansion
-Prescriptive Privileges for Psychologists

Public Health
-Improving Michigan's health through prevention and preparedness;
-Preventing Obesity and Promoting Healthy Lifestyles;
-Biodefense;
-Improve Funding for Family Planning;
-Tobacco Reduction;
-Treatment for Gambling Addiction;
-Violence Reduction Efforts;
-Retention of Michigan's Helmet Law;
-Immunization Efforts.

Contract Negotiation and Antitrust Reform
-Legislation that would allow physicians to advocate for their patients during contract negotiations.

Electromyography (EMG) Testing
-Reassuring patients by seeking legislation that makes EMG tests the practice of Medicine.
View this agenda online at www.msms.org/grpa/ (click on "Legislative Agenda").
For more information about MSMS state advocacy efforts, contact Colin Ford at 517-336-5737 or cford@msms.org

Letter: Treating obesity, one patient at a time
Editor:
Physicians have always known that obesity has a tremendous impact on the health and well being of their patients. Only recently has this illness begun to receive attention from the media, private and public sectors. According to the Centers for Disease Control and Prevention, 64 percent of Americans are overweight and obese, resulting in 300,000 preventable deaths each year. Recently, Detroit has received the distinction of being the “most obese” city in the nation, a title previously held by Houston. Michigan is also near the top of the list according to an annual study underwritten by United Healthcare.
The recent articles on this subject prompted me to take a look at my practice. Chart review of one recent week of 84 consecutive office visits revealed the following: those in the normal weight range (Mody-Mass Indices 20-25), 25 percent; Overweight (BMI 26-30), 39 percent; Obesity I (BMI 31-35), 16 percent, and extreme Obesity (BMI>35), 8.3 percent. Underweight individuals (BMI<19) were only 3 percent.

In my experience, as the BMI rises, the patient’s burden of chronic medical illnesses rises exponentially. Thankfully, physicians are receiving tools from a variety of sources to combat obesity.
The AMA, in its recent publication, “Assessment and Management of Adult Obesity: A Primer for Physicians,” available at www.ama-assn.org/go/roadmaps; has contributed a valuable resource. Specialty societies such as the American Academy of Family Physicians, Blue Cross/Blue Shield of Michigan, the Michigan Department of Community Health and many other national, state and local organizations also have resouces available.

We, as physicians, can make a difference in this battle against obesity one patient at a time. A brief question regarding exercise or diet can empower the patient to seek more information and support from his/her physician. Often, a few words of advice can motivate a patient. Some of the best success stories I have seen occurred after I asked a patient to carry his lunch instead of going out for fast food. A reduction in carbonated drinks, beer, ice cream and pizza will result in pounds and inches lost.

Like smoking cessation, changes in eating habits and exercise are very difficult. As physicians, we must do our best to motivate and inspire our patients as they strive to improve their health and well being.
-E. Chris Bush, MD

Editorial: What Is Within Our Ken
By JOSEPH WEISS, MD
Editor
The Sunday Feb, 1 issue of the Detroit News/Free Press contained an article titled: HEALTH CRISIS REQUIRES UNIVERSAL FIX. Its gist was that the present way of providing health care in America doesn't work. The uninsured receive fragmentary care, while many with coverage today, are threatened with decreasing benefits tomorrow.  In contrast, others with health insurance ( Medicare as an example) are able to use more health resources than they reasonably need.

The article was a question-and-answer format with Dr. Robert Kelch, U-M executive president for medical affairs, and Mary Ann Coleman, president of the University of Michigan. Dr. Coleman emphasized the need for universal health coverage. Dr. Kelch brought out the need for health care plans of the future to focus on prevention more than promoting therapeutic and procedural innovation.

U of M President Coleman did not say how to achieve coverage: whether by expansion of coverage already available by government and enterprise, or by institution of single-payer, or by expansion of regional approaches as represented in the Chicago/Cook County model.

How and when this country is to achieve universal coverage is not a decision physicians will make, though we should contribute to what form is chosen. Remember, it will be left to us to implement that coverage.

Dr. Kelch did not provide a blueprint of the best type of health plan. This is where we should step forward: in devising the plan itself.  What do we, as physicians, see as needed services for everyone? What preventive medicine and diagnostic procedures do we recognize as fundamental? Finally, what do we, in contrast to the pharmaceutical companies, believe is the place of existing and new drugs?
Adding to our willingness to step forward, is the prod of what happens if we do not. The recently passed Medicare Prescription Bill illustrates the confusion and contradiction that results when politicians and lobbyists push medical reason aside. We should ask the Michigan State Medical Society to use its resources to develop a basic health care plan.

If we do not take the lead in this matter, we will be led.

GDAHC committee, chart book to help set stage for Detroit health care overhaul
A new chart book put out at the behest of the Greater Detroit Area Health Council (GDAHC) aims to help frame the debate on public health solutions in Detroit.

The chart book was created to support the Southeast Michigan Health Care Future Directions Task Force, itself an entity created by GDAHC to come up with new, improved ways of delivering health care in Southeast Michigan’s seven counties.

The Task Force roster contains health care, business and community leaders. The chart book is an effort to “bring together in one place a broad selection of research on health and health care in Southeast Michigan.” It is intended to support three of the Task Force’s goals:
To create a new vision and priorities for health care in the region.
To develop and implement concrete, achievable strategies to imporove health and health care meaningfully in the region.

To select and present research and indicators of health and health care in the region that stakeholders agree are the foundation of achievable strategies.

An expert research team was convened to assist GDAHC and Public Sector Consultants, a Lansing-based think tank, with the collection, validation and clarification of information. The research team contained representatives from various health care industry and provider organizations, along with academics from Michigan universities.
The research presented in the chart book is focused on four areas:
-Health behaviors and health status
-Health system capacity
-Access/covering the uninsured/safety net
-Costs, utilization and quality

For more information on the chart book and task force, please contact GDAHC at (313) 963-4990 or www.gdahc.org. The address is: 333 W. Fort St., Ste. 1230, Detroit, MI 48226.

Blues reps available to help docs troubleshoot
For help in troubleshooting problems with Blue Cross and Blue Shield of Michigan, physicians should contact the following representatives from Provider Consulting Services. Call (313) 225-0615.

Lorna Seidl, RN, covers the cities of Dearborn, Dearborn Heights, Garden City, Grosse Pointe, Hamtramck, Harper Woods, Highland Park, Livonia, Redford and Westland. She also covers Oakwood, St. Mary and Garden City hospitals.

Dawn Stoner covers the cities of Allen Park, Belleville, Brownstown Twp., Canton, Ecorse, Flat Rock, Gibralter, Grosse Isle, Inkster, Lincoln Park, Melvindale, New Boston, Northville, Plymouth, River Rouge, Riverview, Rockwood, Romulus, Southgate, Taylor, Trenton, Van Buren Twp., Wayne, Woodhaven and Wyandotte.

Obituaries
Edward L. Quinn, MD
Edward L. Quinn, MD, died December 22, 2003. He was born August 27, 1917. The Birmingham resident was husband of Nelden B. Quinn; father of Patricia (Dennis) Ritchie, Jane (Dale) Paccamonti and Michael L. Quinn; grandfather of Kelly, Kirsten, Sara, David, Sam and Hanna; two great granddaughters Cameron and Hayden.
Memorial tributes may be made to First United Methodist Church, 1589 W. Maple, Birmingham, 48009, or to Henry Ford Health System c/o Edward L. Quinn, Infectious Disease Fund, Office of Philanthropy, One Ford Place, Suite 5A, Detroit, 48202. Arrangements by the William R. Hamilton Co. of Birmingham, (248) 644-6000.

William Noshay, MD
William Noshay, MD, died November 25, 2003. He was a neurologist who always put his patients first. The 88-year-old physician died of complications from a broken hip.

During the 1967 Detroit Riots, Dr. Noshay braved the turbulent streets to provide health care at Henry Ford Hospital and was exposed to gunfire. He spent his entire career at the hospital. He believed he could help more patients there than in private practice, his daughter, Marge Noshay-Bevers, told the Detroit News.

Dr. Noshay was born October 3, 1915, in Buffalo. He earned his medical degree in 1940 from the University of Buffalo.

During World War II, Dr. Noshay was a Naval doctor assigned to the US Marine Corps. He was stationed at Okinawa.

After the war, he attended the University of Michigan, where he earned a degree in neurology in 1949.

In 1950, Dr. Noshay began his career at Henry Ford Hospital. That year, the hospital decided to split its Department of Psychiatry and Neurology into two entities.

Heart problems forced him to retire in 1973 at age 58. In retirement, Dr. Noshay raised orchids and became a gemstone cutter. He loved taking his guests on board his boat and every year threw a party for hospital employees.

Survivors include two daughters, Marge Noshay-Bevers and Bets Leadbetter; a son, Dave; and eight grandchildren.

SAVE THE DATE

Twelfth Annual
Francis P. Rhoades, MD
Memorial Lecture

Detroit Yacht Club
6 p.m. - Friday, April 2, 2004

“The Detroit Health Care Crisis”
Janet Olszewski, Director
Michigan Department of Community Health

Responders:
Dean John Crissman, MD
WSU School of Medicine

Michael Duggan
President Detroit Medical Center

WCMS Candidate Biographies
President Elect
Federico Mariona, MD, MBA
Born, reared and completed my basic education in Buenos Aires, Argentina, immigrated to the United States; trained in Obstetrics and Gynecology in the United States in the mid ‘60s; embraced American citizenship in the ‘70s. Joined the faculty in the department of Obstetrics and Gynecology at Wayne State University, initiating and directing the first Division of Fetal Medicine at Hutzel Hospital in Detroit until 1987 and have maintained my faculty appointment to the present.

As a board-certified specialist, taught and practiced Maternal-Fetal Medicine, serving the practicing physicians and patients in the community uninterruptedly for 29 years. Later, founded the Division of Maternal Medicine and practiced in a major metropolitan hospital in western Wayne County.

Actively participate in Wayne County Medical Society committees regarding maternal mortality, teenage pregnancy, the Charles C. Vincent, MD, Memorial Scholarship Fund and, more recently, communications, public health and membership.

As a member of the Michigan State Medical Society serve on the Maternal-Perinatal Health Committee, the Maternal Mortality Committee, Educational Planning and the Third-Party Payer Liaison Committee. Also serve on the Maternal Mortality Medical Review Committee of the Michigan Department of Community Health.
As an OB/GYN, serve on the State Council Legislative Committee, Past Chair of the Michigan Section of the American College of Obstericians and Gynecologists. Also served as District V Secretary. At the national level, I’ve served on the ACOG Committee on obstetric practice, the Fetal and Infant Mortality Review Task Force and, currently, on the Adolescent Care Committee. At the international level, maternal fetal medicine advisor for several medical schools obstetrical departments, and a member of the advisory council on patient safety and professional liability.

Learned firsthand the health care insurers’ approach to medical practice issues and physician reimbursement during an administrative working period with a major insurer in the state.
Currently in clinical practice and teaching of Maternal-Fetal Medicine in the Detroit Metropolitan area, while serving WCMS as a delegate to MSMS and member of the Executive Council.

I feel extremely honored to have my name placed in nomination and to be given the opportunity to continue serving the physicians of Wayne County. My clinical activities and the understanding of the critical issues that impact all of us in our practice in southeastern Michigan make me a strong candidate for the position of President Elect of the Wayne County Medical Society.

President Elect
Jean Sinkoff, MD
One of my priorities is to increase the membership in the Wayne County Medical Society. Over the years, I have seen a gradual erosion of of the membership. Unfortunately, too many of our residents and fellows leave the area upon completion of their training. I feel that they should be apprised of the opportunities for practice in Wayne County vis-a-vis the quality of the various institutions and their staffs. This information should be made known to them during their training, not upon its completion. Offering associations in existing practices would help the situation.

Although there has been an increase in advertising regarding our institutions, I feel this should be expanded. Closer liaison with our representatives in Lansing should be continued. Their attendance at the meetings has proven successful and there has been positive feedback.
The crisis in malpractice continues and the various hospitals should band together and approach an independent company as DMC has done and make a deal. This would cut off the gouging of the various companies.

A physician should be allowed to refer a patient to his or her hospital without hours of approval time to unknown specialists. The same holds true for prescription requests with hours of time consumed to get approval.

If elected, I shall attempt to implement the above agenda and return the practice of medicine back to the physician.

Secretary
Robert Jackson, MD
Robert J. Jackson, MD has been in Family Practice for 18 years after graduating from Wayne State University School of Medicine in 1982 and completing his internship and residency at Oakwood Hospital in 1986.

He is currently the Chief of Family Practice at Henry Ford Wyandotte Hospital. He is also the director to two hospital physician groups.
Dr. Jackson is married and has three daughters.

Secretary
Sophie Womack, MD, MBA
Dr. Sophie Womack is the Division Chief of Neonatology of Sinai-Grace Hospital. She is an Assistant Professor at Wayne State University in Pediatrics and on the Board of Trustees of the Detroit Medical Center.

Dr. Womack is a graduate of Howard University and Meharry Medical College where she received her training in Pediatrics and Neonatology. She now resides in Detroit. She is the Chairman of the Board of Tommorrow’s Child/Michigan SIDS and active in promoting the Back to Sleep Campaign in Michigan, particularly in the urban community.

Along with her husband, she formed The Coalition, Inc. - Circle of Hope, an organization that promotes childhood health and well being. They have raised more than $1 million for many community efforts. Dr. Womack is Vice Chair of the Medical Public Health Committee and Chairperson of the Wayne County Medical Society’s Violence Reduction Committee. Under her direction, they provide a continued liaison with the medical profession and the community as it relates to child abuse, gun violence and domestic violence. They have provided educational seminars in domestic violence and its impact on the family.
Her committee has now linked with other community leaders to form the 21st Century Club to provide needed funds for counseling services to children who are victims of domestic violence. The 21st Century Club has raised more than $300,000 for domestic violence shelters.
Dr. Womack received The Image Award in Medicine from the Women’s Justice Center in 1988. She also received the Ameritech and Channel 56 Living the Dream Award for community service. In 2002, she received the Spirit Award from the Wayne County Council Against Family Violence and the Caring for Children Angel Award from Blue Cross and Blue Shield of Michigan.

Dr. Womack received her MBA degree from the University of Tennessee in Knoxville Dec. 12, 2002.

Board of Trustees
H. Michael Marsh, MBBS
I am running as a candidate for the Board of Trustees of Wayne County Medical Society (WCMS) because I believe in the strengths of our physician directed organization and wish to see it thrive. Our county society, as the largest and strongest component of MSMS, must work within MSMS and the AMA to achieve realization of physician-directed, patient-dedicated leadership for our medical systems, moving away from the currently chaotic situation dominated, as it is, by third party interests. As an Anesthesiologist, I also recognize the strengths of the specialty societies and the need for these societies to maintain a common front with the AMA on key issues, if we are to regain our true leadership position as physicians.

My major goals as a member of the Board of Trustees would be to:
1. Continue to strengthen WCMS and to increase physician participation, thereby assuring fiscal and mission-directed success for WCMS.
2. Increase the dialog between physicians and third party interests, including state and federal government and the payor groups, regarding optimal systems for provision of community health care and health promotion, while maintaining fair returns to providers for the care and health promotional efforts they undertake, and
3. Focus State and Federal support on the problems presented to physicians by the numbers and poor health of the uninsured and underinsured (Medicaid) members of society in our county and in our state.

I am the immediate Past President of our WCMS and currently serve as Professor and Chair of Anesthesiology at Wayne State University and Specialist-in-Chief, Detroit Medical Center.  In the past I trained in Australia, was on staff at the Mayo Clinic for 15 years and served as Chair of Anesthesiology at the Henry Ford Health System for nine years. I have served as Secretary and President of the Minnesota Society of Anesthesiologists and am currently on the Executive Council for WCMS, having served as Secretary of WCMS and liaison to MSMS for their Medical Economics Advisory Committee. I have been a delegate from WCMS to the MSMS house for the last five years. I currently serve on the Board of Directors of MSMS.
If you support the issues which I have espoused, you can count on my strongest efforts on your behalf. I further pledge to strongly support young physicians in rebuilding WCMS and will do all I can to promote them in leadership.

Board of Trustees
Lonnie Joe, MD
Lonnie Joe, MD has been in an Internal Medicine/Pulmonary practice for 21 years. After graduating from the University of Michigan School of Medicine in 1978 he completed his internship and residencies at Providence Hospital in1983.

He is currently a Michigan State Medical Society Director from WCMS and the President of the Detroit Medical Society.
Dr. Lonnie Joe is married to Anne Joe, MD.

A Ballet at the Detroit Opera House
April 3, 2004
A Streetcar Named Desire
North Carolina Dance Theatre
Love and lust collide in Mark Diamond’s dark, intensely powerful ballet inspired by the Tennessee Williams play. Blanche Dubois tries to preserve her beautiful but dreamlike world of the past in the brash and decadent atmosphere of New Orleans in the 1950s. The exciting score includes jazz, as well as contemporary and classical music.
Under the internationally acclaimed leadership of Jean-Pierre Bonnefoux as President and Artistic Director and Patricia McBride and Jerri Kumery as Associate Artistic Directors, North Calolina Dance Theatre has fast become one of the Nation’s most successful professional dance companies.

WCMS members can attend for a special price of $70
($90 for a box seat)

2004 WCMS Golf Outing
Essex Golf and Country Club
Monday, May 10, 2004
Buffet Luncheon 11:30 a.m.
Shot Gun Start 12:30 p.m.
$200 for fees, cart, lunch and dinner
$60 for dinner only
Silent Auction on pro shop items
BMW Convertible: 1st hole-in-one
Games of Chance: individual holes