E-DMN - August 13, 2007

August 13, 2007

Editor's Column: Patient-Focused Compensation System
Udow To Direct Center For Health Care Quality
Oakwood Honors Fitzgerald
NPI Update
Cancer Walk
Unbalanced SCHIP Bill Favors Some Hospitals
Retail Clinics Continue Growth Amid Mounting Concerns

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Editor's Column: Patient-Focused Compensation System

By JOSEPH WEISS, MD
Summertime is when medical meetings and agendas go into hibernation. But the cessation of that labor is not complete. Work continues on developing an alternative to the present medical malpractice system.

Specifically, effort is going to refine the present no-fault concept to ready it for the fall/winter term of the Michigan Legislature. An important aspect of that preparation is changing the name of the no-fault bill MSMS will introduce. The new name is The Patient-Focused Compensation Act.

The name change is important. It focuses on features of the bill that incorporate timeliness, reasonable compensation, an emphasis on error rather than fault, a response to injury rather than a chance for revenge and provides a means for appeal if either patient or physician believes the decision is unfair.

Lawyers familiar with the malpractice environment in Michigan say the present tort reform laws suffice to give physicians the protection the profession needs to ward off frivolous lawsuits. However, the point of the MSMS initiative resides in the new name of the act. The thrust is to extend equal protection to patients against the law’s delay and opportunity for equity in an instance of medical error.

Summertime, and the living is easy, but the work of medical politics goes on: not in smoke-filled, but in air-conditioned rooms.

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Udow To Direct Center For Health Care Quality

The board of directors of the joint venture between the University of Michigan Health System and Blue Cross Blue Shield of Michigan has named Marianne Udow as the first director of the Center for Healthcare Quality & Transformation, a joint venture dedicated to improving the quality of Michigan's health care, and transforming the way patient care is delivered in the state and beyond. Udow will begin in September.

Udow will be an employee of UMHS, which is providing staffing for the Center. BCBSM is providing seed funding, allocating up to $10 million.

Udow is currently the director of the Michigan Department of Human Services, a post she has held since being appointed by Gov. Granholm in January 2004. From 1992 to 2004, she served in several executive positions at Blue Cross Blue Shield of Michigan, including senior vice president of health care products and provider services. She was senior vice president of plans and operations at Mercy Alternative and Care Choices from 1986 to 1988. She holds a master's degree from the University of Michigan's School of Public Health.

The Center was created as part of the University of Michigan's sale of its M-CARE health plan to BCBSM and its HMO subsidiary, Blue Care Network, which was finalized on Dec. 31, 2006. The sale terms included the creation of a separate joint venture aimed at improving the quality, safety, efficiency and appropriateness of health care in Michigan. UMHS and BCBSM are equal partners in the venture.

The Center has already undertaken its first project, which is evaluating the impact of lower prescription drug co-payments for U-M faculty, staff and dependents who have diabetes. The project is evaluating how reducing costs influences participants' use of drugs to control blood sugar, cholesterol, blood pressure and depression — all important steps that may reduce their long-term health costs by preventing or delaying kidney failure, nerve damage, cardiovascular problems and blindness.

The Center board will meet regularly to consider potential areas of health care that might be open to projects that will improve the delivery of services, get the right care to the right person at the right time, prevent medical errors, reduce risks, avoid unnecessary treatment, or get more value for the dollars spent.

In the future, the Center will allow health experts from all areas of U-M, including UMHS, and from other institutions, to pursue projects under contract with the new entity. Blue Care Network and other BCBSM subsidiaries also will be closely involved with the work of the Center. Any use of data for research will be under the jurisdiction of the appropriate research-oversight process to protect patient privacy and rights.

Results or findings of most of the projects commissioned by the Center will be available to all health experts. The Center also may endorse and promote programs and care delivery enhancements developed through projects it fosters.

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Oakwood Honors Fitzgerald

Oakwood Healthcare System (OHS) is paying tribute to longtime President and Chief Executive Officer, Gerald D. Fitzgerald, by naming the Surgical Pavilion at Oakwood Hospital & Medical Center (OHMC) the “Fitzgerald Pavilion” to commemorate his retirement. Fitzgerald dedicated 40 years of service to Oakwood, and in return, the organization is dedicating its state-of-the-art surgical center in his name.

“The Surgical Pavilion & Heart and Vascular Center...is a true point of pride for Oakwood and I can’t think of a better way to honor Jerry than to dedicate this wonderful center in his name,” said Brian Connolly, president and CEO, Oakwood Healthcare, Inc.

The Fitzgerald Pavilion houses Oakwood’s Heart and Vascular Center and the Oakwood Surgical Center. In addition to new signage reflecting the new name, there is now a hand-painted portrait of Fitzgerald displayed in the lobby of the Pavilion - visitors are welcome to enjoy the space and view the portrait.

Fitzgerald will continue to serve Oakwood as vice-chair of the OHI board of directors.

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NPI Update

NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS will be disclosing these data via the Internet. Data will be available in two forms:

A query-only database, known as the NPI Registry.
A downloadable file.

CMS is extending the period of time in which enumerated health care providers can view their FOIA-disclosable NPPES data and make any edits they feel are necessary prior to our initial disclosure of the data.

We must build in time to resolve any errors or problems that may be encountered with edits that health care providers submit. Therefore, in order to ensure edits are reflected in the NPI Registry when it first becomes operational and in the first downloadable file, health care providers need to submit their edits no later than Monday, August 20, 2007. Health care providers who submit edits on paper need to ensure that they are mailed in time for receipt by the NPI Enumerator by that date.

CMS will be making FOIA-disclosable NPPES health care provider data available beginning Tuesday, September 4, 2007. The NPI Registry will become operational on September 4 and the downloadable file will be ready approximately one week later.

Some of the key data elements that are FOIA-Disclosable are:

NPI
Entity Type Code (1-Individual or 2-Organization)
Replacement NPI
Provider Name (First Name, Middle Name, Last Name, Prefix, Suffix, Credential(s), OR the Legal Business Name for Organizations)
Provider Other Name (First Name, Middle Name, Last Name, OR ‘Doing Business As’ Name, Former Legal Business Name, Other Name. for Organizations)
Provider Business Mailing Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
Provider Business Location Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
Healthcare Provider Taxonomy Code(s)
Other Provider Identifier(s)
Other Provider Identifier Type Code
Provider Enumeration Date
Last Update Date
NPI Deactivation Reason Code
NPI Deactivation Date
NPI Reactivation Date
Provider Gender Code
Provider License Number
Provider License Number State Code
Authorized Official Contact Information (First Name, Middle Name, Last Name, Title or Position, Telephone Number)

The delay in the dissemination of NPPES data does not alter the requirement that HIPAA covered entities must comply with the requirements of the NPI Final Rule no later than May 23, 2008. All NPI contingencies that may be in place must be lifted by that date.

Still Confused?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

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Cancer Walk

The 4th Annual NAAMA's Walk for Women's Cancer

New Date: Saturday, September 29th, 2007

Mark your calendar for Saturday, September 29, 2007 for the 4th NAAMA's Walk for Women's Cancer.

This one mile non-competitive walk at the Detroit Zoo in Royal Oak, Michigan was established in 2004 by the Michigan Chapter of the National Arab American Medical Association (NAAMA) in partnership with the Karmanos Cancer Center.

The walk is the first of its kind to target all women's cancer, and one of the few to focus on ovarian and gynecological malignancies.

Its mission is to increase public awareness, support surviving patients, honor memories of those lost and to create a community of individuals and businesses dedicated to eradicating the concerns of future generations.

Sponsorship revenue helps to underwrite the event expenses and along with entry fees and donations will go directly towards supporting Karmanos gynecological oncology clinic as well as funding community focused services for women with cancer.

For details or to sign up visit: www.cancerwalk.org

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Unbalanced SCHIP Bill Favors Some Hospitals

The House has "quietly funneled hundreds of millions of dollars to specific hospitals and health care providers" under the SCHIP reauthorization bill passed earlier this month, the New York Times reports (Pear, New York Times, 8/12). The House SCHIP bill would reduce payments to Medicare Advantage plans and increase the federal cigarette tax by 45 cents per pack to increase funding for SCHIP by about $50 billion over five years. The bill also would make a number of revisions to Medicare (Kaiser Daily Health Policy Report, 8/9).

According to a Times review of the legislation, the House bill would "direct millions of dollars a year to about 40 favored hospitals by increasing their Medicare payments," mostly "at the request of Democratic lawmakers." Many of the earmarks would reclassify suburban hospitals as located in urban areas, which generally receive higher Medicare reimbursements to cover higher wages for hospital workers, according to the Times. Although Democrats have promised greater transparency of earmarks and other projects, the bill describes the hospitals "in cryptic terms, so that identifying a beneficiary is like solving a riddle," the Times reports.

House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) said that increasing payments to some hospitals is a way for Congress to improve "the equity and fairness" of Medicare reimbursements. Under Medicare, "you are basically setting prices, and the system is clumsy," Stark said.

Health Subcommittee ranking member Dave Camp (R-Mich.) criticized a proposed adjustment that would reclassify Bay Area Medical Center -- located on the border of Wisconsin and Michigan -- as located in Chicago. Camp called the provision "absurd on its face," adding, "Every hospital in America would like to be reclassified" into a labor market with higher wages.

Nadeam Elshami, spokesperson for House Speaker Nancy Pelosi (D-Calif.), said, "It's easy to criticize individual provisions of large, complex bills," but "the focus should be on the huge number of uninsured children who will be eligible for life-saving health care under our bill" (New York Times, 8/12).

2008 Campaign
Efforts to pass SCHIP legislation provide "a glimpse into the emerging 2008 campaign strategies of Republicans and Democrats" and illustrate "some of the problems House Republicans face in their first election cycle as the minority party," the Times reports.

A proposal in the House SCHIP bill that would reduce payments to MA plans provides Republicans "an irresistible opening to go after Democrats," according to the Times. Former Speaker J. Dennis Hastert (R-Ill.) said, "When seniors find out what is really going to happen [if payments to MA plans are cut], they are not going to be happy." However, analysts and others "suggest this could be a tough sell for Republicans" because Democrats "have accumulated decades of credibility on Medicare while Republicans, until recent years, were identified more as foes of the program," the Times reports.

In addition, Democrats "believe they can easily paint Republican opponents of the measure ... as being against helping poor sick kids," according to the Times. Democrats also are "getting important political cover" from AARP, which supports expanding SCHIP, according to the Times (Hulse, New York Times, 8/11).

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Retail Clinics Continue Growth Amid Mounting Concerns

Retail clinics -- low-cost, walk-in facilities often located in supermarkets, pharmacies and large retail stores that in large part are staffed by nurse practitioners -- are "fast becoming a serious industry" in the United States., the AP/Tennessean reports. According to the Convenient Care Association, which represents retail clinics, 7 percent of U.S. residents visited such facilities at least once, with the rate expected to increase as the number of facilities expands.

CCA estimates that the number of retail clinics will increase from 400 to more than 700 by the end of the year and to about 2,000 by the end of 2008. In addition, about 40 percent to 50 percent of clinics accept health insurance from Aetna, Humana, UnitedHealth Group and other large companies, according to CCA.

Concerns
However, "concerns about quality of care are rising among physicians, and some industry experts say the clinics' services need to be more broad if they are going to have a big impact on reducing overall health care costs," the AP/Tennessean reports (D'Innocenzio, AP/Tennessean, 8/12). The American Medical Association in June adopted a resolution to ask state and federal agencies to launch investigations into whether retail clinics place the health of patients at risk and whether the facilities encourage patients to fill their prescription on site. In addition, AMA will seek a ban on a practice in which health insurers offer to waive or reduce copayments for members who seek care at retail clinics (Kaiser Daily Health Policy Report, 6/26).

A number of states have passed legislation to clarify the role of nurse practitioners at retail clinics. In response to concerns about the quality of care provided at retail clinics, Tine Hansen-Turten, executive director of CCA, said that such facilities are monitored by state nursing or medical boards or both. Michael Howe, president and CEO of MinuteClinic, added, "I wouldn't call it express care. I would call it efficient care."

AMA has denied that "criticism of these clinics is being driven by economic interests," but "there's no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments," according to the AP/Tennessean (AP/Tennessean, 8/12).

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