E-DMN - August 21, 2006

August 21, 2006

Editor’s Column: Privileges
Medicaid Problems Could Presage Medicare Trouble
States Battle Fed On Medicaid Cuts
HFHS Launches Online Doctor Visits
September CME At Oakwood

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Editor's Column:
Privileges

By JOSEPH WEISS, MD

Dorland’s Medical Dictionary contains no entry for the word “privileges,” but in medicine that word carries a very technical meaning. In general, when we talk about a physician having “privileges,” we are saying that individual has the right to perform a procedure that requires special training. Having a privilege means some person, committee or organization has reviewed the qualifications of the physician to do that procedure and agreed that the physician’s training and experience suffices. In most cases, gaining a privilege is important for the income the privilege brings.

A recent article in the New York Times gives a reason for the medical community to turn its attention to privileging. In the Aug. 1 edition, a front-page story ran about two cardiology groups, one in Charlotte, North Carolina, and the other in the nearby city of Rock Hill. The story detailed the groups’ different paths to learning the new procedure of defibrillator implantation. The Charlotte group trained under the supervision of the national electrophysiology organization, the Heart Rhythm Society. The Society’s three-day course culminated in a proctored written examination that on average, one-third of the participants failed to pass. The Rock Hill cardiology group attended an evening dinner and lecture on defibrillator implantation sponsored by the defibrillator company Biotronik. The Piedmont Medical Center hospital in Rock Hill immediately granted the Rock Hill cardiologists hospital defibrillator implant privileges. The Times report noted that the Rock Hill cardiology group uses Biotronik defibrillators exclusively and to date has implanted 100 defibrillators at $20,000 each. The article also mentioned that Piedmont Medical Center is owned by Tenent HealthCare, a for-profit hospital chain.

The sell-out of privilege for profit isn’t something that happens only down South, it can occur here. The WCMSSM needs to maintain vigilance. We must work to keep hospital credentialing committees, at the very least, an arm’s length from hospital administrators, not only for patients’ sake, but to keep our self respect.

Medicaid Problems Could Presage Medicare Trouble

By PAUL NATINSKY

A recent study revealed that while Medicaid payment rates to physicians have increased modestly, the number of doctors accepting new Medicaid patients is decreasing. The percentage of physicians who receive no Medicaid revenue has increased from 12.9 percent in 1996-97 to 14.6 in 2004-05, stated The Center for Studying Health System Change, a Washington, DC, health system research firm.

The study, released Aug. 17, also found that care for Medicaid patients is consolidating in large group practices, academic medical centers and community health centers; a development the study’s authors view as a double-edged sword.

“It isn’t clear whether the increasing concentration is harmful to Medicaid patients’ access to care, since many large Medicaid providers are in areas where enrollees tend to live, such as inner cities and medically underserved areas,” stated Peter J. Cunningham, PhD, a senior fellow at HSC. “But, if large Medicaid providers face increased financial pressures and rising patient demand, quality of care and access to some services could be negatively affected.”

Numbers from the study indicate that 84 percent of physicians who won’t accept new Medicaid patients cite low payment as a reason for their actions. Seventy percent objected to the billing requirements and paper work as reasons for their moratorium on new Medicaid patients.

“This unsettling data comes as little surprise given Medicaid’s high administrative costs and low payment rates, while overhead costs associated with practicing medicine continue to increase,” stated J. Edward Hill, MD, immediate past president of the American Medical Association.

“This study also serves as a reminder that our nation’s Medicare program is at risk of going the way of Medicaid,” he added. “More Medicare cuts on top of existing inadequate Medicare reimbursement rates threaten to reduce patient access to care.

“Medicare physician payments are scheduled to be cut 37 percent over the next nine years. If Congress does not stop next year’s payment cut, 45 percent of physicians say they will be forced to decrease or stop taking new Medicare patients.”

In its policy proposals for 2007, The Centers for Medicare and Medicaid Services (CMS) plans to cut payments to providers to bring spending into line with its targets. Adjustments sparing larger cuts were made for several years, but CMS reports that those legislative interventions only widened the gap between CMS’ target spending figures and actual money paid for services, the volume and cost of which exceeded the government’s expectation.

Also part of the CMS recommendations are increased coverages for preventive services including abdominal aortic aneurysm screening for some patients and an allowance for colorectal screening under the Part B deductible.

States Battle Fed On Medicaid Cuts

By PAUL NATINSKY

As the Bush administration pushes to change Medicaid rules and reduce expenditures for the program, governors, health care leaders and members of Congress from both sides of the aisle are pushing back hard.

An Aug. 12 New York Times story reported that the administration’s plan is to “reduce Medicaid payments to many hospitals and nursing homes by redefining allowable costs” and limiting the ability of states to tax providers to bring in more federal matching money.

In Michigan, with extreme pressure from physicians, Gov. Granholm’s physician-tax plan was defeated. But doctors aren’t the only providers who have been subject to the taxes designed to increase matching funds. Other provider groups, such as hospitals and nursing homes, have been part of such mechanisms and two-thirds of states employ them and value them as a tool to bring in federal dollars for Medicaid services. In addition to a philosophical objection, part of the rationale for physician opposition to the tax was that doctors are already underpaid for providing such services and are not generally in a position to absorb such added expenses even if money eventually comes back.

According to the Times, the Bush Administration estimates savings of $12.2 billion over five years. But more than 330 members of Congress, including 103 Republicans, oppose the plan. A bipartisan group making up almost half of the Senate has also urged the administration to back down.

The Medicaid cutback plan comes on the heels of a study that discusses the downturn in the number of physicians who accept new Medicaid patients and a severe proposed slicing of the Medicare budget for next year that threatens to have a similar effect on that program (see related stories, this edition).

HFHS Launches Online Doctor Visits

For the first time in Michigan, patients can now consult with their physicians online.

Henry Ford Health System has launched eVisits, a computerized service that allows Henry Ford patients to describe their non-urgent health and medical issues to doctors and receive instructions for treatment without leaving their computers.

Henry Ford is launching this pilot service to explore how technology can make health care easier for patients to navigate and increase convenience. The eVisits pilot project is aimed at patients with chronic conditions like diabetes, hypertension, heart failure and depression.

“Using the eVisit, Henry Ford physicians can stay in closer contact with their patients and make more frequent adjustments in their treatment regimen to achieve clinical goals,” said Bruce Muma, MD., Henry Ford’s Northern Region medical director and a consultant on the project. “That will result in better health care.”

Not all doctors and patients would benefit from online consultations; Henry Ford is only making eVisits available with primary care physicians. eVisits will be available for all primary care doctors at Henry Ford’s Harbortown, Southland and Novi medical centers and some doctors at the Troy and Lakeside medical centers.

If the service is found to be successful in increasing patient and doctor satisfaction as well as clinical quality, it will be implemented for all Henry Ford patients in 2007. “We plan on enrolling 100,000 patients in eVisits by the end of the year,” said Pamela Landis, Henry Ford’s director of Web Services.

Henry Ford currently has one of the largest patient portals in the country and the largest in the state, with 50,000 patients using MyHealth on henryford.com to view customized health information, obtain lab test results and renew prescriptions online.

“We always worked to gain experience and get technology in place so when the world did change, Henry Ford was ready and ahead of the curve,” said Landis.

To use eVisit, Henry Ford patients will be assigned a username and password to log into the system and describe their health problem. The health issue the patient enters into the computer triggers a series of questions. The patient’s answers, along with additional comments, are sent to the doctor. The doctor checks his or her inbox frequently and the eVisit appears like an email with the patient’s answers and comments organized as if the physician had actually asked the questions and recorded the answers. Doctors respond to patient eVisits within one business day.

The doctor may respond in various ways such as ordering lab tests or prescriptions, instructing the patient to take action at home or advising him or her to come in for an office visit. Each eVisit costs $20. Patients are not charged if they have HAP insurance or if the doctor recommends an outpatient visit.

September CME At Oakwood

September 2006
Oakwood Heritage Hospital
CME Programs, Approved CME Category I
Conference Rooms 1 & 2

Sept. 6, 8 a.m.
Using Evidence In Daily Practice Of Medicine
Mark D. Hannis, MD

Sept. 12, 9:30 a.m.
Morbidity And Mortality
Albino Gimenez, MD

R. Rajaraman, MD, Director
Continuing Medical Education
Oakwood Heritage Hospital
10000 S. Telegraph
Taylor, MI 48180
(313) 295-6794

This publication brought to you by Natinsky Publishing Network.

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