April 23, 2007

IN THIS ISSUE

Editor's Column: What Doctors Think
House Dems Look To Slash Medicaid Payments
Physician Group Denounces Supreme Court Abortion Ruling
Henry Ford Continues Growth In '06
Henry Ford Chief Named A 'Top Woman In Healthcare'
AMA, CDC Address Key Issues At Flu Summit
Hear Lawmakers And Futurist At HOD
Physician Speakers Wanted For School Health Programs
 

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Editor's Column: What Doctors Think

By JOSEPH WEISS, MD
In his new book How Doctors Think, Dr. Jerome Groopman, MD, goes after the medical profession. He finds that doctors  think in patterns that act to reinforce their own bias and bad habits. According to Dr. Groopman, the patient with an unusual condition faces an uphill battle in moving the doctor to recognize the patient’s out-of-the-pattern condition.

Dr. Groopman gives patients strategies to counter a physician’s rush to judgment. He tells patients to not allow the doctor to interrupt his narrative of the illness. When a physician makes a diagnosis, Groopman urges patients to ask: “What else could it be?”

Few of us would argue that we make errors in diagnosis. Each of us can call upon personal experience to recall incidents in which we didn’t heed a patient’s statement about the nature of the pain or dismissed what brought on a fever.

In most instances we were not complacent, but rather tired, harried, or distracted. Likely, most doctors attempt to put aside such states of mind while in front of a patient. However, we are not always successful.

In part, physician error in judgment occurs because of the way we are tested on our boards and re-certifications. The usual test book question begins with a scenario such as: “45-year-old woman comes to see you because of mid epigastric pain that began after eating raw oysters, etc.” In life we have to elicit this information or, as occurs in re-certification, make do with what data is in front of us.

It is unlikely a book can explain “How Doctors Think,” or instruct physicians how to think better. The medical profession has not cultivated a herd mentality. Unusual diagnoses come out of a combination of intuition, study, insight, logic, and luck. This approach may lead to errors, but to date, computer guided schemes do no better.

Groopman devotes himself to stories about errors doctors make in diagnoses, but he does not weigh these anecdotes against the times our assessments are accurate.

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House Dems Look To Slash Medicaid Payments

Rejecting Senate Republicans' one-percent cut, House Democrats proposed a general fund budget measure on April 17 for the current fiscal year that, if signed into law, would cut Medicaid physician payments by 6.25 percent beginning June 1. (Gov. Jennifer Granholm's plan proposes no cut in Medicaid funding.) The Partnership for Michigan's Health (MSMS, Michigan Health & Hospital Association, and the Michigan Osteopathic Association) urges the legislature to find solutions to Michigan's dire budget situation that don't threaten access to basic health care services through Medicaid to babies, children, mothers, and seniors from Michigan's middle class and low-income families.

TAKE ACTION NOW - Use the online MSMS Action Center (http://www.msms.org)   to send a customizable message to your state senator and representative, urging them to preserve access to care by rejecting any Medicaid cuts. View a chart outlining FY 2007 state budget proposals from Gov. Granholm, the House and the Senate at www.msms.org/medicaid . For more information, contact Colin Ford at MSMS at (517) 336-5737 or cford@msms.org.  Or visit www.msms.org/medicaid .

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Physician Group Denounces Supreme Court Abortion Ruling

The Supreme Court last week upheld the first federal ban ever on a specific abortion method. In response to the ruling, Physicians for Reproductive Choice and Health issued the following statement from board chair Wendy Chavkin, MD, MPH:

"Today's Supreme Court decision is not only a tremendous loss for women's health, it also undermines the right of every American to make personal decisions about their health care. By allowing Congress to ban abortions early in the second trimester, the Supreme Court has tied physicians' hands and restricted our ability to protect our patients'
health.

"This ruling ignores expert testimony and the views of major medical associations, including the American College of Obstetricians and Gynecologists. It is absurd to think that Congress knows more about medical safety than doctors, yet that is exactly what the Supreme Court has declared.

"Physicians treat each of our patients with caring and compassion, and we know that every woman has unique medical needs. An abortion method that works for one woman may not be the best or safest for another. Doctors are now barred from using certain abortion methods, even though they offer significant safety advantages to women.

"Our opponents don't want to make abortion safer -- they want to make it impossible. While they are cheering today's decision, doctors like me are worried about the consequences for women's health. I remember the women who suffered before abortion was legalized, and I fear that politicians will continue chipping away at the right to abortion until it disappears completely.

"This ruling is a clarion call to all Americans who believe politics has no place in the doctor's office. If a federal law can ban an abortion method -- even in cases when a woman's health is at risk -- what will be next? Will politicians be allowed to outlaw every medical procedure they personally oppose? It's time for Americans to push back and demand that Congress stay out of our personal reproductive decisions."
 

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Henry Ford Continues Growth in '06

Continued growth in hospital admissions and outpatient procedures allowed Henry Ford Health System to experience another fiscal year of increased revenue and net income.

Henry Ford reported total revenues of $3.25 billion, an improvement of $228.7 million or a 7.6 percent increase from 2005. Net income in 2006 was $134.9 million, an improvement of $22.6 million or a 20 percent increase from 2005.

Fiscal year 2006 represents the fourth consecutive year in which Henry Ford has reported positive net income.

“Despite the difficult economy in southeast Michigan, we continue to experience high demand for health services at Henry Ford Health System,” said Nancy Schlichting, president and chief executive officer for Henry Ford.

She notes that during the last three years, admissions at Henry Ford Hospital, the flagship hospital for the health care system, have increased 17.5 percent. And last year, outpatient surgery at the hospital grew by 14 percent from 2005. In addition, the Henry Ford Medical Group continues to hire new physicians to meet the demand for patient services. Today, the medical group has about 1,000 members, including 900 physicians and 100 researchers.

"Notwithstanding operating in a challenging economic environment, these results are a real tribute to the engagement and loyalty of our employees and physicians and how they are embracing The Henry Ford Experience," says Schlichting.

Between 2006 and 2010, the System is investing $1 billion in capital projects including the $300 million Henry Ford Hospital expansion and renovation; the new $310 million Henry Ford West Bloomfield Hospital; Wyandotte Hospital’s new Center for Health Services; and the anticipated purchase of total ownership of St. Joseph’s Healthcare in Clinton Township.

In addition, other initiatives include the replacement or purchase of new medical equipment such as a linear accelerators, CT scanners and MRIs; the deployment of CarePlus Next Generation, an electronic medical record system; a new clinical simulation center at Henry Ford Hospital and the establishment of a new Contact Center to enhance customer service.

Henry Ford Health System is committed to investing in its employees including, in 2006, $17.9 million for employee pay raises and $1 million in wellness incentives and subsidies for employees; and $22.4 million in employee Group Performance Awards since the program’s inception in 2004.

Henry Ford officials continue to express cautious optimism about 2007 and the impact manufacturing and other corporate layoffs will have on the number of underinsured and uninsured. Last year, Henry Ford provided more than $104 million in uncompensated medical care, says Henry Ford Chief Financial Officer James Connelly.

“Companies in metropolitan Detroit have and are continuing to downsize their workforce through early retirement buyouts and layoffs,” says Connelly “This means more individuals may not have employer-paid health insurance.”

In addition, Connelly pointed out that last year Henry Ford Hospital & Health Network alone received $2.2 million in state cuts due to budget shortfalls and this year it is unknown how the state budget crisis will impact Henry Ford. In addition, further cuts to the federal Medicare and Medicaid programs have been proposed.

Henry Ford Health System, one of the country's largest health care systems, integrates primary and specialty care with research and education. It includes the 1,000 member Henry Ford Medical Group, five owned hospitals, the 576,000-member Health Alliance Plan, 25 primary care centers and many other health-related entities located throughout southeastern Michigan.
 

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Henry Ford Chief Named A 'Top Woman In Healthcare'

Nancy Schlichting, president and CEO of Henry Ford Health System, has been selected as one of the “Top 25 Women in Healthcare” by Modern Healthcare magazine in this week’s issue.

The magazine noted that Schlichting is the first woman to lead Henry Ford Health System in Detroit in its 90-year history and that she is credited with the health system’s financial turnaround. “After losing nearly $75 million in 2001, the system was in the black by 2003. In 2005, the system had $3.05 billion in revenue and net income of $112 million,” notes the magazine.

Schlichting joined Henry Ford in 1998 as senior vice president and chief administrative officer and shortly afterward, became its executive vice president and chief operating officer. A few years later, she became president and chief executive officer of Henry Ford Hospital. In June 2003, Schlichting was named the health system’s president and CEO.

The final selections were made by five senior editors of the magazine after receiving nominations from all sectors of health care. The five criteria used for selection was, has the candidate:
* Successfully served as a leader or managed an organization or company
* Shown the ability or power to effect change in the healthcare industry
* Demonstrated a willingness to share expertise with others in the field
* Served as a role model or mentor to other female healthcare executives Assumed a leadership position in the industry outside of the candidates’ own organization or company
 

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AMA, CDC Address Key Issues At Flu Summit

At a national vaccine summit in Atlanta last week health care leaders joined forces to discuss flu vaccine issues and begin preparations for the 2007-08 flu immunization season. The National Influenza Vaccine Summit is an annual meeting co-sponsored by the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC). More than 200 health care professionals, vaccine manufacturers, and medical and health organizations will attend.

"Each year, more than 200,000 Americans are hospitalized from flu complications, and nearly 36,000 patients die as a result," said Ronald Davis, MD, AMA President-elect and WCMSSM Member. "To better protect America's patients, we need to improve the supply and distribution of the flu vaccine and bolster the adult immunization infrastructure so it is on par with that of child vaccinations."

"The flu is a unique public health problem, as each season presents new challenges," said Anne Schuchat, MD, Director, National Center for Immunization and Respiratory Diseases (NCIRD). "This year's Summit will address some of the flu vaccine challenges faced during the 2006-07 flu season, and lead to innovative approaches to get more Americans vaccinated in 2007-08."

This year, the Summit focuses on finding new and better ways for public health and clinical medicine to work together to get all high-risk patients vaccinated. Topics discussed include: vaccine supply for 2007-08 season; immunization recommendations; pediatric vaccine supply; vaccine supply chain; flu vaccine tracking system; monitoring vaccine distribution; vaccine uptake; and vaccine financing.

"The American public must be better aware of the necessity and timing for flu vaccination so all high-risk patients are protected," said Dr. Davis. "We hope the Summit will serve as a tool to bring us closer to this goal."

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Hear Lawmakers And Futurist At HOD

MSMS invites all members to earn up to 3.5 hours of AMA PRA Category 1 Credit(s)™ and learn about several interesting topics during two afternoon House of Delegates sessions on Saturday, April 28. The Physician Issues Forum, 12:00-2:00pm, will offer 1.5 hours of AMA PRA Category 1 Credit(s)™, and will address health care issues in the state and federal legislatures. Confirmed speakers include US Congressman John Dingell (D-Dearborn), state Sen. Roger Kahn, MD (R-Saginaw), and futurist David Ellis, of the Detroit Medical Center. To register, contact Jeanne Miller at (517) 336-5726 or jkmiller@msms.org.  "Health Care Crisis: Single Payer Solution?", 2:30-4:30 p.m., will offer up to two more credits. The programs are free and open to any MSMS member. To register, contact Angie Kemppainen at (517) 336-5724 or akemppainen@msms.org.  
 

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Physician Speakers Wanted For School Health Programs

At the direction of a 2006 House of Delegates resolution, MSMS is gathering the names of physicians and medical students willing to volunteer as guest speakers at local schools on health issues. Physicians and medical students with expertise in areas such as healthy weight (nutrition, fitness), tobacco, bullying, mental health (depression, anxiety), substance abuse and other school age-appropriate health topics are encouraged to volunteer. Names will be shared with various patient advocacy and health organizations with existing educational outreach programs for schools (such as the National Kidney Foundation of Michigan). If you are interested in volunteering, email your full name, address, phone number, the county (or counties) you would be willing to visit, and the topics you could speak about to Jessy Sielski at MSMS at jsielski@msms.org (subject line: "Volunteer Speaker").

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