May 22, 2006

Editor's Column: If We Are Not For Ourselves, Who Will Be There For Us?
Blues Must Fix Reimbursement Problem Promptly
Wayne County Internal Med Practice Wins Award
HFHS Awarded $5 Million To Fight Disparities In Cancer Care
May Has Been A Rollercoaster Month For Liability Reform
An Evening With The Attorney General May 24
State's Strategies For Uninsured Run Full Spectrum
Searching For Authors

Click Here To Contact Us

Editor's Column:
If We Are Not There For Ourselves, Who Will Be There For Us?
-- Talmud saying attributed to Hillel

By JOSEPH WEISS, MD

My previous e-edition column, on April 10, took to task an outsider, a Nobel Prize winner economist at that, for his sweeping and simple-minded solution to this country's problems in medical care access and financing.

This column rails against someone who should know better, that is, a fellow physician. I refer to a New York Times editorial on March 22 by Dr. Peter Salgo, an internist out of Columbia University. In that editorial he asserts that the profession 1) has buckled under to accepting a seven-minute patient encounter; 2) considers patients, not as people but as customers or consumers; 3) has capitulated to hospitals' obsession with length of stay; and 4) lacks will or resources to right these wrongs.

Dr Salgo's solution is to tell his readers to take matters into their own hands and in his words: " insist on being treated with care and respect." He concludes with what he believes are ringing words:" Turning doctors into shopkeepers who regard patients as customers is unacceptable."

Each of us can look to our own practice of medicine to refute his charges against us. His solution is even more absurd: what patients want from and obtain is attention to their distress. What the profession needs are no more critics like Dr. Salgo floating the usual cliches about doctors following a financial beacon indifferent, or at best annoyed by problems of patient care. We need new voices speaking out on how we can carry our mission without the burden of stress and subterfuge presently imposed upon us.

Blues Must Fix Reimbursement Problem Promptly

By FEDERICO MARIONA, MD
WCMSSM Immediate Past President

Members may be aware of a concern related to prompt and adequate BCBSM payment for claims using the modifier 57, that began in January 2006.

In response to society inquiries, the Blues acknowledges the current problem with this reimbursement issue. The company will “fix it” at the time of their next “update,” which is not scheduled until next September. Physicians are asked to contact their provider consultant to collect the denied claims and handle them for prompt payment. In the meantime, WCMSSM has asked BCBSM to resolve this issue in a faster manner than currently planned.

Wayne County Internal Med Practice Wins Award

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, a WCMSSM member, 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.

HFHS Awarded $5 Million To Reduce Disparities In Cancer Care

Henry Ford Health System has been awarded funding from the Centers for Medicare and Medicaid Services (CMS) to determine if navigating patients through cancer screening, diagnosis and treatment can reduce or eliminate disparities in cancer outcomes for African-Americans.

Most research to date has focused on identifying disparities in health care outcomes for minority patients. Less research has focused on interventions designed to reduce disparities.

The Josephine Ford Cancer Center at Henry Ford was one of six sites to receive national funding by (CMS) for the demonstration project. Henry Ford was awarded $5.2 million out of $25 million given to six sites to fund the national project.

Minorities targeted in the national demonstration project include American Indians, Asian Americans and Pacific Islanders, African Americans and Hispanic Americans.

The demonstration project at Henry Ford will focus exclusively on African-American Medicare beneficiaries in Wayne, Oakland and Macomb counties. Henry Ford will begin enrolling participants in July, 2006.

Approximately 3,050 participants will be followed over a four-year period. Patients with and without cancer will be randomized so that half are followed by their practitioners with routine appropriate care and the other half will have care handled by Henry Ford clinicians to ensure all appropriate recommendations are addressed.

Patients at risk for breast, prostate, cervical, and colorectal cancer will be targeted to see if coordinating care through facilitation of screening services, follow-up of abnormal findings and diagnosis, improved access and follow-up of treatment can reduce disparities in outcomes for African-American cancer patients. It is expected that patients who are followed may also benefit from optimal care and early diagnosis of other underlying medical conditions.

“We are honored to be chosen as one of a select few of nationally renowned cancer centers for this federally funded project,” said Robert Chapman, MD.\, interim director of the Josephine Ford Cancer Center. (Other sites chosen include Johns Hopkins University and MD Anderson Cancer Center). “We hope this project will lead to a new level of care that will not only improve outcomes for African-American patients but all patients,” says Dr. Chapman.

African-American Medicare beneficiaries interested in enrolling in the project can call (888)-734-JFCC.

May Has Been A Rollercoaster Month For Medical Liability Reform

By PAUL NATINSKY
Managing Editor

In what has been an up and down month for the American Medical Association’s push for national medical liability reform, an AMA-supported reform bill was introduced in Congress but failed to overcome a Senate filibuster; while one med mal study was applauded and another refuted.

An attempt to override the filibuster tallied 48 of the needed 60 votes, stalling the S. 22, which contains a $250,000 cap on non-economic damages and other provisions, many similar to those passed in Michigan in 1993.

Despite the setback, the AMA reported that polls revealed 75 percent of Americans say they want their lawmakers to support medical liability reform and 76 percent say they support caps on non-economic damages.

The AMA also cited a Harvard University study that found “medical liability lawsuits are clogging the courts, with 40 percent of lawsuits filed with either no verifiable medical injuries or errors.” The study also found that in 83 percent of cases that go to trial physicians are found not negligent, but that defense costs average more than $90,000 per case.

On the other side of the spectrum is a paper titled, Malpractice Premiums And Physicians’ Income: Perceptions Of A Crisis Conflict With Empirical Evidence, which appeared in the May/June 2006 edition of the journal Health Affairs. That article examines medical liability data from 1970 until 2000, along with physician practice cost and income data. The authors conclude that medical liability rates have fluctuated for periods during those 30 years, with significant periods during which they decreased substantially. The authors say the numbers, taken from AMA data, point to factors such as higher overhead (rent, utilities, etc.) and declining physician reimbursement as the real culprits of higher practice costs. They say medical liability insurance has been a small part of most physicians’ practices and continues that way.

The paper ends with this assessment: “Claims that the level of malpractice premiums justify a tax credit to prevent physicians from leaving the practice of medicine are hyperbole, especially when physicians’ income is viewed compared with that of others. Average physician income in 2003 was between the ninety-fifth and ninety-ninth percentiles for all Americans.”

In a statement, the AMA shot back: “The study does not address the current crisis as the authors use data that end in 2000 – prior to the current medical liability crisis. Since then, the medical liability crisis has threatened patient access to care in crisis states. This type of smoke and mirrors suits the agenda of those who oppose real medical liability reforms working to stabilize premiums and preserve patients’ access to care.”

MDPAC
Michigan Doctors' Political Action Committee

Mohammed Arsiwala, M.D.
Invites you to an evening reception with

Attorney General Mike Cox

Wednesday, May 24, 2006
5:30 to 7:30 p.m.

at the home of Mohammed Arsiwala, M.D.
16505 Wayne Road
Livonia, MI 48154

$200 per person/ 300 per host committee member / $500 per organizational host

If you have not RSVP’d prior to receiving this notice, please fax this form to Lindsey A. McNeill, Chief, Political Affairs, MSMS at (517) 337-2490. For further questions, please call (517) 336-5788.

States’ Strategies For Uninsured Run Full Spectrum

By PAUL NATINSKY
Managing Editor

In their quest to provide coverage to the nation’s 46 million uninsured, states are employing a wide range of solutions.

In Michigan, Governor Jennifer Granholm’s proposed Michigan First Healthcare Plan will develop guidelines for a basic benefit package that will be available to uninsured residents who earn above 100 percent of the federal poverty line ($19,350 for a family of four). Once the guidelines are established, a variety of private health insurance providers will have the opportunity to design benefit packages that meet the state’s requirements.

The governor’s office says the benefit packages will include basic preventive and primary care coverage, emergency room services, hospitalization, mental health care and prescription drugs.

In its May 2006 issue of State Legislatures magazine, the National Conference of State Legislatures reported on the variety of approaches to the uninsured problem across the country. In some cases, states have begun the move toward universal health care coverage, in others, demographics dictated the strategy. Below is an outline of the approaches highlighted by NCSL.

Maine enacted its Dirigo Health Reform Act in 2003. Provisions include a health plan called Dirigo Choice that anybody can buy into; a new health system designed to improve quality and lower costs; and an expansion of the state’s Medicaid program to cover more of the low-income uninsured. The program has enrolled 15,000 since January 2005.
Massachusetts’ widely publicized universal mandate for health care coverage is leading the charge for universal coverage within states. The plan includes a Medicaid expansion, state insurance subsidies, a new entity called Connector to help individuals and small employers buy insurance and a requirement for individuals to buy health insurance or face penalties.
The Fair Share Health Care Fund Act in Maryland requires large employers to provide coverage meeting specific guidelines or pay into a state fund. NCSL reports that 20 states have similar bills pending.
Oklahoma’s O-EPIC (Oklahoma Employer-Employee Partnership for Insurance Coverage) program addresses the issue of small businesses and their ability to buy coverage for employees. NCSL reports that 41 percent of the nation’s workers are employed by small firms. The O-EPIC plan is designed to increase coverage availability for employees of small businesses and low-income workers. The program is open to employers with 25 or fewer workers and might increase to firms with 50 or fewer employees. The costs are covered by employer and employee contributions, tobacco taxes and Medicaid dollars (secured through a federal waiver). The state expects to enroll 70,000 Oklahomans.
Insure Montana, another program to increase coverage at small businesses, has two parts: state subsidies to help pay premiums under a heal insurance pool and a state income tax credit for small businesses that already provide health insurance for their workers. The program is funded by a $1 cigarette tax passed by voters last fall.
Healthy NY gives small businesses in New York a break by subsidizing high premiums and high-cost claims.
West Virginia is using its state employee health plan to leverage lower cost deals with health care professionals for small businesses.
A recent New Jersey law allows adults up to age 30 to remain on their parents’ health care insurance policies; in some cases reducing the cost of insurance from $6,000 to $2,000 per year, according to one state legislator.
NCSL reports that 26 states have enacted legislation permitting “consumer-driven” health plans such as Health Savings Accounts, which combine an investment account with a high deductible insurance policy. Such plans are intended to offer flexibility and savings to those who use them, but critics fear the investment accounts will be used for purposes other than health care costs.

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

This publication brought to you by Natinsky Publishing Network.

Problems seeing this email? You may view it online at http://www.wcmssm.org
To subscribe or unsubscribe to this newsletter contact info@wcmssm.org