December 26, 2007

IN THIS ISSUE

Editor's Column: Universal Health Care: Fine Goal, Wrong Direction
Congress Approves Medicare Bill
Michigan, Sinai-Grace Get National Ink For ICU Excellence
WSUSOM Makes Push For Translational Medicine Grant
P4P Evaluation Raises Doubt On Value
ER Doc and TV Health Reporter Joins Henry Ford
Clinical Trials Chief Moves From Karmanos to WSUSOM

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Editor's Column: Universal Health Care: Fine Goal, Wrong Direction

By JOSEPH WEISS, MD
For the last 45 years, MichUHCAN (Michigan Universal Health Care Access Network) has championed universal health care along the lines of a single-payer system as in Canada or the United Kingdom.

In a change of strategy, the organization has shifted to promote universal health care for Michigan citizens by either governmental and/or private insurance to achieve that goal. Seeing the legislative process in Michigan bogged down in budget crises and sectarian strife between Republicans and Democrats, MichUHCAN wants to compel, by mandate, that the state legislature pass a Michigan Universal Health Care Bill. The mandate would be an amendment to the State Constitution, and would read as follows:

The State Legislature shall pass laws to make sure that every Michigan resident has affordable and comprehensible health insurance coverage through a fair and cost-effective financing system. The Legislature is required to pass a plan that, through public or private measures, controls health care costs and provides for medically necessary preventive, primary, acute and chronic health care needs.

Obstacles to universal coverage include:

-those who feel the process clashes with individual choice and responsibility

-those who are satisfied with the policies they now have

-those with Medicare who believe that change may somehow disrupt their benefits.

Furthermore, taxpayers have the right to worry about how much paying for universal care will cost them, a concern felt even more by the medical community who sees the threat of special taxes imposed on them to pay for universal health care.

Reconciling these forces to accept universal health care in Michigan will take time just as Medicare took time. Fiat by constitutional amendment will fail as it cannot hurry the political process any faster than psychological currents permit.

The wording of the MichUHCAN amendment will cause only further delay. The phrasing in the amendment is sufficiently vague to make possible an interpretation that our current mix of governmental and private insurance already meets the requirements of the proposed amendment.

Concepts of fairness and medically necessary care are contentious issues with no clear-cut guidelines. It will be inevitable that opponents will take any universal health care bill, if passed, to the Supreme Court in challenge of that bill’s constitutionality.

I am a dues-paying member of MichUHCAN but I cannot support the idea of forcing universal care on a skeptical public through the ploy of a state constitutional amendment.

There are better ways to proceed to obtain health care for all Michigan residents. First, is to support candidates who favor this legislation.  Second is to learn from the experience of Massachusetts, Maine, and Vermont (all of which have adopted some form of universal coverage during the past two years), and apply their lessons to lobbying and networking for Michigan.

What not to do is to waste political and financial capital on forwarding a constitutional amendment that is both foolish and faulty.

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Congress Approves Medicare Bill

Federal lawmakers passed a $4.6 billion legislative package that reverses a scheduled Medicare physician pay cut of about 10 percent and extends funding for the State Children’s Health Insurance Program (SCHIP) through the early part of 2009. The House last week voted 411-3 on the bill that includes a host of provisions to extend several Medicare and Medicaid programs that were set to expire, including a physician quality-reporting initiative and a system of bonus payments to doctors who practice in shortage areas. The Senate unanimously passed the bill on Dec. 18. Next, the legislation will go to the White House where President Bush is expected to sign it into law.

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Michigan, Sinai-Grace Get National Ink For ICU Excellence

By PAUL NATINSKY
We recently reported that despite obvious and well-publicized economic and political problems, Michigan is ahead of the curve in facilitating development of a health information technology infrastructure.

Well, the state has made national headlines once more. This time Michigan has been lauded in a December 10 New Yorker Magazine article for its landmark efforts at reducing patient deaths and reducing costs on intensive care units in hospitals throughout the state.

The lengthy article, penned by Atul Gawande, focuses on Peter Pronovost, a Johns Hopkins University researcher who developed a system of checklists and regular communications between hospital administrators and clinicians focused on executing simple tasks in ICUs. The checklists reinforce well-established, but often neglected ICU protocols, mostly involving intravenous lines and ventilators, both of which are major sources of secondary infection and often deadly complications in ICUs.

Gawande’s overall thrust is that much like flying modern jet airplanes, an activity that became subject to pilot checklists after some early disasters, present day medicine is too complicated to rely on the memory and diligence of individual physicians, regardless of how bright and conscientious they are.

In late 2003, the Michigan Health and Hospital Association (MHA) initiated a program it dubbed Keystone as a 501 (c) (3) organization under the MHA Foundation. The program instituted Pronovost’s system and achieved impressive results. Pronovost achieved great results at Johns Hopkins, but met with skepticism when he tried to take his system on the road. The Keystone group ended up being a perfect fit. The results? Between March 2004 and March 2007 120 hospitals, all but five in Michigan, an estimated 1,729 patient lives were saved along with a whopping $246,638,054.

While researching for his article, Gawande visited Sinai-Grace Hospital last summer. A place he described as: “Occupying a campus of red brick buildings amid abandoned houses, check-cashing stores, and wig shops on the city’s West Side, just south of 8 Mile Road, Sinai-Grace is a classic urban hospital. It has 800 physicians, 700 nurses, and 2,000 other medical personnel to care for a population with the lowest median income of any city in the country.”

Gawande described the Keystone effort and its results, as reported in the December 2006 New England Journal of Medicine. “Within the first three months of the project, the infection rate in Michigan’s ICUs decreased by 66 percent. The typical ICU – including the ones at Sinai-Grace Hospital – cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average ICU outperformed 90 percent of the ICUs nationwide…The successes have been sustained for almost four years – all because of a stupid little checklist.”

Not too shabby for a state busy establishing its political machinations as the laughing stock of the nation and earning the nickname “Michissippi” because of its woeful economic plight. And even better for a hospital operating in city that provides one of the most challenging medical practice environments in the country.

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WSUSOM Makes Push For Translational Medicine Grant

New Biostatistical, Study Design and Epidemiology Services have been launched as part of Wayne State University School of Medicine’s initiative to secure a Clinical and Translational Science Award.

The services will tie into the School of Medicine’s “Vision 2011” strategic plan and objective of achieving a Clinical Translational Science Award from the National Institutes of Health.

The new services are now available on a trial basis to all consortium investigators from Wayne State University and its collaborating institutions.

The Clinical and Translational Science Award was instituted by the National Institutes for Health in response in part to the need to remove the silos that now exist in the clinical research enterprise, said Michael Diamond, MD, principal investigator.

“It is anticipated that these changes will result in improving and expediting the translation of new knowledge to patient care,” Dr. Diamond said. “A CTSA award provides resources to rebuild the research infrastructure to support the goal of greater research collaboration in pursuit of more efficient, effective and timely health care delivery.”

Wayne State University School of Medicine has partnered with Henry Ford Health System and other institutions to prepare the grant and participate in its implementation. “Our CTSA Biostatistical, Study Design and Epidemiology Services is one of the many steps to enhance the research infrastructure for investigators within our consortium,” said Dr. Diamond.

Consortium investigators planning a research grant that meets CTSA criteria will be able to obtain assistance for contributions relating to study design, power calculations and other services in support of grant submissions, as well as access to support for data analysis. The staff will help investigators in the spectrum from conceptualizing an idea for a research study to the type of analysis that should be used to obtain results.

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P4P Evaluation Raises Doubt On Value

Federal and private pay for performance programs are growing in number, but it’s still unclear whether they’re improving care, according to a report released by the Robert Wood Johnson Foundation.

Evaluations of large-scale pay-for-performance efforts have consistently found improvements in care following the program’s intervention. However, because these incentives were often paired up with other quality improvements, “the precise impact of the incentives cannot be determined,” according to the report prepared by the foundation’s Synthesis Project, which summarizes research findings on health care topics.

Most health plans have pay-for-performance programs, and one-third or 30 percent of primary-care physicians have pay-for-performance quality incentives in their plan contracts. Payers typically use a mix of performance measures in these programs such as clinical care, patient satisfaction, efficiency, and use of information technology.

Physicians in general support the concept of pay-for-performance, but have little confidence that payers or health plans have the ability to design a fair and effective reward system, the report found.

“A lot of physicians have been skeptical” about pay-for-performance, and whether these measures actually reflect what they’re doing in their practices, Mark McClellan, director for the Engelberg Center for Health Care Reform at the Brookings Institution, said during a meeting to release the results.

For these programs to work there needs to be support for collaborative efforts between stakeholders to test how they work, then come up with measures that could be put into practice, he said.

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ER Doc And TV Health Reporter Joins Henry Ford

Frank McGeorge, MD, an emergency medicine physician and medical reporter for WDIV-TV4, has rejoined the Henry Ford Medical Group at Henry Ford Hospital.
Dr. McGeorge attended Northwestern Medical School graduating with honors and completed his residency in emergency medicine at Henry Ford Hospital, where he was chief resident. Later, he became the assistant residency program director in emergency medicine at Henry Ford.

From 1997-2007, he was on staff at William Beaumont Hospital in Royal Oak, where he was director of the residency program in Emergency Medicine. He returned to Henry Ford in November.
Dr. McGeorge has been the medical reporter for WDIV-TV4, NBC’s Detroit affiliate, since August 2006.
He is a fellow of the American College of Emergency Physicians and on the Board of Directors of the Michigan Chapter. He also is board certified in emergency medicine.

In addition, he is on the Board of Directors and the medical director of HAVEN-START, the Oakland County Domestic Abuse and Rape forensic and treatment center and peer reviewer for Annals of Emergency Medicine.

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Clinical Trials Chief Moves From Karmanos To WSUSOM

Beth Golden, RN, has joined the Wayne State University School of Medicine as director of Clinical Trials.

Ms. Golden, who joined the School of Medicine in August, comes to Wayne State University from the Karmanos Cancer Institute, where she served as director of Clinical Trials for four and a half years.

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