April 24, 2006

Editor's Column: Who Is 'Getting It Wrong?'
Executive Director's Column: Keeping Our Noses To The Grindstone
Hiding The Truth In Truisms
WCMS Foundation's 13th Annual Golf Classic
Massachusetts Mandate
Health Information Tech Standards Still A Few Years Away
Searching For Authors
MSMS Leadership Summit

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Editor's Column:
Who Is 'Getting It Wrong?'

By JOSEPH WEISS, MD

In a recent lead article in the New York Times, business columnist David Leonhardt wrote a column titled, Why Doctors So Often Get It Wrong.

According to Leonhardt, the “it” is diagnosis, and the reason we are wrong so often is because we have no incentive to get it right. To quote his words: “There is no bonus for curing someone and no penalty for failing.” He considers doctors as being paid to order tests, do surgery, and write prescriptions. Leonhardt sees the profession as having no incentive to work carefully or “double check their instincts.” His solution is to pay doctors extra for getting right diagnosis, and introducing us to medical software. He gives high praise to a software program that hospitals can purchase for $80,000. Loenhardt thinks the software a marvel because: “all doctors need to do is type in symptoms and the program spits out a list of causes.”

First, he disregards completely that as professionals we have reason to do the best job possible, He has no concept that a good standing among our colleagues acts as a powerful incentive to do high quality work. The threat of malpractice as unpalatable as it is, pushes us to quality in our medical practice and consideration of the patient. Moreover, as a business columnist, Mr. Leonhardt should be sensitive to the role that quality plays in keeping patients and attracting new ones.

Second, he shows abysmal ignorance of the way medicine remains a craft. Diagnosis is more than plucking something from a list generated by a computer; and it can take years before one knows that a diagnosis or treatment was “right.” Furthermore, the reasons an outcome is good (right) or bad(wrong), may have little to do with what you or I as physicians did.

Physicians cannot laugh off this columnist as merely a fool. The New York Times built a reputation and maintains a high profit margin because millions of people believe what they read in its pages. We must counter his ignorance. The best way to do so is by educating our patients.

We need to bring each patient with us as we undertake the journey of their care. Only by sharing with them our doubts and questions will we teach them that medicine is still art, and that the unexpected, catastrophic, and unknown are the defining features of personal health.

Executive Director's Column:
Keeping Our Noses To The Grindstone...Together

BY ADAM JABLONOWSKI, MPA

While the medical society at the state and county are engaged in a whirlwind of administrative and policy making activities * annual business meetings, House of Delegates, Presidents' inaugurals * we continue to be engaged in the issues of the day. As many of you know, the medical school and its hospital partner are in a very strained relationship which is not in anyone's best interest: certainly not the patients being seen by students, residents and faculty! At the same time, Blue Cross continues to commit blunders which it blames on its antiquated computer system. The uninsured apparently will always be with us (unlike in Massachusetts) as we approach another Cover the Uninsured Week. The Congress continues to dither with Medicare changes that are essential as we approach the massive influx of baby boomers into coverage by the feds. And of course in the midst of all of this, here in SE Michigan we face the serious economic repercussions of continuing high unemployment and more lay-offs by the autos and their suppliers. And what are we doing for you lately: Trying to stay on top of all this and much more? In order to do that, we need every bit of help we can get from the members through their participation. Additionally, we need all those physicians who have not joined organized medicine to become members. Remember, together we are stronger.

Hiding The Truth In Truisms

By GEORGE SHADE, MD

Editor’s note: the following is commentary on Dr. Weiss’ editorial on patient empowerment from the April 10 edition.

It is interesting in how one can hide The Truth in truisms. It is a truism that there is waste in health care. The Truth is that it comes not from physicians per se, as bureaucrats would have the public believe, but more so from an ever burgeoning corporate bureaucracy within the healthcare industry that becomes less and less accountable to the premium payers of health care insurance or their enrollees. The beneficiary of policy has become the maker of health care policy. Where are the checks and balances? The industry dictates levels of compensation, need for service, quality of service and length of service by their intricately woven rules and regulations that determine and govern who shall and shall not participate in their plan. If we as educated and experienced practicing physicians cannot unravel the knot that has been tied, then how can we expect the lay public to do a better job?

As was mentioned in another article, Master Medical was an attempt to put the money directly in the hands of the consumer and trust them to pay their medical bills in a timely and responsible manner. All that resulted, for the most part, was patients pocketing the money and leaving their medical debts unpaid. Is this type of anarchy something we want to revert back to? I should hope not. This makes as much sense as an automotive manufacturer giving a new car to a customer and the have the check from the finance company for the purchase of that car sent directly to the consumer for him or her to ultimately pay the dealership.

WCMS Foundation's 13th Annual
Golf Classic

Monday, May 8 2006
Lochmoor Club, Grosse Pointe Woods
Click here for to register.

Massachusetts Mandate

By PAUL NATINSKY
Managing Editor

In Michigan you have to insure your car to drive; in Massachusetts soon you will have to insure your health or face penalties. Gov. Mitt Romney signed a bill April 12 that is intended to extend health care coverage to Massachusetts’ 460,000 uninsured by requiring all residents in the state to buy health insurance.

Exceptions are made for people earning less than the federal poverty level. The poorest individuals will pay a small copay and no premium. A sliding premium schedule based on income tops out at $200 to $250 per month. Tax penalties of about $1,200 would attach to those who choose not to buy health insurance.

News reports say Romney, a Republican, is likely to line-item veto a provision in the law that places a $295 per employee annual tax on employers who do not offer health insurance to their employees. The Democrat-dominated legislature likely will override the veto.

Reports indicate that part of the impetus for the legislation was the choice among many low-income working people to forego health insurance to pay for other essentials and use hospital emergency rooms as their primary source of health care.

Princeton University health economist Uwe Reinhardt told the Washington Post that he views the American system of allowing uninsured patients to receive care at the government’s expense as nothing more than “freedom to mooch.” He told the Post, “Massachusetts is the first state in America to reach full adulthood. The rest of America is still in adolescence.”

Still, fears abound in some quarters that even reduced-premium plans will be unaffordable for a substantial percentage of the working poor.

The cost of the health care package is expected to be $316 million the first year, climbing to $1 billion in the third year, according to the Associated Press.

Health Information Tech Standards Still A Few Years Away

By PAUL NATINSKY
Managing Editor

Panelists in an April 10 web cast at www.bcbshealthissues.com said the work of a government advisory panel on health information technology will likely become policy in one form or another.

“The secretary (Health and Human Services Secretary Mike Leavitt) views this as his legacy,” said Scott Serota, President and CEO, Blue Cross and Blue Shield Association. “The secretary has made it clear that he is going to use his regulatory authority as much as he can to move this forward.”

The 16-members of the American Health Information Community (AHIC) were assembled in September 2005 and charged with developing standards for health information technology, including e-prescribing and electronic medical records, and their uses, including personal health records, medication histories, chronic disease monitoring, fast-access information for emergency room health professionals and disease surveillance.

AHIC was chartered for two years, but can renew for up to five. Panelists agreed that work on standards likely would result in demonstration projects to test feasibility; and that in any event, federal money for programs based on the standards wouldn’t be available until at least late 2009. In addition to Serota, the web cast panel included Charles Kahn of the Federation of American Hospitals, an industry group representing for-profit hospitals; and Kevin Hutchinson of SureScripts, an electronic prescribing network formed by chain drugstores and pharmacists.

At the top of the question list for the panel was who will pay for the necessary technology changes and who will reap the benefit.

“The benefit is reaped by the consumer,” said Serota. “It has to be a joint investment. It isn’t fair for either party – payers or providers – to absorb the whole burden and the full risk.”

“Payers will reap benefits first,” said Kahn, “then consumers, with lower rates.” But, he said, health care professionals must figure into the mix somewhere or the system will never get off the ground.

Serota acknowledged that issues such as paying health care professionals for online or e-mail consultations must be addressed. If such patients don’t come into physician offices, doctors risk not being paid for their professional services.

Views were mixed on whether the private sector or government health plans would lead the way and about how the committee’s recommendations would be implemented.

“The secretary is focused on 12-18 months, and is emphasizing ‘getting rid of the physician’s clipboard,’” said Hutchinson. He said that’s a short time frame, but Leavitt can use his regulatory power through CMS (which regulates both Medicare and Medicaid) to move forward on the public side.

Kahn, who served on a committee developing Health Insurance Portability and Accountability Act policy, said those working on that issue expected Congress to pass regulatory legislation. Instead, the regulations for implementing HIPAA were formed through a departmental regulatory process.

“If we have to wait around for Congress to produce implementing legislation on (health information technology) standards, man, it ain’t gonna happen,” he said. “Even with the frustrating idiosyncrasies of regulation – that it can’t be questioned – give me regulation over legislation on this issue anytime.”

Serota would prefer a public-private partnership approach be used to advance the use of health information technology. “Get it ingrained in the private sector to make sure politics can’t affect it. If the private sector takes the lead, it can transcend any politics that present themselves in 2008 or 2009,” the earliest point when public money might become available to create and monitor standards.

AHIC has six more meetings scheduled this year. For more information, go to http://www.hhs.gov/healthit/ahic.html .

Searching For Authors

If you are a WCMSSM member who has written a book on anything (wines, hunting, fiction, non-fiction, medicine) please let us know. We can help you publicize your work. Contact us at info@wcmssm.org

MSMS Leadership Summit

The 3rd annual MSMS Leadership Summit - scheduled for Wednesday, May 17, in Lansing - will feature timely topics and speakers, as well as the opportunity for physicians to earn six hours of Category I CME credit. This year's summit, titled "Current Directions and Emerging Views in Health Care," will offer participants the opportunity to hear from a number of Michigan's key leaders in health care and business, including Michigan Attorney General Mike Cox and gubernatorial candidate Dick DeVos. Other topics and speakers include the following:

National Health Care Reform
Christopher Conover, PhD, assistant research professor of Public Policy Studies, Duke University

Political Leadership in Michigan
Moderator: Kenneth J. Edwards, Vice Chair, MSMS Board of Directors Mike Cox, Michigan Attorney General Rep. Kevin Elsenhiemer (R-105th District), Chairman of Tort Reform Committee Rep. Gary Newell (R-87th District), Vice Chair, Health Policy Committee, Special Committee on Medicaid Reform and Innovation and Health and Information Technology Subcommittee Jan Whitehouse, President, CyberMichigan

Future of Health Care in Michigan
Dick DeVos, Michigan Gubernatorial Candidate, President, Alticor

Perspectives from Health Plan CEOs
Moderator: Rose M. Ramirez, MD, House Vice Speaker, MSMS Board of Directors Kimberly Horn, President and CEO, Priority Health Roman T. Kulich, President and CEO, Molina Healthcare Thomas L. Simmer, MD, Vice President and Medical Director, Blue Cross Blue Shield of Michigan William E. Moeller, President and CEO United Healthcare Jeff L. Connolly, CPA, President and CEO, PPOM

Lunch Panel - The Future of Medicine: Leading the Way to a Better Health Care System
Moderator: John M. MacKeigan, MD, MSMS Immediate Past President, MSMS Board of Directors Paul Harkaway, MD, President, Huron Valley Physician Association James D. Grant, MD, Vice Chair, Department of Anesthesiology, William Beaumont Hospital Martha Gray, MD, President and CEO, Partners in Internal Medicine, PC & Member Internal Medicine Staff, St. Joseph Mercy Hospital David Share, MD, MPH, Medical Director, The Corner Health Center & Clinical Director, Center for Health Quality and Evaluative Studies, BCBSM

Health Care Outlooks from the Big Three
Moderator: Alan M. Mindlin, MD, MSMS President Joe W. Laymon, Vice President Corporate Human Resources, Ford Motor Company Kate Kohn-Parrott, Director, Integrated Health Care and Disability, Chrysler Group Joe Fortuna, MD, Medical Director Delphi Corporation

State of Michigan's Economy
Moderator: Paul Farr, MD, MSMS President-elect, MSMS Board of Directors Paul W. Brand, President, REAL Health Organization Ed Wolking, Jr., CCE, Executive Vice President, Detroit Regional Chamber James C. Epolito, President and CEO, Michigan Economic Development Corporation

Updates from Michigan Medical Schools
Moderator: Michael A. Sandler, MD, Chair, MSMS Board of Directors Marsha D. Rappley, MD, Acting Dean, Michigan State University College of Human Medicine Robert M. Mentzer, Jr., MD, Wayne State University School of Medicine John E. Billi, MD, Associate Dean for Clinical Affairs, University of Michigan Medical School

Cost of registration is $140 for MSMS and MMGMA members, $185 for non-members. For more information, contact Melinda Sandford at MSMS at 517-336-7575 or msandford@msms.org. To register, visit www.msms.org/eo/courseinfo/courseinfo.asp or contact the MSMS Registrar at 517-336-7584 or abatten@msms.org .

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