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MSMS/MOA amend
Blues lawsuit
MSMS and the Michigan Osteopathic Association (MOA) filed a
motion in Ingham County Circuit Court on Nov. 22 to amend
the complaint the organizations previously filed against
Blue Cross Blue Shield of Michigan (BCBSM).
The need to amend the complaint arises from BCBSM's recent
attempt to unilaterally modify its TRUST Network Agreements
with thousands of Michigan physicians. In October, affected
physicians received a letter from the Blues that attempted
to amend the Agreement by adding a missing definition of
"sponsorship," the very issue that prompted the
original complaint.
The amendment to the complaint would seek an additional
declaratory judgment from the court that BCBSM's unilateral
modification of the TRUST Network Agreement is not valid
because the Agreement does not give BCBSM the unilateral
right to modify it.
MSMS and MOA sued BCBSM on Sept. 9, arguing that the TRUST
Network Agreement does not give BCBSM the right to fix
physicians fees for services physicians provide to enrollees
in non-BCBSM health plans for which BCBSM serves only as the
administrator including the new auto company PPOs for United
Auto Workers.
The hearing on the motion to amend the complaint will be
held on Wednesday, Dec. 1. A motion for summary disposition
will be filed after the first of the year.
For more information, visit http://www.msms.org/bsyp/index.html
or contact Julie Novak at MSMS at (517) 336-5768 or jnovak@msms.org.
Liability coverage in free clinics
As you may recall, Congress authorized medical liability
protection for volunteer health professionals working in
free clinics through Section 194 of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). If a
volunteer health care professional meets certain
requirements, the related free clinic can sponsor him/her to
be a "deemed" federal employee for the purpose of
medical liability coverage under the Federal Tort Claims Act
(FTCA).
Implementation of the Free Clinics Federal Tort Claims Act
Medical Malpractice Program began on Sept. 24, 2004. Under
the Program, administered by the Health Resources and
Services Administration's (HRSA) Bureau of Primary Health
Care (BPHC), HHS will deem a volunteer free clinic health
care professional to be an employee of the Public Health
Service for purposes of FTCA medical malpractice coverage if
the free clinic and health care professional meet certain
requirements. An application process must be followed, and
approval granted by HHS, before liability protection is
granted.
Detailed information on the Free Clinics FTCA Medical
Malpractice Program, as well as application instructions and
eligibility requirements, can be found on the HRSA/BPHC Web
site at www.bphc.hrsa.gov/freeclinicsftca/application.htm.
Please feel free to contact Debra Cohn, JD, AMA Washington
Counsel, (202-789-7423; debra_cohn@ama-assn.org
) if you have any questions about this program.
Mary Ellen Howard, RSM,
Director
St. Frances Cabrini Clinic of Most Holy Trinity Church
1050 Porter Street, Detroit, MI 48226-2405
Phone: (313) 961-7863
FAX: (313) 965-9891
E-mail: cabriniclinic@sbcglobal.net
Web Site: www.cabriniclinic.org
This race may not have any
finish line, so keep looking for reasons to stop and
celebrate along the way.
President's Message: Autumn Abounds With Activity
By RICHARD SMITH, MD
WCMSSM President
WSU School of Medicine
As you are aware, Dr. John Crissman's contract as Dean of
the medical school was not renewed by the WSU Board of
Governors. Dr. Crissman participated in a number of WCMSSM
activities and committees during his busy tenure as Dean of
the medical school. A search committee has been appointed.
The committee includes a number of WCMSSM members and the
Executive Council's public member, Ms. Mary Kramer (the full
roster is attached). Dr. Robert Frank is now serving as the
interim Dean. Dr. Frank recently attended a medical staff
meeting at Sinai Grace Hospital. He expressed his interest
in becoming a member of organized medicine. An application
and invoice were delivered to his office.
General
Membership Meeting
Many of you participated in the well-attended combined
meeting held at the Magnolia Restaurant at which Dr. John
Nelson spoke about the AMA and its activities, especially on
health care reform. A short time after Dr. Nelson's two-day
trip to Detroit, his editorial board meeting with the
Detroit News resulted in a very favorable editorial on the
AMA plan for covering the uninsured and reforming health
insurance plans for the public.
Delegate Body
Meeting
At the Delegate Body meeting last month, Mr. Dan Schulte,
MSMS legal counsel, spoke extensively about the MSMS and MOA
lawsuit against Blue Cross Blue Shield of Michigan. The
original trial judge has removed herself due to a conflict
of interest and a new one has been assigned. Preliminary
motions have been filed by both sides. We are awaiting the
initial rulings by the judge. Further, the Blues recently
sent a letter to all participating physicians amending the
TRUST agreement. MSMS legal counsel believes this is an
effort to insert provisions that would cover any future
actions to alter participation agreements.
Blue Cross-Blue
Shield of Michigan
The second problem with the Blues continues in the form of
the disaffiliation letter that has been sent to a number of
our members, participating in the Blue Preferred Plus
provider network. Perhaps as many as 700 primary care
physicians statewide have received letters. MSMS and WCMSSM
are compiling information on the disaffiliated physicians to
determine if there is any possible legal course of action
that can be pursued against the Blues.
Beaumont
Lecture
Well over 200 physicians attended this year's lecture during
the MSMS Annual Scientific Meeting. Dr. Paul Bach-y-Rita of
the University of Wisconsin spoke on artificial vision and
the progress he and his team have made in studying the
brain's ability to adapt to different stimuli in blind
individuals that simulate the sensation of sight.
Hospital
Medical Staff Meetings
Since our last meeting, our Executive
Director, Adam Jablonowski and I have attended a number of
hospital medical staff meetings, including: Wyandotte, St.
Mary, Oakwood, St. John, Oakwood-Southshore, Sinai-Grace and
Harper. MSMS Member Service Representative, Rob Beattie,
also attends and provides information on MSMS and its
affiliated organizations that offer a wide variety of
products and services.
Tomorrow's
Child
On Nov. 4, 2004, this child advocacy
organization honored our own WCMSMS Secretary, Dr. Sophie
Womack, along with Sen. Debbie Stabenow and HFHS' Marilyn
French Hubbard. I was pleased to represent WCMSSM at this
semi-annual gala honoring community leaders dedicated to
saving Michigan's babies and eliminating the great disparity
in infant mortality rates.
PriMed
Once again over 500 physicians attended this
excellent continuing medical education program, held at Cobo
Hall over two days. Attendees could have earned as many as
16 CME hours for their participation. WCMSSM staff attends,
meet with members and recruit non-members.
AMA Alternate
Delegate
There are four seats opening up due to retirement or
reinstatement of seats. If you are interested in this
position or know of someone who is, please speak with Adam
Jablonowski about the time commitment for participation in
the AMA. Our delegate body will be voting on candidates in
February.
Upcoming
Events:
-WCMS Foundation 19th Annual Holiday Party for
Underprivileged Children, Detroit Science Center, December
11, 2004.
-Delegate Body Meeting - 6:00 p.m., Wednesday, December 15,
2004, Hyatt Regency Hotel, Dearborn, Speaker- Gail Warden on
the Detroit Wayne County Health Authority.
-21st Century Club's, Healing the Hearts of Children Gala,
Saturday, February 5, 2005, Marriott Renaissance Hotel.
-WCMS Foundation Rhoades Lecture - April 8, 2005, Detroit
Yacht Club, 6:00 p.m. "Healthcare Rationing"
presented by Bruce Goldberg, MD, Administrator, Office for
Oregon Health Policy and Research.
-Combined General Membership Meeting, Detroit Medical
Society, Tri-County Osteopathic Society and WCMSSM, 6:00
p.m., April 20, 2005, Marriott Renaissance Hotel, Detroit.
-MSMS House of Delegates, April 29 - May 1, 2005,
Ritz-Carlton Hotel, Dearborn.
-WCMS Foundation Golf Outing, Essex Golf and Country Club,
Monday, May 9, 2005.
-WCMSSM Annual Business Meeting, Wednesday, 6:00 p.m., May
18, 2005.
-WCMS Foundation Inaugural Gala for WCMSSM President, June
11, 2005.
Editorial: We Can See Our Future Now
By JOSEPH WEISS, MD
Editor
The call for a single-payer health care system continues.
The movement will not stop as long as we have millions of
American uninsured with thousands of hospitals and hundreds
of thousands of doctors bearing the burden of uncompensated
care.
Does single payer really matter to us? Medicare has already
placed us in that box. Blue Cross, Aetna, Health Choices,
etc., base their reimbursements on what Medicare pays. No
health insurer works up its own relative value units or
determines which procedures are bundled and which are not.
No health carrier considers a rate higher than Medicare
allows. Carriers publicly state that their reimbursement
policies are in line with Medicare and privately huddle to
twist their payment policies to gain a lesser rate.
The medical community contributes to the idea of single pay.
An example is the effort of MSMS to increase Medicaid
reimbursement. What we ask for is Medicare rates, in effect
we accept Medicare as setting the standard for what a fee
should be.
How does Medicare set our reimbursements? Recent experience
with the Medicare Modernization Act and and Health and Human
Services' Sustainable Growth Rate formula makes physicians
only too aware of how our rates are set. When government
takes control of health care reimbursement, logic gives way
to lobbying.
As disturbing as that experience is, one could argue that
for physicians in Michigan, our present place in a market
economy is worse than single pay. I refer to the contracts
BCBS-Michigan wants us to accept. The TRUST ( an ironic
name) contract, if we sign it, could bring us to fees lower
than Medicaid pays.
One could argue we would be better off lobbying Congress
than pleading with judges in the slow and quirky Michigan
judicial system.
Physicians know that when single pay arrives, it will not be
the plan the nation needs or eventually will want. What is
likely better, is what no one reading this column today will
live long enough to see. In the far future pharmaceuticals
will be under government control, but doctors' fees will be
determined by the marketplace. Admittedly, this vision is
beyond conception today. But such a mix will balance
overbearing control on the profession with unfettered
independence for the doctor. At the same time the nation
will receive practical and equitable health care.
Doctor Sandler Appointed to the AMPAC Board of
Directors
MSMS Board of Directors Chair Michael A. Sandler,
MD, recently was appointed to the American Medical Political
Action Committee (AMPAC) Board of Directors. The
announcement was made by the AMA Board of Trustees.
Doctor Sandler previously served as chair of MDPAC. A board
certified diagnostic radiologist in Oakland County, he also
has serves as MSMS Board Chair since 2003, and previously
served as Vice Chair as well as Chair of the Legislative
Policy Committee of the MSMS Board of Directors. He has been
a member of MSMS since 1978.
AMPAC is the AMA's bipartisan political action committee and
its goal is to support and elect pro-medicine candidates at
the federal level. With the support of MDPAC, AMPAC is the
largest federal PAC in the country.
Letter: Better Provost Selection Method Needed
This letter was submitted to Mary Kramer,
Associate Publisher/Editor of Crain's Detroit Business, in
her capacity a member of the search committee for a new dean
at the WSU School of Medicine. Kramer is also public member
of the WCMSSM Executive Council.
Dear Ms. Kramer:
At the risk of being repetitious, I would like to
reiterate my personal and professional disappointment for
the manner in which the WSU Provost elected to establish the
search committee for the Dean of the medical school.
As a major urban medical school and with one of the largest
medical student classes, the WSU School of Medicine heavily
influences the characteristics and distribution of
practicing physicians in Southeast Michigan, as you clearly
heard expressed Nov. 17.
We understand the search process is barely off the ground,
however first impressions are usually lasting ones. The
absence of a University Dean as Chair of the search
committee may well give the impression that the position is
subservient to interests other than leadership
identification and selection. The presence of a
preponderance of department chairs and tenured professors
provides the opportunity for those individuals to exert
their departmental priorities, which has the distinctive
danger of deviating from the community good. Unfortunately,
we continue to experience the perpetuation of the
"town-gown" issue, which in all appearances will
not be easily resolved. We no longer seem to have stability
in the office of the Dean to build long lasting
relationships in the community we serve.
We further understand the possible influence of labor in
this process. (We are in Southeast Michigan after all) and
therefore the obvious disproportion.
We note that there is not one single recognizable member of
the clinical faculty or a WSU medical school graduate from
within the community of practicing physicians on the search
committee. Academic and community models exist to put in
place effective search committees to identify, evaluate, and
recruit the best candidate for a very crucial position. This
is, once again, a critical time in the life of the
university, the School of Medicine and the health care of
the community. We appreciate your dedication, expertise and
effort as you join us in conveying this information to your
peers in the search committee.
With very best wishes for
successful deliberations,
Federico G. Mariona,
MD, MBA
Clinical Professor, Obstetrics & Gynecology
Maternal Fetal Medicine
Wayne State University School of Medicine
President-Elect
Wayne County Medical Society of Southeast Michigan
MSMS provides testimony to improve patient safety
At a public hearing Nov. 15 in Lansing, MSMS provided
written and verbal testimony to the Michigan Health &
Safety Coalition to help guide the organization in its new
role as the State Commission on Patient Safety. Gov.
Jennifer Granholm selected MHSC to serve as the State
Commission on Patient Safety after she signed into law
Public Act 119, which created the new agency.
Two additional hearings, which will be used to create a
report on patient safety recommendations for the governor,
where scheduled for Wednesday, Nov. 17 in Southfield, and
Tuesday, Nov. 30, from 9 a.m. to 4 p.m. in Traverse City.
As stated in the written testimony, MSMS has supported
state-level activities to improve patient safety since 2000.
A founding member of the Michigan Health & Safety
Coalition, MSMS has worked diligently to support the various
efforts of the Coalition, keeping physicians involved in
Coalition activities, and educating physicians about patient
safety initiatives. With the transition of the Coalition to
the State Commission on Patient Safety, there is an even
greater opportunity to develop or enhance systems that
support physicians and other health care providers in their
efforts to deliver the best care to Michigan citizens.
MSMS will support the efforts of this new Commission with
all physicians and health care communities in Michigan. Some
specific actions will include:
-Maintaining a list of local physicians involved in various
quality/patient safety initiatives at the state and local
level, and asking those physicians to work with appropriate
MSMS committees to keep our leadership and general
membership informed about their efforts.
-Educating members about state and local initiatives through
a series of articles that profiles their goals and
activities.
-Maintaining awareness of and collaborating with other
organizations, including hospitals and health systems, that
are involved in quality and patient safety activities.
-Using the MSMS Committee on Technology to evaluate
recommendations regarding the consideration and
implementation of policies and guidelines where information
technology can improve the well-being of the patients in the
state of Michigan.
-Continuing efforts to educate physicians about electronic
prescribing as a way to encourage quality, cost and
efficiency.
Ronald N. Horowitz, MD, a Lansing pathologist, testified on
behalf of MSMS and also the Ingham County Medical Society,
re-emphasizing physicians' support of the Coalition and
discussing the need for improved information systems.
MHSC is a group of 15 organizations that includes health
plans and major employers as well as hospital, physician,
consumer and labor organizations in the state. Its mission
is to help improve health care quality and patient safety
across all care settings.
For more information, visit www.msms.org/peml/qpsi/MHSC_patient_saftey.html
or contact Julie Novak at MSMS at (517) 336-5768 or jnovak@msms.org.
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