May 8, 2006

Editor's Column: Consumer-Directed Health Plans
'House' Elections, 'Future' Work Groups Top MSMS Adenda
It's Cover The Uninsured Week
New Medicare Report Could Spell Trouble For Docs
A Judicial View From The Top
Searching For Authors
MSMS Leadership Summit

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Editor's Column:
Consumer-Directed Health Plans - Where Are They Leading Us?

By JOSEPH WEISS, MD

Consumer-directed health plans represent the last campaign for competitive marketplace-based health insurance. The idea is that patients who personally pay for their health care will make decisions about spending that are savvy and efficient. If millions of Americans act in this manner, then the savings in national health care expenditures is supposed to reach into the billions or hundreds of billions of dollars.

To practice effectively, consumer-directed health plans require the individual to understand treatment costs and options, compare cost and benefits, and select a best fit in a health plan and a primary physician. The only tool available to the individual is the Web, with its infinite, contradictory and often wacky information.

No study to date confirms that patients can interpret Web data intelligently or spend their personal account dollars wisely.

Consumer-directed plans could further fragment medical care. By siphoning a healthier pool of patients to these plans, the insurance market for individuals with illness will become increasingly expensive. In turn, increases for the public, will only add to the pool of people who cannot afford health insurance. Within the next five years the nation likely will decide on the option of single-pay or extend and refine the concepts of consumer-directed health plans.

Physicians play no role in this debate; we are already under the rule of single-pay. The government through Medicare, determines our reimbursements. Health insurers throughout the country use “Medicare rates” as their benchmark; in turn, every specialty and subspecialty medical society has its PAC ( Political Action Committee). At the moment, the only difference between our brethren in Canada, Britain and Scandinavia is the size of our reimbursements. The politics for the profession is the same worldwide.

'House' Elections, 'Future' Work Groups Top MSMS Agenda

Physicians Elect Leaders, Set Policy at Annual Meeting
In April, MSMS physician members from across the state met for the annual MSMS House of Delegates meeting in Grand Rapids. During the three-day event, physician delegates determined policy, set the year’s agenda, and elected leaders for the 15,000-member medical society. Paul O. Farr, MD, a Kent County gastroenterologist, was welcomed as the new MSMS president. More than 90 resolutions were discussed by the House, regarding such issues as Medicaid reimbursement, a junk food tax, pharmaceutical litigation, flu vaccines, stem cell legislation, the “morning after pill,” expert witness testimony, pay for performance, and much more. See details online at www.msms.org or contact David Fox at (517) 336-5731 or dkfox@msms.org.

Work Groups Move ‘Future’ Initiative Ahead
When MSMS unveiled The Future of Medicine: Leading the Way to a Better Health Care System in March, it announced three work groups to begin major action steps outlined in the plan. The work groups, which will begin to meet in June, will engage a broad range of stakeholder groups to address the issues of Wellness, Administrative Simplification, and Essential Benefits. The Future of Medicine plan calls for 47 specific action steps to ensure that health care reaches a sustainable plane and covers all patients in Michigan. All MSMS members received a copy of the report by mail. For details, visit www.msms.org, watch e-mail and Medigram, or contact Julie Novak at (517) 336-5768 or jnovak@msms.org.

Tell Blue Cross to Fix Voucher Problem Immediately
In January, Blue Cross initiated new funding for their performance based incentive program for physicians. Physicians meeting certain criteria could be entitled to financial incentives that reward completion of specific performance indicators. MSMS supports the intent of this program; however, the implementation of this program has been seriously mishandled, leading to confusion in medical offices, animosity toward the health plan, and multiple payment posting issues for physicians and their staff. Most troubling is the fact that there does not appear to be a resolution in sight. To send letters to BCBSM and lawmakers, visit the MSMS Action Center (http://action.msms.org). For more information, contact Julie Novak at (517) 336-5768 or jnovak@msms.org.

Guidelines on P4P, PO/Health Plan Contracting Finalized
MSMS recently finalized a document outlining the ideal contracting relationship between physician organizations and health plans. MSMS already provides a Managed Care Contracting Checklist to members, but the MSMS Council of Physician Organizations’ discussions revealed more details about the best way to structure these relationships (visit www.msms.org/bsyp/timelypayment/index.html). MSMS also finalized its Principles for Pay-for-Performance Programs, designed to define and strengthen organized medicine’s involvement on this issue. MSMS believes that quality and patient safety should be at the center of any such program (visit www.msms.org/bsyp/ra/pay4performance.html). For more information, contact Julie Novak at (517) 336-5768 or jnovak@msms.org.

MSMS Opposes Scope of Practice Bills
MSMS is opposing two bills that would expand the scope of practice for psychologists and marriage counselors. House Bill 5473 seeks to strike the term “limited license” from the psychology section of the Public Health Code. As a result, master’s level psychologists would essentially have the identical scope of practice as a PhD level psychologist and would no longer need to 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 these individuals. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org.

Oakview Medical is Risk Management Award Winner
American Physicians Assurance Corporation has announced that Oakview Medical, an internal medicine practice in Dearborn, is the winner of its 2006 Excellence in Risk Management Award. Shabana Khan, MD, and Farah Mehdi, MD, along with their staff and guests, will be honored at a celebration dinner and will be featured in American Physicians’ newsletter Best Practices. Entries were judged on how effectively the practices use key risk management systems; their use of examples to illustrate the importance of these systems; and additional systems that have been successfully implemented. For more information, visit www.apassurance.com or contact Cathy Burke at American Physicians at (517) 324-6776 or CBurke@apassurance.com.

It's Cover The Uninsured Week

Uninsured adults are nearly four times more likely not to see a doctor when they need to compared to people who have health coverage, according to a report released April 25 by the Robert Wood Johnson Foundation to kick off Cover the Uninsured Week.

The report shows that the uninsured not only miss needed medical care due to cost, but they are also far more likely to miss important health screenings that can detect cancer in its earliest, most treatable stages. Such statistics are especially troubling for the uninsured population that is older, when the need for such screenings dramatically increases.

Expanding coverage for the uninsured and increasing access to care is part of the AMA Health Care Advocacy agenda, and the AMA is a national partner in Cover the Uninsured Week. In the short term, the AMA advocates for incremental measures to expand coverage for children and lower-income families and individuals. The AMA's student members are particularly active on this issue, using Policy Promotion Grants from the AMA to organize community projects around the country to help uninsured populations. In the long term, the AMA continues to press for the adoption of a consumer-driven, market-based plan to expand coverage through tax credits and insurance market reforms.

Visit http://covertheuninsured.org/ to learn more about the thousands of events happening this week.

Visit http://www.ama-assn.org/ama/pub/category/3373.html to learn more about AMA's efforts on the uninsured.

New Medicare Report Could Spell Trouble For Docs

By DUANE CADY, MD
AMA Board Chair

A recent Medicare Trustees Report projects steep long-term cuts in Medicare payments to physicians that will harm seniors' access to care. Next year's cut of 4.7 percent is just the beginning, as the Trustees now project that Medicare physician payments will fall 37 percent over the next nine years. At the same time as these steep Medicare cuts, the government projects that practice costs will increase 22 percent. The numbers just don't add up, especially considering that these cuts follow five years of Medicare payments that do not cover increases in medical practice costs.

Nearly half, 45 percent, of the physicians surveyed by the AMA say next year's Medicare cut will force them to either decrease or stop seeing new Medicare patients. Physicians want to treat seniors, but Medicare cuts are forcing physicians to make difficult practice decisions.

Doctors are stuck between a rock and a hard place as they try and do more to improve the quality of medical care for seniors with fewer resources. Under the current Medicare payment system, doctors are penalized with lower payments per service for doing more to help prevent disease and care for patients. The large gap between Medicare payments and practice costs is a huge barrier to physician investment in technology used to improve quality.

Today's report on the dire future of Medicare cries out for reforms to ensure that Medicare will be there for future generations; Congress must take an immediate step to preserve seniors' access to physicians by tying Medicare physician payments to the cost of caring for seniors."

A Judicial View From The Top

Presented by the
Hon. Maura D. Corrigan
Justice, Michigan Supreme Court

Thursday, May 11, 2006
7:30 – 9:00 AM

Wayne County Medical Society
3031 W. Grand Boulevard, Suite 645

To Register Now:
Fax: (313) 874-1366 or
Phone: Karen at (313) 874-1360
Email: kcarter@msms.org
On-line: www.detroitlawyer.org .

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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