July 10, 2006

Editor's Column: Mandates And Their Meaning
Rising Drug Prices, Falling Physician Pay; Something's Wrong Here
State Launches Drug Price Comparison Web Site
Blue Cross, Hospitals Get Together On Patient Safety
Michigan Docs At The AMA
WCMSSM Members In The News
Searching For Authors
Cat Purple
MSMS News

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Editor's Column:
Mandates And Their Meaning

By JOSEPH WEISS, MD

In his State of the Union address in January, President Bush called on Congress to create legislation that would allow small business to purchase low-cost health insurance for employees. The Senate responded with S. 1955: Health Insurance Modernization and Affordability Act, with a similar bill already passed in the House of Representatives.

In their zeal to help employers purchase health insurance cheaply, legislators are crafting an act that contains no office visit or emergency room coverage, no mental health services, limited hospital benefits, no drug coverage, no maternity services and little in the area of preventive health such as immunizations, PAP smears, mammography or well baby care.

It is obvious to physicians that a health plan so lacking in benefits will cost little and still yield a profit to any one that offers it. Readers should also be aware that if the federal bill becomes law, it will preempt any state regulations that mandate any benefit on an insurance health plan offered in that state.

At the same time that S.1955 is moving to become the law of the land, the Michigan State Medical Society as part of its Future of Medicine plan is crafting a health plan with essential benefits. This effort is part of the State Society’s call for universal health care coverage.

This work by MSMS now takes on greater importance. The only way that physicians can stop the narrow perspective of the federal health plan is to counter with a proposal that creates a balance between necessity, benefits and cost. This balance is the essence of the MSMS effort. However, this undertaking could prove a turning point for the health care of the country.

Rising Drug Prices, Falling Physician Pay; Something's Wrong Here

By PAUL NATINSKY

Two New York Times Articles appearing articles appearing on consecutive days in late June chronicled a disturbing tandem of trends.

The first, a rise in drug prices revealed in separate studies by AARP and Families USA, shows that the price of brand-name consumer drugs has risen 3.9 percent with some drugs rising as much as 13 percent. The Times reported that Medicare cannot directly negotiate with drug makers, as can the private insurers who administer prescription coverage programs for Medicare under its Part D benefit.

The AARP study estimates an average increase of almost $240 per year for older Americans who participate in the Medicare Part D program. The article points out that the Part D plan has been a windfall for pharmaceutical makers because patients who formerly qualified for prescription coverage through Medicaid -- which does have negotiating power and paid 25-30 percent less than what Medicare is paying now – were forced to switch to Medicare Part D for their coverage once that program became available.

In the meantime, insurers and pharmaceutical companies continue to point fingers at one another to assign blame for the rise in cost for those on the Medicare Part D plan.

The next day’s Times reported doctors’ average pay dropped 7 percent in the eight-year period ending in 2005, while income for lawyers and other professionals increased 7 percent during the same period.

The study, a survey of 6,600 physicians by the Center for Studying Health System Change, showed an increase in physician specialization and expects the trend to continue as primary care physicians account for the bulk of the income decline.

The AMA’s comments on the survey buttressed this argument, indicating that general inflation was 21 percent during the eight years of the study and Medicare reimbursement rose only 13 percent.

There are myriad conclusions that can be drawn from this latest round of studies; among them that a the combination of a shortage of primary care physicians and rising drug prices could delay the treatment of curable and manageable medical conditions, forcing patients to continue the overuse of costly hospital emergency departments to receive care. The ironic thing about this set of conclusions is that almost every government-led health care “reform” ostensibly seeks to reduce the cost, increase the efficiency of and access to health care.

For more on the access issue as it relates to Medicare reimbursement, visit http://www.ama-assn.org/ama/pub/category/16122.html

For more on the AMA’s response to the physician reimbursement study, visit http://www.ama-assn.org/ama/pub/category/16493.html

State Launches Drug Price Comparison Web Site

Consumers now have online access to state pricing information for commonly prescribed prescription drugs searchable by pharmacy and region, making decision-making and shopping easier, Michigan Governor Jennifer M. Granholm June 29.

"The best available price for commonly prescribed prescription drugs are now just a click away for Michigan's consumers," Granholm said. "We are continually working to make prescription drugs and quality health care more accessible and affordable to everyone in Michigan. The new website is one more tool – along with the MIRx Prescription Drug Discount Card and the Michigan First Health Care Plan – to help consumers by bringing the high costs of health care down."

Michigan's new Web site – found at www.michigandrugprices.com - gives consumers the ability to search prescription drug prices by pharmacy name, or by zip code. Users can select the pharmacy closest to them, or look at pharmacy prices from as far as 100 miles away from their homes – within Michigan's borders.

The site also makes pharmacy addresses and telephone numbers easily accessible, since prescription drug prices can vary daily, said Janet Olszewski, Director of the Michigan Department of Community Health.

"From Lipitor to Neurotin to Clartin, citizens across Michigan now have the latest information available to us to make the best decisions about their prescription drug costs,"Olszewski said. "We have expanded the capabilities of our existing web site to make the information much more useful for consumers who continue to grapple with prescription drug costs." As the state continues to build the site, more prescription drugs may be added to the state's list as information becomes available, she said.

The Web site also contains links to five commonly used discount programs for prescription drugs: the Michigan Prescription Drug Discount Card (MI-Rx), the national Together Rx Access Card, the Michigan Medicare/Medicaid Assistance Program (MMAP), RxAssist, and the Michigan Partnership for Prescription Assistance program.

Michigan continues to be a leader in providing assistance with the cost of prescription drugs. Since the state's MI-Rx card debuted in September 2004, more than 36,000 uninsured Michigan citizens have taken advantage of the program.

Blue Cross, Hospitals Get Together On Patient Safety

Blue Cross Blue Shield of Michigan (BCBSM) and the Michigan Health & Hospital Association (MHA) June 29 announced an agreement that will enable the MHA Keystone Center for Patient Safety & Quality to engage hospitals across the state in new activities to improve quality and safety through the application of best practice, evidence-based health care.

BCBSM has earmarked $6 million to fund quality and safety initiatives for hospitals to be coordinated by the MHA Keystone Center. The funds will help keep costs as low as possible for hospitals participating in new quality and safety initiatives. The amount includes $350,000 announced in April to launch an initiative to reduce health care-acquired infections in Michigan hospitals.

New improvement initiatives will be identified based on evidence and opportunities to improve the quality and the safety of care delivery under the BCBSM and MHA agreement. Other areas of focus will be determined over the next few months.

"The MHA Keystone Center has the unique ability to bring a large number of hospitals together for improvement initiatives," said Daniel J. Loepp, Blues president and CEO. "We are excited to assist Michigan hospitals to collaborate and effectively improve patient safety and quality of care.

"Since Blue Cross was founded 67 years ago, we have collaborated with hospitals to deliver the best care possible. We all share common goals for Michigan — we all want safe, high quality patient care and affordable coverage for our residents."

"As a result of efforts of the MHA Keystone Center and Michigan hospitals, medical errors are being avoided, and lives and health care dollars are being saved. Michigan hospitals are working diligently and innovatively to remain at the forefront of patient safety and health care quality improvement initiatives," said MHA President Spencer Johnson.

The MHA Keystone Center was created by the MHA in March 2003 in response to growing concerns about patient safety and health care quality and in recognition of the unique willingness of Michigan hospitals to collaborate to improve care. Since its inception the center has coordinated partnerships and initiatives to improve patient treatment and safety in intensive care units, to reduce the incidence of strokes and to ensure that appropriate care is delivered to patients who suffer them, and a collaborative to boost organ donations and save lives.

The MHA Keystone Intensive Care Unit (ICU) initiative began in March 2004 to improve patient safety and health care quality by reducing errors in Michigan hospital ICUs. Between March 2004 and September 2005, the initiative saved more than 1,500 lives and $175 million in health care costs during this 18-month span at Michigan hospitals. More than 120 Michigan ICUs and 70 Michigan hospitals participated.

"Our efforts will ensure the continued leadership of Michigan hospitals and most importantly, the safety of care delivered to the patients we serve," said Johnson.

"We look forward to working with the MHA to achieve similar success in other areas of patient care as was experienced in intensive care units," said Loepp. "Our joint aim is to demonstrate that Michigan is a leader in patient safety and quality."

The MHA Keystone Center’s success is a product of its ability to provide evidence-based, best-practice interventions to participating hospitals aimed at making care safer. This, coupled with the gathering of data and sharing it with hospitals and doctors, supports improving the quality of care, enhancing the culture of safety and staff satisfaction, and eliminating unnecessary or avoidable costs. The improvement initiatives have translated and expedited research into applicable interventions for patient safety improvement at the patient’s bedside.

The MHA Keystone Center for Patient Safety & Quality was created in 2003 as a 501(c) (3) division of the MHA Health Foundation and is headquartered at the MHA in Lansing. MHA Keystone brings together hospitals, national experts and best practice evidence to improve patient safety by addressing the quality of health care delivery at the bedside. The Keystone: ICU project exists through an ongoing and innovative partnership with patient safety experts at The Johns Hopkins University. In June 2006 Blue Cross Blue Shield of Michigan announced a new and broader agreement with MHA to develop new MHA Keystone Center initiatives. For more information, visit http://www.mhakeystonecenter.org/.

Michigan Docs At AMA

A number of Michigan physicians earned leadership roles with the AMA, including the following: WCMSSM Member Ronald M. Davis, MD, a preventive medicine specialist from East Lansing, was selected as president-elect; Venkat Rao, MD, a Flint pulmonologist, was elected chair of the AMA-IMG Section; Cathy O. Blight, MD, a Flint pathologist and Chair of the Michigan Delegation to the AMA, was reappointed for a second term on the AMA Council on Long Range Planning and Development; AppaRao Mukkamala, MD, a Flint radiologist, was reappointed for another term on the AMA Council on Legislation; and WCMSSM Member Michael A. Sandler, MD, a Detroit radiologist, continues to serve on the AMPAC Board of Directors. For more information, visit www.ama-assn.org or contact Julie Novak at (517) 336-5768 or jnovak@msms.org. Don’t miss DMN’s August cover story on Dr. Davis!

WCMSSM Members In The News

Dr. Rival Honored
The Michigan Chapter of the American College of Physicians has selected Dr. Jan Rival to receive the chapter's LifeTime Achievement Award. This award honors Fellows or Masters of the American College of Physicians who have given dedicated and exceptional service over years to the ACP Michigan Chapter.

During his tenure as Governor of the Michigan Chapter, Dr. Rival brought national distinction to Michigan ACP through the quality of the Chapter's annual programs and innovations in building chapter membership and increasing institutional support for Internal Medicine.

Dr. Sherma Appointed Vice-Chief At Sinai-Grace
The medical staff of Sinai-Grace Hospital recently elected Narinder K. Sherma, MD, as its vice-chief of staff. In this role, Dr. Sherma will perform a variety of duties that include maintaining and enhancing the quality of medical care and the credentialing of the Sinai-Grace Hospital medical staff.

Dr. Sherma is an internal medicine and cardiovascular disease specialist. He has been a member of Sinai-Grace Hospital's medical staff since 1981. He is a graduate of the Government Medical College in Pitiala, India. Dr. Sherma is a member of the Wayne County Medical Society of SE MI (WCMSSM) Executive Council and serves on the WCMSSM Membership Committee. In April, he was re-elected as an Alternate Delegate to the American Medical Association (AMA).

HFHS Names Dr. Chapman Director Cancer Center
Robert A. Chapman, MD, has been appointed director of the Josephine Ford Cancer Center (JFCC) at Henry Ford Health System.

The JFCC has thrived under Dr. Chapman’s leadership since he was asked to serve as the center’s interim director during a transition period three years ago. He directed an evaluation of the entire cancer enterprise as well as efforts by the JFCC Steering Committee to stimulate clinical growth, expand the research mission, and coordinate cancer care.

Dr. Chapman also secured a competitive Medicare grant to study disparities in cancer care in the African American population and succeeded in gaining philanthropic support for the JFCC.

Dr. Chapman is an expert physician and clinician-researcher in medical oncology. He is well-known for his lung cancer research and involvement in major national trials in addition to his leadership as head of Henry Ford’s Hematology/Oncology division. He was listed as a Top Doc in Hour Detroit magazine the last three years and was listed in America’s Top Doctors for Cancer in 2005.

Dr. Chapman obtained his medical degree from Cornell Medical School and completed his internal medicine residency at Henry Ford Hospital and his medical oncology fellowship at Memorial Sloan Kettering in New York City.

The JFCC is the focus of all cancer-related services within Henry Ford Health System and is ranked among the top cancer programs in the country. It is one of the largest cancer centers in Michigan and provides a variety of services in six treatment facilities throughout the metro area, including radiation therapy, chemotherapy, surgical oncology and support groups.

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

Cat Purple

Don’t miss an excerpt from “Cat Purple in Grosse Pointe,” in the August DMN print edition. The book is a novel by Grosse Pointe gynecologist Dr. J.C. Di Musto.

MSMS News

Last Chance to Contact Governor about Medicaid Fee Increase
The Michigan House of Representatives has recommended a 4 percent increase to the fees paid to physicians under the Medicaid program. A report compiled by the Michigan State Planning Project for the Uninsured, a group convened by the Governor, concluded that “inadequate Medicaid payment rates...are having an adverse impact on health care access for the people of Michigan.” It is anticipated that the budget will be resolved this month, so action is needed quickly. TAKE ACTION NOW – MSMS urges everyone to visit the online MSMS Action Center (http://action.msms.org) to send a prewritten message to the governor, urging her to support the four percent increase to Medicaid physician payments. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org.

Work Groups Move ‘Future’ Initiative Forward
When MSMS unveiled its Future of Medicine initiative, it announced three work groups to begin major action steps outlined in the plan. The Wellness Work Group, chaired by David A. Share, MD, MPH, agreed to form three subgroups: tobacco, childhood obesity prevention, health risk assessment use. The Essential Benefits Work Group, chaired by John E. Billi, MD, agreed to develop an essential core benefit design focusing on the uninsured population. The Administrative Simplification Work Group, chaired by John M. MacKeigan, MD, turned its attention to streamlining the claims submission process, among other issues. For more details, see the June 26 issue of Medigram, watch e-mail, or contact Julie Novak at (517) 336-5768 or jnovak@msms.org

MSMS Opposes Scope of Practice Bills
MSMS is opposing three bills that would expand the scope of practice for psychologists, marriage counselors, and nurses. House Bill 5473 would give master’s level psychologists essentially the same scope of practice as PhD level psychologists and would no longer require that they be supervised. Senate Bill 489 would add the terms “psychotherapy” and “diagnosis” to the description of Practice of Marriage and Family Therapy. Clearly, these terms are within the purview of medicine and beyond the training of marriage counselors. Senate Bill 1245 would provide independent prescriptive authority to Advance Practice Nurses. Take action at http://action.msms.org. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org.

Mental Health Parity Clears Senate Committee
MSMS supports Senate Bills 229 and 230, introduced by Sen. Beverly Hammerstrom (R-Temperance), which would require benefits for mental health services equal to that offered for physical health care in insurance plans that provide coverage for mental health care. The bills won approval by the Senate Health Policy Committee on a divided vote. Joining Sen. Hammerstrom in sending the bills to the full Senate were Sen. Bruce Patterson (R-Canton) and Sen. Gilda Jacobs (D-Huntington Woods). If ultimately adopted, Michigan would join 39 other states that already require some form of mental health parity. The requirement would apply to insurers, HMOs and Blue Cross programs. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org

This publication brought to you by Natinsky Publishing Network.

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