October 23, 2006

Editor's Column:Technology & Mortality
Stop Medicare Cuts Now!
Legislator To Try Lame-Duck Medicare Move
CMS To Tighten Self-Referral Rules
Events Of Interest
The Benefit Of Paying Dues Early
PROM Seeks Specialty Reviewers For Peer Review
Anti-Smoking Contest For Kids

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Editor's Column:
Technology & Mortality

By JOSEPH WEISS, MD
Two articles in the medical journal Pediatrics should come to the attention of all of us, whether we treat children or not. I refer to:

Han YY et al: Unexpected Increased Mortality after Implementation of a Commercially Sold Computerized Physician Order System(CPOES) 2005: 116: 1506-1512; and

Sittig DF et al: Lessons From “Unexpected Increased Mortality AfterImplementation of a Commercially sold Computerized Physician Order Entry System 2006: 118: 797-801.

The overall child mortality in the pediatric hospital that was the basis of the article by Han et al was 2.8 percent before the hospital changed to CPOE, and 8 percent after the institution of it. The reasons for this increased mortality included:

1. insufficient time for physicians to adjust from a paper tradition to a computer system;

2. insufficient appreciation of the need for paper systems in the interface between ER admission and arrival on the ward; very sick patients cannot wait for computer protocol;

3. centralization of all medication to pharmacy -- can and did fatally slow the flow of drugs;

4. nurses particularly in ICU spent more time at computers and less at bedside;

5. decreased physician and nurse face to face communication;

6. decreased physician time with the patient because of time the computer required for writing orders;

7. computer breakdowns.

Han notes that to date the focus of CPOE is in its role ending untoward drug reactions and mistakes in giving medication. His article is the first to assess the effect of CPOE on deaths of hospitalized patients.

The article by Sittig et al recommends that the rush to CPOE be stayed, and future implementation be gradual. Sittig et al also supports the observation by Han, that those who would implement CPOE consider the problems it brings, as much as the tradition it ends. Sittig concludes by speaking out for more studies that assess pre and post CPOE hospital mortality.

The medical liability insurers are well aware of the limits of CPOE. No insurer in the country gives a reduction in liability premium for a doctor using EMR( Electronic Medical Record) in the office.

Just because the change to computer entry is inevitable, it does not mean is should not be controllable.

Editor’s note: I wish to thank Dr. Omar Majid for bringing the Pediatrics articles to my attention.

Stop Medicare Cuts Now!

MSMS has intensified its efforts to help prevent the scheduled 5.1 percent Medicare physician payment cut, which will go into effect January 1, 2007, if action is not taken now. Physician leaders recently met with many of Michigan’s lawmakers in Washington, DC, and Sen. Debbie Stabenow (D-Lansing) has helped MSMS by twice pushing Senate leadership for a vote to stop the proposed cut and support a moderate Medicare payment increase. All it takes for physicians to help in this effort is to visit the MSMS Action Center (www.msms.org) and send a prewritten e-mail message to lawmakers; or, call them using the AMA Grassroots Hotline at (800) 833-6354. For details, contact MSMS Executive Director Kevin A. Kelly at (517) 336-5742 or kkelly@msms.org.

Legislator To Try Lame-Duck Medicare Move

Senate Finance Committee Chair Chuck Grassley (R-Iowa) said last week that during the upcoming lame-duck session of Congress he will try to implement a six-month extension of a provision in Medicare law that allows reclassification of certain hospitals into different geographic regions for the application of the wage index to receive higher reimbursements, according to published reports. The provision, which affects 120 hospitals, will expire in March 2007 (CongressDaily, 10/20). According to the Kaiser Daily Health Policy Report (www.kaisernetwork.org) Grassley said, "Medicare hospital payments need to adequately account for differences in wages so that hospitals are able to obtain staffing in a competitive workforce environment." According to Grassley spokesperson Jill Kozeny, the extension would allow Congress to consider revisions to the Medicare wage index proposed by the Medicare Payment Advisory Commission. She added that the extension would cost less than $100 million. Grassley said that he would seek the extension as part of a Medicare package that Congress might consider during the lame-duck session scheduled to begin on Nov. 13. A Grassley aide said that negotiations on the Medicare package have begun between House and Senate staff.

CMS To Tighten Self-Referral Rules

Draconian reimbursement cuts isn't the only Medicare issue percolating in Washington. CMS is considering stricter rules regarding the diagnostic tests physicians perform in their offices or through independent provides with whom they contract, according to a report in the Wall Street Journal . The agency is concerned that current rules allow doctors to inappropriately profit from the practice. The new rules would prohibit physicians from billing Medicare at a higher rate for medical tests and scans than it costs the doctor to conduct the test; or what the physician pays a contractor to perform the test. Current Medicare rules prohibit doctors from making referrals to scanning centers and labs in which they have a financial interest, but under a provision called the "in-office ancillary services" exception, physicians in group practices are allowed to refer patients for tests performed in the group's offices or in a separate facility that is leased by the group for the purpose of performing tests. According to the Journal, in some cases the separate facilities are established and operated by a separate company rather than the practice itself. Acting CMS Administrator Leslie Norwalk said some providers are exploiting the in-office exception by profiting from the difference between the amount the group pays for conducting the tests and the higher rate it bills Medicare. Medicare expenditures for medical imaging have increased an average of 20 percent annually since 1999, with spending reaching $7 billion in 2005.

Events Of Interest

MSMS Discusses Pay-for-Performance & More at Michigan Hospitals
As part of its "Making the Rounds" program, the Michigan State Medical Society will be visiting a number of Michigan hospitals and other medical facilities - including the St. Joseph Health System in Tawas City - to discuss current pay for performance initiatives with physicians. The MSMS “Making the Rounds” program is a unique opportunity for hospital-affiliated physicians to meet with MSMS staff and learn about a variety of health care and financial topics, including the following:
· The Future of Medicine Initiative
· Reimbursement Services and Assistance
· Michigan’s Wellness Initiative
· Physician Contracting Pitfalls
· The Michigan Board of Medicine
· Medical Records and the Law
· Ensuring Accurate Billing for Hospital Services
· Preparing for the OIG: Are You Compliant?
· Civics 101: Health Care Legislative and Advocacy Update
· The ABCs of Owning a Business
· Health Savings Accounts
· Michigan Doctors’ Political Action Committee
· The Benefits of MSMS Membership

"Making the Rounds" has been hosted at Crittenden Hospital in Rochester, Oakwood Healthcare System in Annapolis, Mary Free Bed Hospital & Rehab Center in Grand Rapids, Sparrow Health System in Lansing, Bon Secours Hospital in Grosse Pointe, North Ottawa Community Health System in Grand Haven, and Central Michigan Community Hospital in Mt. Pleasant.

Generally, the Making the Rounds program is free. If you are interested in hosting the Making the Rounds program at your facility, contact Pooja Naik at MSMS at (517) 336-5719 or pnaik@msms.org. For additional speakers and topics, please contact Rebecca Blake at (517) 336-5729 or rblake@msms.org.

Learning from Leaders: Pathways to Success Friday, Oct. 27 - Troy
This annual leadership training session, held in conjunction with the Annual Scientific Meeting, will provide physicians, medical group managers, and other health care professionals with the opportunity to meet with and learn from accomplished leaders from a variety of fields and professions. Each speaker will share first-hand experiences and knowledge on topics related to leadership, including relationship building, empowerment and communication. The program is FREE for MSMS/MMGMA members and will feature presentations from:

· Ronald M. Davis, MD, President-Elect, American Medical Association
· Ella Bully-Cummings, Esq., Chief of Police, Detroit Police Department
· David Hollister, CEO, Prima Civitas Foundation and former mayor, City of Lansing
· State Senator Samuel Buzz Thomas III (D-Detroit)

"Learning from Leaders" will take place on Friday, October 27, 9:00-11:30 a.m., at the Somerset Inn in Troy.

This program has been approved for a maximum of 2.5 AMA PRA Category 1 Credit(s)* and is FREE for MSMS and MMGMA members. Cost is $35 for non-members.

For more information, contact Angie Kemppainen at (517) 336-5724 or akemppainen@msms.org. To register, visit www.msms.org/events or call the MSMS Registrar at (517) 336-5784.

Rep. Gaffney Fundraiser Scheduled
There will be an evening reception honoring State Representative Ed Gaffney, Chairman, House Health Policy Committee, at the:

Detroit Athletic Club
Randolph Room

241 Madison Ave • Detroit, MI

Monday, October 30th
5:30 p.m. to 7:00 p.m.

Sponsored by
Health Care Association of Michigan
Michigan Health & Hospital Association
Michigan Pharmacists Association
Michigan State Medical Society
Primary Care Cares PAC

Tickets: $100 per person
(No cash or corporate contributions, please)

Please make contributions payable to:

Ed Gaffney Victory Fund
and bring to the door, or send c/o Nan Fletcher to:
1965 Pawnee Trail, Okemos, MI 48864

Please R.S.V.P. to Nan Fletcher at
(517) 853-0279 or mipharmacists@hotmail.com

Group Managers: Save the Date for Third Party Payer Day!
Friday, November 17, Lansing
Sponsored by MSMS, the Michigan Medical Group Management Association, the Michigan Medical Billers Association, and the Michigan Osteopathic Association, Third Party Payer Day features all the major payers of Michigan, who will present expected changes for the coming year, give feedback on how to get claims paid in a timely manner, and answer questions about claims processing and reimbursement.

The Medicaid claims department also will be on hand to meet one-on-one with attendees to discuss problem claims and answer questions. (Bring your Medicaid claims and the remittance advice that had the rejection on it for each claim.)

For details, visit www.michmgma.org
or contact Sherry Barnhart at (517) 336-5786 or sbarnhart@msms.org

The Benefit Of Paying Dues Early

Pay your 2007 Membership Dues by December 31 to receive free CME! Paying your dues in full by December 31, 2006, will enable you to receive one free registration to any MSMS educational program or conference in 2007 (excluding the MSMS Annual Scientific Meeting). Upon receipt of your dues, you’ll receive a coupon for which to use when registering. And don’t forget, up to 86 percent of your dues may be tax-deductible!

PROM Seeks Specialty Reviewers For Peer Review

The Physician’s Review Organization of Michigan (PROM) is now offering packages of focused external peer reviews to assist hospitals and medical offices meet JCAHO. The new bundled review service allows the medical facility to enroll annually and choose the review service package that best meets its needs. In addition, by signing up for a package, medical facilities can save roughly 15 percent off the traditional price of separately scheduled reviews.

The new focused external peer review service encourages routine quality assessment of medical staff members. PROM believes there is a need for prospective clinical quality review to aid in the early identification of variant clinical performance that, if left unattended, may lead to clinical privileging evaluations. By creating a program of focused review that looks for elements that are associated with increased risk of malpractice claims or other institutional complications, organizations will be better equipped to retain their staff members and maintain a high quality of patient care.

PROM has served as the sole peer review body for medical groups, as well as a validating service for those medical facilities with existing peer review boards.

For more information about PROM’s focused external peer review service, contact PROM at (517) 336-1400, (800) 688-1895, or prommail@medadvgrp.com. Also, visit www.peerreviewmi.net.

Seeking Specialists
Due to its considerable growth and demand for review services, the Physician’s Review Organization of Michigan (PROM) is seeking specialists in the fields of hematology/oncology, neurosurgery, and oral surgery.

Since being founded in 1983, PROM has provided thousands of case reviews to a wide range of groups including hospitals, physician practices, managed care organizations, and major insurance companies. PROM recently renewed a five-year contract with Blue Cross Blue Shield of Michigan and began a new relationship with Great Lakes Health Plan.

PROM utilizes the expertise of its experienced staff and over 150 carefully selected reviewers to ensure that clients receive informed, confidential, and objective reviews. PROM is fully accredited by the American Accreditation Health Care Commission.

If you are interested in becoming a reviewer, contact Judy Trotter at PROM at (517) 336-1400, (800) 688-1895, or jtrotter@medadvgrp.com.

Anti-Smoking Contest For Kids

To help kids fight back against tobacco advertising and raise awareness about the dangers of smoking, Henry Ford Health System is co-sponsoring the Southeast Michigan Tobacco Counter-advertising Contest for Kids.

“One of our goals for this program is to help kids better understand the messages in tobacco advertisements so they are better prepared to resist the pressures to smoke,” says Ronald M. Davis, MD, director of Henry Ford’s Center for Health Promotion and Disease Prevention.

The contest is open to students in K-12 throughout southeast Michigan. Students will create an anti-tobacco counter-advertisement either as a poster, computer-generated artwork, radio commercial, song, TV commercial or music video. Each entry should be accompanied by a typed statement describing the work in no more than 350 words.

Every day it is estimated that 4,000 US teenagers try their first cigarette, and another 2,000 become regular smokers. Of those, about half will eventually die from a smoking-related disease.

But the health consequences of smoking are probably the last thing on the minds of teens when they light up. Television, movies and other forms of advertising are influencing kids more than ever these days, and tobacco companies are constantly looking for new ways to get their attention.

Entries can be submitted beginning Monday, Oct. 16 to Amanda Holm, project manager, Henry Ford Health System, 1 Ford Place, Suite 5C, Detroit 48202. Deadline for entries is midnight Wednesday, Nov. 15.

Prizes of $200 and $100 will be awarded for the top two entries in each grade. Schools whose students submit a winning entry will receive $250.

The contest is co-sponsored by the Wayne County Medical Society Foundation, and funded by the Community Foundation of Southeastern Michigan, Blue Cross/Blue Shield of Michigan Foundation, Michigan State Medical Society Foundation, Francis Rhoades Memorial Foundation, Linda Ford and R. Joe Dennis, and Flight Attendant Medical Research Institute.

For more information, contact Holm at (313) 874-3959 or visit www.counteradvertising.com

This publication brought to you by Natinsky Publishing Network.

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