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AMA President
Nelson weighs in on key issues during Detroit visit
By PAUL NATINSKY
Managing Editor
Our health care system is a boat on a stormy see,
buffeted by strong waves and in great peril, AMA President,
John Nelson, MD, told attendees of the WCMSSM and Detroit
Medical Society Joint Membership Meeting Sept. 21 in
Detroit.
But the future doesn’t have to be that way, he said,
provided physicians work hard to change the current climate.
The AMA has a plan to address major issues facing physicians
(see page 8) but needs the help and action of individual
physicians to move forward.
“Medicine is three interlocking circles that comprise the
tide of professionalism,” said Dr. Nelson. “You can’t
control the waves unless you control the tide.”
Dr. Nelson identified the first circle as an evidence base.
“It’s science, it’s the truth, it’s what makes us
tick as physicians,” he said.
The second circle is the circle of caring; not only caring
for patients, but caring about them.
The final ring is ethics, the principle that puts patients
first.
“If we don’t control the tide, someone else will,”
said Dr. Nelson. “They might not use an evidence base,
they might not care about our patients and they might not
have the same ethics that we do.”
Dr. Nelson, an OB/GYN, told the story of Mary, a patient who
for whom he delivered three healthy babies through three
challenging pregnancies. When she moved to a distant town,
he thought he’d seen the last of her. That is until she
got pregnant and drove a great distance to receive his
services. Her reason: Dr. Nelson is her doctor.
As rewarding as such instances must be, Dr. Nelson told
other stories. Stories of the “waves” that can sink the
boat. He told a story at the request of a family about a man
who was in a serious car accident on the way to McCarran
Airport in Las Vegas. The Level I trauma center at the
University of Nevada Las Vegas was minutes away, but had
closed two days prior because doctors there couldn’t pay
the high medical liability insurance premiums anymore.
Dr. Nelson also told of a Wyoming woman who had to drive out
of state to have a caesarean section delivery because she
couldn’t find a hospital any closer that would perform the
procedure.
Dr. Nelson spoke strongly about three issues he views as top
priorities.
“The most significant problem facing America today is 45
million people without access to health care coverage. We've
got to solve that problem. The AMA has a plan of which I'm
proud. It talks about advanceable, refundable tax credits
inversely related to income. Advanceable means you get them
at the first of the year when you need them. Large enough to
buy real insurance that works. Refundable means you get them
whether you pay taxes or not. Inversely related to income
means the poorest get the most help because that's fair.
That project alone will cover 85 percent of those 45 million
people because 85 percent of those people either have a job
or live in a family where somebody has a job. I don't know
if it will cover the other 15 percent. But if it doesn't,
maybe you have an idea that will help cover that 15
percent.”
Dr. Nelson also discussed the flawed Medicare payment
system, particularly the Sustainable Growth Rate formula
used to determine remuneration for physicians.
“The sustainable growth rate. Those three words are the
biggest lie in Washington. It is a rate, it's not
sustainable and it's not growth - it's a cut. What happened
last year was the correction of a clerical error. We got an
act of Congress. It restored $58 billion over 10 years to
the Medicare program that was only taken out in the first
place because of a clerical error.
“The Medicare Modernization Act came up, with some warts
on it. Nonetheless, it was the first time Medicare had been
substantively changed since 1965. We got a reprieve. We were
given two years to come up with a better formula. One of
those years is gone. No one wants to talk about it because
we have an election. They want to talk about
‘substantive’ things. But the AMA has a plan to fix the
formula and we're grateful for that.
“We need to have appropriate payment so that physicians
can keep their offices open. A doctor in Florida told me the
other day that it costs him $10 more to keep his office open
than what he is paid. He can't keep his office open at a
loss, that is why I'm concerned.”
Dr. Nelson illustrated the damage caused by our “broken
medical liability system.” He said only 68 percent of OB/GYN
residencies were filled during the past year. Four-hundred
neurosurgeons are retiring each year, but the nation’s
medical schools are training only 100 per year. The result
is what Dr. Nelson called “a law of diminishing
returns.”
He said medical liability premiums force many doctors to
retire, restrict their practices or move to a state where
liability reform has taken place. The result is reduced
access to health care in many parts of the country.
“The AMA has a plan for that too,” said Dr. Nelson.
“We believe that when there has been an injury caused by a
physician, that person who has been harmed should be paid
all of the money that that person is owed, for medical care,
prostheses, medication, lost wages, hospice care, future
earnings; and that there is pain and suffering. So we want
to pay them a reasonable amount of money. We suggest a
quarter-million dollars per case where there is negligence.
Others say there should be no limit. What happens is there
is a tremendous amount of money given in the so-called pain
and suffering area, which is not quantifiable. It is easy to
write a check when someone else is paying the money. So
what's happened is that the premiums have gone up
tremendously.
2004 WCMSSM Children’s Holiday Party Contributors
Beth Ann Brooks, MD
Gwendolyn H. Parker, MD
Dr. S.V. Mahadevan
Dr. Mary and Rev. William S. Logan
Homer Smathers, MD
Dr. Michael and Halena Yurkanin
Dr. & Mrs. Mark F. Pezda
John M. Malone, Sr., MD
M. Natacha Umlauf, MD
Indu & Bala Pai
Dr. and Mrs. Homer A. Howes
Arthur J. Frazier, MD
Phyllis A. Vallee, MD
Eastside Dermatology/
Dr. Lisa Manz-Dulac & Associates
Dr. David & Mrs. Barker
Iris & Fred Whitehouse
Dr. and Mrs. Ellis J. Van Slyck
Michael A. Sandler, MD
Louis Z. Shifrin, MD
Dr. and Mrs. Martin Daitch
Andrew Wilson, MD
Kathleen Yaremchuk, MD
In Memory of Drs. Shailesh & Ishu Acharya
Scott Monson, MD
Paul Mazzara, MD
Elizabeth W. Edmond, MD
Louis J. La Joie
Grosse Pointe Dermatology Assoc.
Maryjean Schenk
Dr. & Mrs. John Calwell
John Kurtz, MD
Kurt A. Kralovich, MD
Krishna & Pamela Sawhney
Joseph J. Weiss, MD
John M. Flack, MD, MPH & Jennifer Flack, JD
Vincent Yu, MD
Drs. Lalitha and Babu R. Vemuri
EDITORIAL: In The Name Of Clarity, More Confusion
By JOSEPH WEISS, MD
Editor
In a letter sent to all physicians on Sept. 9, BCBS
stated that their purpose was to clarify two issues:
(1) TRUST office visit fees as applied to Auto workers, and
(2) The Blue Preferred Plus plan to drop 700 primary care
physicians.
On the same day, the Michigan State Medical Society filed a
law suit seeking a court judgment stating that physicians
are not obligated to charge TRUST office visit fees to auto
workers. In addition, the MSMS suit requested an injunction
preventing BCBS from terminating a physician from all BCBS
insurance business if that physician refused to implement
the BCBS arrangement.
The BCBS letter began by stating that the TRUST agreement
covers BCBS underwritten and administered plans, the
administered ones being the self-funded plans for which BCBS
is not the underwriter. Physicians should disregard that
statement. MSMS legal counsel has already established that
TRUST agreements as now written can only apply to BCBS
underwritten plans. There is no basis in TRUST contracts
signed by doctors or in contract law that allows BCBS to
transfer the TRUST agreements to BCBS's arrangements with
the automakers.
The next paragraph in the letter possibly is a concession by
BCBS. Originally the Blues stated that any physician not
accepting the imposed fees on office visits would be dropped
from any and all BCBS and BCBS sponsored plans in which the
physician participated. This statement is the reason the
MSMS suit asks for an injunction.
The Blues Sept. 9 letter states a different stance: "We
also want to assure physicians that they will not affect
their business relationship with BCBS by charging Auto/UAW
patients higher fees than the TRUST fee schedule for office
visits. "Likely, physicians can take that statement to
mean that BCBS will not drop a physician for charging an
independent fee. A clearer statement would be to say
outright that BCBS is rescinding its initial declaration to
drop doctors not accepting the office visit part of the
Auto/UAW agreement.
BCBS could have avoided this whole controversy. The Blues
could have informed the state's physicians of the Auto/UAW
agreement, and asked doctors who wanted to participate to
sign a contract which included the reimbursement arrangement
on office visits. Likely, most doctors when given a choice
to choose would have agreed.
Remember, the present controversy is not on fees but over
principle. MSMS filed a lawsuit because the BCBS use of the
TRUST agreement in the auto contracts cannot go
unchallenged. If the precedent taken by BCBS in this
contract is allowed to stand, there is nothing to prevent
BCBS from negotiating anything the employer wants or adding
other services that are "covered" but require a
100 percent copay by the patient. Physicians cannot accept
the imposition of such contract conditions.
The second part of the letter deals with Blue Preferred Plus
(BPP) network and BCBS's announcement that it will drop 700
primary care physicians from the network. The Sept.9 letter
states that the reason is because: "Declining
membership and high benefits costs compelled our auto
customers to make a business decision…"
The letter does not explain that if the cost/patient is say,
$9,000 a year, with a pool of 4,000 doctors, why the cost
will become any less per patient, if that auto group is
cared for by 3,300 physicians. Furthermore, the letter
states that physicians to be terminated will be informed at:
"…the end of October." Three paragraphs down,
BCBS states that physicians wanting a reconsideration of
termination must have the request for review into BCBS no
later than Oct. 23. Also, sandwiched in between these
statements is an acknowledgement by BCBS that termination of
a physician requires a 60-day advanced notice.
In the Sept. 9 letter BCBS deals in fuzzy thinking and
arcane legal logic at the expense of common sense and
fairness. The physician community that faithfully fulfills
its commitments deserves better; what we cannot obtain by
cooperation we will gain through conflict. Let the court
battle rage.
EDITORIAL: Tax Breaks, Vouchers May Answer
Health Insurance Needs
The following editorial first appeared in the
Detroit News Sept. 29. It is reprinted with permission.
A proposal by doctors to help the uninsured buy
coverage offers common sense solutions to crisis. The
Detroit News The American Medical Association is offering a
refreshing new approach that relies on the power of
consumers to bring down the cost of health insurance and put
affordable coverage within the reach of the uninsured. It
deserves a serious hearing in Washington.
The ballooning population of uninsured is not a theoretical
worry for the association, which represents doctors. They
understand that uninsured patients wait too long to seek
care, and then that care becomes much more costly.
Ultimately, taxpayers and insured patients end up covering
the bill. The AMA proposes a health care tax credit allowing
the cost of health insurance purchased by individuals to be
deducted from their taxes, which is similar to the credits
big corporations receive for providing employee health
insurance benefits. Those who don't earn enough to pay
income tax would get an advance voucher from the government
to help cover the cost of insurance premiums. What sets
apart the AMA's plan is that it would extend tax credits not
just to the uninsured, but to all Americans, even those who
currently get coverage from their employers. That would
increase coverage options for workers not satisfied with
employer plans. And since they own the insurance policy,
individuals would keep it even if they lose their job. The
AMA is betting that consumers who buy their own insurance
will demand more cost-effective options, bringing more
diversity of coverage and lower prices into the health
insurance market. The biggest impediment faced by
individuals attempting to buy health insurance is the high
cost - since they can't pool their risk like large employers
do, they get much higher premiums. The AMA would reform the
insurance market to make it easier for individuals to form
pools to purchase group insurance. The AMA's proposal has
some drawbacks. Universal tax credits would raise the
government's health care obligations at a time when it is
having difficulty paying for current programs. The
association estimates the credit would cost the federal
treasury at least $50 billion a year. But inaction is also
costly. The indirect cost of the uninsured to government and
insured patients exceeds that $50 billion figure. The AMA is
offering a credible blueprint for fundamental health care
reform. It deserves a hearing in Congress.
Canadian health care workers get certification
extension
Move intended to avoid disruption in patient care
US Citizenship and Immigration Services (USCIS)
announced this summer that certain foreign health care
workers from Canada and Mexico will remain exempt, for a
period of one year, from the foreign health care worker
certification requirement. The announcement was published in
the Federal Register. This exemption applies only to
Canadian and Mexican TN (NAFTA professional) health care
workers who were employed as TN nonimmigrant health care
workers before Sept. 23, 2003 and held a valid license from
a US jurisdiction before Sept. 23, 2003.
On July 23, 2003, USCIS announced that, after July 26, 2004,
foreign health care workers, other than physicians, who are
subject to the foreign health care worker certification
requirement, are inadmissible, and ineligible for an
extension of status or change of status if already in the
United States, unless they present a certificate granted by
an approved credentialing organization.
That one-year transition period was sufficient for the vast
majority of foreign health care workers. In the case of
Canadian and Mexican TN health care workers, however, USCIS
has determined that an extended transition period is needed.
Many Canadian and Mexican citizens working in the border
regions regularly travel across their respective borders.
Because the process of obtaining certification is not an
immediate one, USCIS has extended the transition period for
Canadian and Mexican TN health care workers only for an
additional year. This will ensure that there is no
disruption to the regional health care systems along the
Canadian and Mexican borders.
Congress mandated the certification requirement in the
Illegal Immigration Reform and Immigrant Responsibility Act
of 1996.
(See related story, page 10 – Ed.)
MSMS Payer Solutions Network News:
ICD 9 update reminder
It is important that you now begin using the
updated ICD-9 CM diagnosis codes since the US Centers for
Medicare & Medicaid Services eliminated the 90-day grace
period for transitioning new codes, which became effective
on October 1. HIPAA requires usage of the medical code sets
that are valid at the time the service is provided.
Changes to the ICD-9 codes are categorized as new codes,
revisions to existing codes, and discontinued codes (codes
that will no longer be valid after Oct. 1).
For more information about reimbursement issues, contact
Stacie Saylor at MSMS at (517) 336-5722 or ssaylor@msms.org.
For more news and information, view MSMS publications such
as Medigram, Michigan Medicine, and the Monthly Top 10
online at www.msms.org.
MSTRO Resident Competition Awards
On May 13, 2004, the Michigan Society of Therapeutic
Radiologists and Oncologists (MSTRO) held their annual 2004
Delmar H. Mahrt, MD, Resident Research Competition. The
meeting is an opportunity for the residents from the four
radiation oncology training programs in Michigan to present
their clinical and laboratory projects. Residents from Henry
Ford Hospital, the Detroit Medical Center, William Beaumont
Hospital and the University of Michigan Medical Center
participated this year with eight abstracts presented.
The abstracts presented this year were diverse in subject
and all the submissions were of high quality, indicating
everyone’s hard work over the past year. The winner of the
clinical competition was Dr. Daniel Krauss from William
Beaumont Hospital. He presented, “Dedicated Cardiac MRI
Assessment of Reduced Irradiated Left Ventricular Volume Via
Active Breathing Control in Left Sided Breast Cancer.” The
winner of the laboratory competition was Dr. Daniel A.
Hamstra from the University of Michigan Medical Center. He
presented, “Non-Invasive Imaging of p53 Dependent Gene
Expression in Vivo Following Chemoradiotherapy.”
The meeting supports the important mission of MSTRO to
support research in Radiation Oncology. In addition, it is
the only forum for the residents from all the training
programs in Michigan to come together in a collegial
setting.
The AMA’s Big Six Issues
The AMA has identified six issues that warrant special
focus in support of patients, physicians and policy makers
to cure our troubled health care delivery system:
FINANCE CARE FOR
LOW-INCOME PATIENTS
The AMA will seek to expand health insurance options through
changes in the federal tax code that will facilitate the
transition from an employer-based to an individually owned
insurance system. This will empower patients, preserve the
patient-physician relationship, and facilitate the
development of new strategies to extend coverage to the
uninsured.
HEALTH INSURANCE REFORM
The AMA proposes expanding health insurance coverage and
patient choice of health plans by: (1) enabling individuals
to choose and control coverage for themselves and their
families through a system of "defined
contributions," (2) fostering a health insurance market
that offers products that are affordable for individuals and
families and is responsive to their needs, and (3) providing
refundable tax credits to enable and encourage the uninsured
to purchase health insurance.
MANAGED CARE ISSUES/
PRIVATE SECTOR ADVOCACY
The AMA has several tools designed to help physicians solve
problems with managed care companies and insurers, including
devices for reporting difficulties with individual plans.
See the AMA Web site at www.ama-assn.org
for more information.
PATIENT SAFETY
House and Senate bills create confidential, voluntary
reporting systems in which physicians and other health care
providers can report information on errors to entities to be
known as Patient Safety Organizations (PSO). The PSOs will
collect and analyze unique “patient safety data” and
provide feedback on patient safety improvement strategies.
Specifically, this legislation creates a confidential,
voluntary reporting system in which physicians, hospitals,
and other health care providers can report information on
errors to organizations known as Patient Safety
Organizations (PSOs); allows PSOs to collect and analyze
unique “patient safety data” and then provide feedback
on patient safety improvement strategies; provides that
"patient safety data" will be confidential and
legally protected; does not limit or affect the availability
of any information or evidence that is currently available
from sources other than the PSO and can be collected under
existing law; provides for appropriate penalties for
unlawful disclosures; recognizes and preserves the
protection of confidential patient information under the
Health Insurance Portability and Accountability Act of 1996;
does not preempt other state and federal peer review laws.
On July 22, 2004, the Senate passed S.720, an important
quality improvement initiative that would create a system in
which health care professionals share and analyze
information about errors to prevent similar incidents from
recurring. Now, the House and Senate will conference
then send the bill to President Bush for his signature on
this critically important legislation for the safety of our
patients.
The S.720/H.R. 663 Senate conferees are Sens. Gregg (NH),
Frist (TN), Enzi (WY), Alexander (TN), Kennedy (MA), Dodd
(CT), and Jeffords (VT). House conferees have yet to be
named.
AMERICA’S LIABILITY
CRISIS
The US House of Representatives has repeatedly passed strong
medical liability reforms and President Bush has called for
action on this issue. The final hurdle is the US Senate.
Please contact your Senators today and tell them that it is
time to put America’s Patients First by passing strong
medical liability reform!
On Wednesday, May 12, 2004 the US House of Representatives
passed H.R. 4280, The HEALTH Act of 2004 by a vote of
229-197. This legislation is an important step in solving
today’s medical liability crisis in America which is
threatening access to quality medical care, slowing efforts
to improve patient safety, and adding billions of dollars in
additional costs to our health care system. Because of
skyrocketing insurance premiums and a broken liability
system, physicians are being forced to limit services,
retire early or move to a state with medical liability
reforms leaving patients unable to receive the care that
they deserve.
The HEALTH Act of 2004 (Help Efficient Accessible, Low-Cost,
Timely Health Care) will safeguard patients' access to care
through the common sense reforms and help to relieve a
system that is already strained to the breaking point.
This common sense legislation allows patients to recover
economic damages such as future medical expenses and loss of
future earnings while establishing a cap on non-economic
damages, such as pain and suffering, of $250,000.
The law would also allocate damages fairly, in proportion to
a party's degree of fault and limit the number of years a
plaintiff has to file a health care liability action to
ensure that claims are brought while evidence and witnesses
are available.
The US House of Representatives passed a similar measure in
March of 2003 and President Bush has said he would sign a
medical liability reform bill into law if it came to his
desk.
It is now up to the US Senate to pass this important
legislation which will work to solve the medical liability
crisis in America and provide relief to patients and
physicians.
STRENGTHENING MEDICARE
The underlying formula that sets Medicare payments to
physicians, known as the Sustainable Growth Rate (SGR), is
fundamentally flawed, and leads to dangerous payment cuts
that jeopardize Medicare patients' access to care. The AMA
believes the time has come to replace the flawed SGR formula
with an annual update system that reflects actual increases
in physicians' costs. The AMA is working with the Bush
Administration and congressional leaders in both parties to
lay the groundwork for change.
Recently, the US Senate and House sent letters concerning
Medicare's flawed SGR formula to the Centers for Medicare
and Medicaid Services (CMS). Seventy-three Senators signed
the Senate letter and 241 Representatives signed the House
letter.
Canadian health care workers can
continue critical work in Michigan
Congresswoman Candice Miller heralded a decision by the
Department of Homeland Security (DHS) to extend the deadline
for Canadian nurses – who have been certified to work in
the United States since on or before Sept. 23, 2003 – for
one year until July 26, 2005, in accordance with a law
prohibiting foreign health care professionals from crossing
the border without a certificate from the Commission on
Graduates of Foreign Nursing Schools (CGFNS).
The law previously stated that all foreign health care
professionals must have their CGFNS certificate starting
July 26, 2004. All Canadian nurses certified after Sept. 23,
2003 must still comply with the deadline at the end of this
month.
"Every day, more than 3,000 health care professionals
leave their homes in Canada and commute to Michigan to treat
Michigan patients in Michigan hospitals," Miller said.
"These new restrictions from DHS threatened to severely
clog the daily flow of health care workers into Michigan,
with so many people needing their certificates and only one
organization available to process their applications.
Without DHS intervention, many nurses would have been denied
entry into our country, effectively disrupting the quality
of hospital services."
In April, Rep. Miller and her colleagues in Michigan's
congressional delegation sent a letter to DHS Secretary Tom
Ridge asking for a solution to ensure these Canadian health
care professionals could both meet these new requirements by
the July 26 deadline and continue to work in Michigan
hospitals.
DHS announced that foreign health care professionals
certified to work in the United States prior to Sept. 23,
2003 (when the regulation was issued) will be given an
additional year to comply with the new requirements.
According to figures supplied by DHS, this new regulation
should eliminate more than 90 percent of the outstanding
cases and get rid of the looming backlog of applications.
"This is great news, particularly for those of us in
Southeast Michigan, where a majority of these Canadian
healthcare professionals work," Miller said. "With
this compromise in place, we can rest assured knowing that
caring and competent nursing professionals are ready and
available when you need them.
EDITIORIAL: The Car Repair Model For Health Care
By PAUL NATINSKY
Managing Editor
Debates about health policy often become steaming cauldrons
of emotion and cause the debaters to lose perspective.
Gaining back that perspective could prove beneficial to all
involved and maybe even lead to some solutions.
When the delivery of and payment for health care services is
considered from a broad perspective it finds itself in close
company with other basic needs in modern society, such as
the acquisition of food, shelter, and transportation.
The need for transportation is a good point of comparison
because it ranks as an important basic need and serves as an
apt analogy for how we might more efficiently and fairly
deliver and pay for health care services.
Its rank as an important need might at first blush seem
peripheral but, upon closer inspection, it becomes primary.
Lack of transportation is a barrier to receiving adequate
health care services. There are not many physician offices
in inner cities. Those who are too poor to own a car or pay
for a taxi in a metropolitan area that lacks effective
public transportation find themselves in a quandary when
seeking primary and preventive health care services.
How we obtain and maintain a source of transportation (in
this city namely a car) provides a terrific analogy for how
we might consider health care delivery. State law requires
that drivers buy car insurance and drivers who can afford it
tend to buy more than the minimum in case an automotive
catastrophe befalls them. Typically, we buy the coverage we
can afford, only use it if we get in an accident, and pay a
substantial deductible before receiving our insurance
benefit. If we are too poor to buy much insurance, a safety
net protects us by paying for our injuries and/or lost
income, but not for the damage to our car.
However, if our car develops a problem on it's own, our
water pump blows, or our radiator springs a leak, our
insurance benefits do not come into play. If chronic neglect
causes our car to suffer complete engine destruction in the
middle of the Lodge Freeway, our insurance pays not a penny.
Somehow, most people find a way to pay for car repair and
insurance. They might be forced to put repairs on expensive
credit cards or drive used cars. Most cities have public
transportation that greatly assists those too poor to own,
insure and maintain a car.
So what if we expected patients to pay $50 for an office
visit when they are sick? What if we asked them to
"change their oil and filters" by coming in
periodically for a checkup, which might cost a little bit
more money? What if paying out-of-pocket for
"repairs" and "routine maintenance" to
our bodies helped doctors get paid and reduced our insurance
premiums? For those who can't afford it, we have
"public transportation," read Medicaid.
Paying for routine and preventive care would put a strain on
some families to be sure. But increasingly this
responsibility is being shifted to patients anyway. Consider
the "100-percent copay" put into place by one of
the Big Three automakers, or the $5,000 deductible put into
place by another. Perhaps it's too late to end the folly of
first-dollar coverage before it is forced on patients by
their employers.
Perhaps it's not too late to late for patients and
physicians to reap some benefit from the shift toward direct
patient payment for services. If patients forewent
first-dollar coverage in favor of catastrophic coverage for
high-ticket services such as heart surgery, cancer treatment
or treatment for severe trauma, premiums could decrease,
freeing up money to spend on routine care or save for future
emergencies, medical or otherwise.
If this sounds like a pitch for tax-deductible medical
savings accounts, it’s not. This kind of perspective works
even if patients save the money in bank accounts, use it for
education or invest it. Money not spent on premiums for
first-dollar coverage is free to be employed elsewhere.
While it could be used to cover future routine care, the
choice would remain with the individual.
Other side benefits might accrue. Choice of physicians,
particularly for primary and preventive care could increase
as the need to keep patients in physician networks would
abate. Payments in most cases would be made directly from
patients to physicians, cutting out troublesome
administrative costs and allowing physicians to charge and
receive market value for their services.
Whether these additional benefits occur or not, the trend is
toward patients paying more and doctors increasingly being
caught between patients and insurance plans. If patients are
going to pay a greater share of their health care service
bills and doctors are going to be asked to collect it,
shouldn't they be the parties who decide the terms?
OBITUARIES
Jack Mandiberg, MD
Jack Mandiberg, MD, passed away in 2003. He was born
December 2, 1914. Dr. Mandiberg was beloved husband of Helen
Mandiberg, dear father of David Mandiberg, Lois (Richard)
Friedland, Dr. Joseph (Linda) Mandiberg and Takao Nagai.
Dear grandfather of Rachel and Ben Friedland, Michael and
Stephen Mandiberg. WCMSSM members morn his loss and pass
their condolences to Dr. Mandiberg’s family and friends.
Rafael E. Quinones, MD
WCMSSM members and staff fondly remember Rafael E. Quinones,
MD, who died November 23, 2003. He was born November 11,
1925. A University of Tennessee Medical School graduate in
1949, Dr. Quinones then completed his internship at Grace
Hospital in Detroit. Dr. Quinones was a surgeon who
completed a four-year fellowship at the Mayo Clinic.
Donald I. Bryan, MD
Donald I. Bryan, MD, 88, died March 1, 2004 in Home of Hope
Hospice in Grand Rapids. He was born in Stevens Point,
Wisconsin, February 9, 1916. Dr. Bryan earned his medical
degree from the University of Minnesota School of Medicine.
He served in the Army Medical Corps during World War II in
Africa, Italy and France. Preceding him is death was his
beloved wife, Laura, who passed away November 10, 1996.
Surviving are his son, Donald Quinn (Peggy) Bryan; his
daughters, Margaret Bauw, and Elizabeth Bryan; three
grandchildren, Heather Bryan, Laura (Ronald ) Pleune, J.
Bryan Bauw; and several cousins.
Harvey Vincent Kroll, MD
WCMSSM was saddened to learn that Harvey Vincent Kroll, MD,
passed away June 22, 2004 in Rancho Mirage, California. He
was 90 years of age. He was a very well known and highly
respected cardiologist in the Detroit area for more than 50
years. Dr. Kroll is survived by seven children, 12
grandchildren and seven great-grandchildren. WCMSSM members
and staff will deeply miss Dr. Kroll and his contributions
to the Detroit health care community.
Charles Kessler, MD
Charles Kessler, MD, 83, of Huntington Woods, died July 3,
2004. After graduating with a medical degree from the
University of Virginia, Dr. Kessler practiced urology in the
Detroit area for 37 years. He coached little league
baseball, was an avid reader and took classes in French. Dr.
Kessler is survived by his wife, Josephine “Jo” Kessler;
son and daughter-in-law, Dr. Daniel Kessler and Cathy Cordes;
daughters and sons-in-law, Amy Kessler and Jim Slowik, Dr.
Susan Kessler and Bruce Shaw; grandchildren, Jonathan, Emily
and Sarah Shaw; sister and brother-in-law Bertha and Al
Raifman; brother-in-law and sister-in-law Lenora and Al
Dorenfest; brother-in-law, Raymond Dreezer.
Lawrence Comstock, MD
Lawrence Comstock, MD, died August 13, 2004. He was 94 years
old. Dr. Comstock cared for thousands of patients during a
career that spanned more than 50 years. He was the chief of
staff at the former Wyandotte General Hospital and Seaway
Hospital in Trenton. He had a private practice in Trenton
and was that city’s health officer during the 1950s. He
earned his medical degree from the University of Michigan in
1940. Survivors include two daughters, Martha Ebeling and
Susan Cole; a son, Charles; 10 grandchildren; and two
great-grandchildren.
Frank P. Raiford III, MD
Frank P. Raiford III, MD, died from complications of kidney
disease August 25, 2004. He was 84, and still had his family
medicine practice in Detroit. Dr. Raiford’s father was a
physician and a co-founder of Detroit’s Trinity Hospital
at East Congress and DuBois streets. He graduated from from
the University of Michigan Medical School in 1943 and served
in World War II as a medic. Survivors include three
daughters, Schera Byas, Perryne Thompson and Jill Hewitt; a
son, Kevin; six grandchildren; and a great-grandson.
Richard A Wahl, MD
Richard A. Wahl, MD, recently passed away. He was an OB/GYN
born February 23, 1934. He earned his medical degree from
the University of Illinois in 1959. He performed his
residency at Providence Hospital in Detroit in 1960-1963. He
will be missed by colleagues in the medical community.
WCMSSM was sorry to hear of his passing.
WCMSSM Foundation Memorial
Fund Contributers
(All in memory of Agnes Borchak)
Darlene Henderson
Dr. & Mrs. Martin Daitch
Dorothy Borchak Ambrozy
Krishna & Pamela Sawhney
Contributions to the
Memorial Fund are always welcome and a nice way to remember
friends and colleagues who have passed away.
The following active members were dropped from
WCMSSM and MSMS
for Non-Payment of 2004 Dues
James D. Adamo, MD
Samira Ahsan, MD
James J. Andonian, MD
Ila Bansal, MD
Elaine A. Barbieri, MD
Sean C. Blackwell, MD
Frank M. Bogun, MD
Cecilia A. Buot, MD
Ginette V. Busschots, MD
David Carswell, MD
Vincent C. Chan, MD
Kassem M. Charara, MD
D. Hari-Kumar Dandapantula, MD
Gunter Deppe, MD
Jose-Marie Albert El-Amm, MD
Naser M. Elsouri, MD
Helen Etemadi, DO
Naiel G. Faraj-Rahim, MD
Frank M. Fayz, MD
Dawn D. Foster, MD
Carl D. Fowler, MD
Thomas Giancarlo, DO
Lisa Rene Gnas, DO
Robert J. Gordon, DO
Narshimha R. Gottam, MD
Issa T. Haddad, MD
Maurice Adams Hall, MD
Magdy M. Hanna, MD
Nafees Hasnie, MD
Paul D. Havenstein, MD
Charlene B. Irvin, MD
Elsa A. Isip, MD
Jitender K. Jain, MD
Raymond Jones, MD
Latha T. Kannan, MD
Velji K. Kansara, MD
Adi Kaza, MD
Riad Khatib, MD
Kathleen M. Kleinert, DO
Conrad C. Maitland, MD
Jesus A. Martinez, MD
Philip J. Mayer, MD
Holly A. McKeever, MD
Madeline M. Melencio-Posadas, MD
Joram O. Mogaka, MD
Lisa M. Moody, MD
Robert T. Morris, MD
Alfred K. Newton, MD
Wafa Odeh, MD
Kavitha Ponduri, MD
Shabana Rasheed, MD
Pamela L. Reaves, MD
Pritpal Sandhu, MD
Donn M. Schroder, MD
Iva A. Smolens, MD
James M. Tucci, MD
Rennard B. Tucker, MD
James F. Urbanick, MD
Peter V. Vaitkevicius, MD
Mary W. VanDike, MD
Martin B.VanDort, MD
Jaya L. Vankayalapati, MD
David A. Vila, MD
Sudhir S. Walavalkar, MD
Denege A. Ward, MD
Deborah L. Webb, MD
Jerome Wilborn, MD
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