February 26, 2007

Editor's Column: Small May Not Be Beautiful; But Big Isn't So Great Either
Health Care Hot Stove
AMA Nips 'Narrow Networks'
Oakwood Docs Prescribe Electronically
Celebrating America's Women Physicians
Mind, Mood, Medicine
MSMS Accepting BOM Nominations

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Editor's Column:
Small May Not Be Beautiful, But Big Isn't So Great Either

By JOSEPH WEISS, MD
In an article in the January 2007 issue of Health Affairs, Jonathan Ketcham et al make an interesting observation. These authors find that patients with acute myocardial infarction, attended by solo practitioners do not fare as well as those patients cared for by doctors who are in group practice.

Possible explanations offered by the authors include problems for the solo practitioner in giving quick attention to a patient with an urgent problem and/or difficulty for the practitioner in keeping up with current trends in care. Another explanation presented by the article is that the approach to medical care by a solo practitioner may differ from the perspective and philosophy of physicians choosing group practice. Ketcham et al also speculate that the types of patients who see solo practitioners may differ in their characteristics and concerns from patients seen in a group practice.

The study uncovers other information. The authors find that outcomes do not differ whether patients are under the care of a group of two or 52 physicians. Bigger is better, but bigger and bigger dies not lead to being better and better.

We in the medical community should keep this finding of the study in mind. Likely the press will seize on the information concerning limitations of the single physician. It becomes our responsibility to remind the public that the same study shows that really big doesn’t equate to really better.

Health Care Hot Stove

By PAUL NATINSKY
On the heels of HHS Secretary Mike Leavitt's whistle-stop tour of Detroit, the health care reform trail stays hot. A recent BusinessWeek article cited a Pew Research Center poll showing that health care has passed the economy, unemployment and (even amid reports of Al Qaeda's recent resurgence) terrorism. Within health care, the Pew numbers reveal that 68 percent view "reducing health care costs" as the top priority, while 63 percent favor making the "Medicare system financially sound," and 56 percent put "providing insurance to the uninsured" in the top spot.

Do these numbers indicate that health care costs have finally run amok long enough and with sufficient severity to push the issue into the mainstream? Will the 2008 presidential election be decided on this issue. The answers are: we'll see and too early to tell.

There is a giant vat of issues churning and only a fraction of the proposals being discussed would result in direct savings for health care consumers. As mentioned in this space last week, government actions and proposals are not playing out according to the Hippocratic Oath, harm is being done.

What are you hearing in your offices? Are patients complaining? Are they bringing forth specific problems that can be formed into policy solutions. For example, the backpressure created by the seemingly constant change in benefits is evident. Patients often don't understand the changes in their health insurance from year to year and are shocked by the cost of services that suddenly face them. It's not just the percentages and copays that change, it's the whole structure of their health plans. My kid's pediatrician has taken the measure of posting a note on the inside of examining room doors indicating that patients are responsible for understanding their health coverage and should not rely on the office staff to notify them of changes in coverage. Drop us a line at info@wcmssm.org and let us know what your patients are saying.

AMA Nips 'Narrow Networks'

At the 2006 Interim House of Delegates meeting, the AMA called for transparency in the methodology third-party payers use to set up tiered and narrow physician networks. Policy was also established calling for the monitoring of such networks to ensure that they are not inappropriately driven by economic criteria and asking AMA to explore legal action against payers that use arbitrary and abusive economic physician profiling in such programs. The AMA successfully partnered with the Missouri State Medical Association and county medical societies in a campaign that resulted in UnitedHealthcare shutting down a narrow network in 2005. Last year, AMA joined in a lawsuit with Washington State Medical Association against Regence Blue Shield, to oppose its narrow network. As a result, Regence suspended operation of the narrow network, while settlement talks are ongoing. If your physicians are complaining about an unfair and abusive tiered or narrow network, please contact Steve Ellwing (312-464-4367) in Private Sector Advocacy or Leonard Nelson
(312-464-5532) in the Litigation Center to see if AMA can be of assistance.

Terri Marchiori
American Medical Association
Director, Federation Relations
(312) 464.5271
terri.marchiori@ama-assn.org

Oakwood Docs Prescribe Electronically

Oakwood Healthcare System (OHS) in cooperation with DrFirst technology recently completed a one-year pilot program for physicians using Rcopia - an ePrescibing initiative allowing doctors to use personal computing devices to electronically send prescriptions to the pharmacy in real time. The pilot program began in 2005 with the anticipation of 70 participating physicians. The results are in and the program was overwhelmingly successful among OHS physicians, especially in saving time and money. Overall, 177 physicians participated - more than doubling the original number - resulting in a 50 percent reduction rate of time spent on refills and pharmacy clarifications.

“It’s definitely made the whole prescribing system safer and it cuts down on any chances of transcription error between a physicians office and the pharmacies that get the prescriptions,” said Robert Boyko, lead staff pharmacist, Oakwood Healthcare, Inc.

ePrescribe gives physicians the ability to share information with other physicians, in addition to being able to access important medical information including insurance, medication history, allergies and pharmacy preferences. In addition, the System also immediately alerts physicians if a prescription will cause an allergic reaction or have an adverse affect if mixed with another of the patients existing medications.

A key aspect of the program is Oakwood’s commitment to private practice physicians. In addition to staffed physicians, each participating private office was equipped with the necessary hardware in order for the practice to successfully implement the ePrescribe program into their day-to-day activities. The program is currently in use in nearly 40 physician practices. The pharmacy connection allows prescriptions to be sent to pharmacies and, in turn, pharmacies can send electronic renewal requests back to physicians in real time, eliminating errors and miscommunication.

“Many times the person who calls in the prescription is not the individual physician and there’s always the possibility of misreading what the physician actually wants. ePrescribe cuts out that middle person and doesn’t leave room for error in misreading a physicians order from a patients chart,” said Boyko. Family medicine physician Carol King, MD, uses the system everyday in her practice and considers the technology interactive and helpful, but believes it’s a necessary safety precaution as well.

“From a safety standpoint I don’t think there should be a choice as we move to electronic medical records, ePrescribe has got to be a part of the final decision for the safety of the patient,” said King.

Recently, ePrescribe was awarded Oakwood’s prestigious Clinical Program of the Year award.

Celebrating America's Women Physicians

Changing the Face of Medicine
Celebrating America's Women Physicians
Exhibit at the Main Library, 5201 Woodward Ave. Hours: Tuesday & Wednesday, Noon-8 p.m. and Thursday, Friday, Saturday, 10 a.m.-6 p.m.. To schedule tours, please contact: Mary Kordyban, Assistant Manager, Business, Science & Technology Department (313) 833-1450 or (313) 833-1420. The activities listed below are open to the public and free of charge. Pre-registration is required for the March 24 event.

Book Talk: Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist
Ngozi Osuagwu, MD, FACOG

WEDNESDAY, MARCH 14, NOON
Skillman Branch Library
121 Gratiot at Library

WEDNESDAY, MARCH 14, 6 P.M.
Hubbard Branch Library
12929 W. McNichols

A Fireside Chat with Local Women Physicians

WEDNESDAY, MARCH 21, 6-8 P.M.
Main Library - Old Browsing
Hear local women doctors discuss their careers and how women have changed the face of medicine.

Girl Talk Luncheon: Everything You Always Wanted to Know About Medical School and Being a Physician
SATURDAY, MARCH 24, 11 A.M.-2:30 P.M.
Main Library - Explorers Room

Mind, Mood, Medicine

2007 Retreat for Women Physicians - "Mind, Mood and Medicine"
Friday-Sunday, April 13-15, Kalamazoo

The MSMS Foundation is proud to announce that the 2007 Retreat for Women Physicians will take place Friday-Sunday, April 13-15, at the Kalamazoo Radisson. This year’s event, titled "Mood, Mind and Medicine," will focus on the needs and interests unique to women physicians, including life transitions for women, scope of practice, epilepsy in women, sexual dysfunction, depression, and more.

Now in its fourth year, the Retreat for Women Physicians will provide attendees with the opportunity to network with colleagues while learning about topics that affect their personal and professional lives. Breakout sessions covering a wide array of topics will allow attendees to choose which sessions best suit their needs and interests.

The weekend also will include a number of recreational/non-medical opportunities, such as spa services and a Saturday evening showing of "The Women," by Clare Boothe Luce, at the Kalamazoo Civic Theatre.

Registration begins at 8:30 a.m. and the daily program will run from 9:00 a.m. to 2:00 p.m. Cost is $200 for MSMS & MMGMA members, $275 for non-members.

For more information or to register, visit www.msms.org/events or contact the MSMS Registrar at (517) 336-5784 or abatten@msms.org.

MSMS Accepting BOM Nominations

The MSMS Committee on Licensure & Discipline has begun the process of soliciting candidates who wish to receive the recommendation of MSMS for appointment to the Michigan Board of Medicine. On Dec. 31, 2007, the terms of five Board of Medicine members will expire. Of those five, four are eligible to be reappointed to a second four-year term. One position will be vacant and require an appointment by the governor. The Committee considers many key factors (peer review experience, board certification, and involvement in organized medicine) when selecting a candidate it believes to be qualified to serve in this capacity. The Committee will begin accepting candidates this month and will continue to do so through the end of April so that the recommendations may be brought to the July MSMS Board of Directors meeting for final approval.

For more information or to obtain a nomination application, visit www.msms.org/advocacy. Or contact Colin Ford at MSMS at (517) 336-5737 or cford@msms.org.

This publication brought to you by Natinsky Publishing Network.

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