January 15, 2007

IN THIS ISSUE

Editor's Column: Keeping Watch
 AMA, Public Citizen Spar On Medical Liability
Medicaid Commission: New Ideas, No New Money
Bush Threatens Drug Bill Veto
Chinese New Year Is Just Around The Corner
 

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Editor's Column:
Keeping Watch

By JOSEPH WEISS, MD
It was said of Ulysses Grant that you never needed to read any order from him twice. He wrote  to the point.

The Dec. 6 letter by the Accreditation Council for Graduate Medical Education (ACGME) to the WSU/DMC is in the Ulysses Grant tradition. The letter included four citations, i.e. areas of non-compliance with principles of appropriate resident training. With each citation, the ACGME gave clear instructions of the changes it requires. Citation 1, Commitment, and citation 3, Responsibility, are of particular interest, as both the problems addressed and the changes required demonstrate how well ACGME understands the WSU/DMC.

In its discussion of Citation 1, Commitment, the ACGME requires evidence that WSU/DMC is providing sufficient dollars, time and medical school faculty to support adequate resident teaching. For Citation 3, the ACGME mandates that the present hydra-headed organizational responsibility of resident training end. WSU/DMC must place control of resident training and its assessment in a single board. This board is to be accountable for standards of post graduate education for both institutions, DMC and WSU.

In its Dec. 6 letter, the ACGME stated it wanted proof of progress on its citations by Feb. 8, 2007. By its review of November 2006 the ACGME showed that it will not be deceived by slips of paper asserting good will and the intention to comply with ACGME requirements. The February report will need to include copies of minutes that show implementation of change. Furthermore in February, residents and administrators at WSU/DMC should be prepared for interviews with ACGME officials calling to find out if changes promised, have in fact, occurred.

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AMA, Public Citizen Spar Over Medical Liability

By PAUL NATINSKY
A government report issued by the Department of Health and Human Services last summer continues to feed a robust difference of opinion between the American Medical Association and the consumer group Public Citizen.

The report, titled succintly enough, "Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs By Fixing Our Medical Liability System," is available here: http://aspe.hhs.gov/daltcp/reports/litrefm.htm 

In a nutshell, the report asserts that without medical liability reform health care services become unafordable and difficult to access. High costs of care attributable to high medical malpractice premiums and large lawsuit payouts contribute to fewer individuals and businesses being able to afford coverage. Rising medical malpractice insurance premiums keep physicians out of many of the areas where they are needed the most.

The rest of the 28-page report backs up these claims with data and analysis from a wide range of sources.

Public Citizen finds fault with the report and, evidently with the medical community for trumpeting its findings. Public Citizen's response, in part reads:

"The medical community continues to tout a report, Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs By Fixing Our Medical Liability System, issued by the Department of Health and Human Services last summer as making an overwhelming case for medical liability 'reform.' In truth, a cursory examination of the report finds it to be a classic 'clip job'—a collection of anecdotes, reports, and propaganda provided by lobbyists and stamped with the government’s official imprimatur. The report cites such sources as Fox News Channel, Congressman Chip Pickering, and the Physician Insurers Association of America, the trade group leading the lobbying campaign. It contains no new research nor any data generated by government health care experts or economists.

A more intensive examination of the report shows that most of the 'facts' it provides are incorrect, incomplete, or misleading; and that its conclusions are contradicted by those of other government agencies."

In fact, the report also cites sources such as the Committee for Quality Health Care in America/Institute of Medicine, the UCLA Law Review, the New England Journal of Medicine, the Quarterly Journal of Economics, and the federal General Accounting Office.

Public Citizen's response contains a "clip-job" of its own as well as a point-by-point refutation of the HHS document. Both can be read at: http://www.citizen.org/congress/civjus/medmal/articles.cfm?ID=8806

As the last word, here is the AMA's response to Public Citizen's criticism. The statement appears on the AMA Web site and is attributable to Board Chair Cecil Wilson, MD.

"Once again, Public Citizen has based its conclusions on an inherently flawed database, the National Practitioner Data Bank. The Government Accounting Office has said in a report that 'the results of our detailed tests raise serious concerns about the integrity of National Practitioner Data Bank information.'

"It is unfortunate that instead of trying to help patients by learning from state medical liability reform success stories, Public Citizen continues to put out variations of their same-old discredited studies. The entire nation has seen the positive results of medical liability reforms enacted in Texas. In 2003, Texas enacted medical liability reforms with limits on non-economic damages — and the new law works. Premiums are down, and physicians have flocked to the state, improving access to care for Texas patients.

"The AMA supports proven reforms, including a cap on non-economic damages to stop the crisis and provide patients with access to timely medical care. America's patients agree: poll after poll shows that nearly three-quarters of Americans support reforms including a cap on non-economic damages."

And so the battle continues.

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Medicaid Commission: New Ideas, No New Money

A Medicaid Commission appointed by the Bush administration issued its final report Dec. 29. It features a number of recommendations that states have been pushing for or implementing, according to the National Conference of State Legislatures. The Commission's report calls for tax subsidies for the purchase of private long-term care insurance, greater use of health information technology and expansion of home- and community-based long-term care.

But, according to NCSL, the report also contains a number of almost radical new provisions, including:

A study of policy options for using alternative insurance models, like social insurance, to cover long-term care costs. Such programs are intended to hold down costs, but create controversy as they rely on private competition models to achieve their savings.

Another controversial recommendation from the Commission is to reimburse states who enroll the poorest of the poor at an elevated rate. The idea is to target Medicaid's "core purpose" of providing health care for the very poor, partly by signing up more poor, single men. The sticky issue here is that such efforts might stymie state's attempts to expand eligibility and cover a larger cross-section of the population.

Another proposal would attempt to coordinate care for those eligible for both Medicaid and Medicare. It would give states the option of creating Medicaid Advantage plans for such “dual eligibles.” Modeled on Medicare Advantage managed-care plans, the plans selected by states would provide core Medicaid and Medicare services, and patients would have the ability to opt out. The federal government would pay for Medicare services, but through a risk-adjusted, capitated system. States would help pay for Medicaid services—both levels of government would share in any savings. The recommendation is designed to eliminate one of the biggest problems in caring for dual eligibles—that is, coordinating Medicare and Medicaid’s separate funding streams and the benefit packages they cover.

Not mentioned in the report, according to NCSL, was any indication that the federal government will take on more of the costs associated with the Medicaid program.

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Bush Threatens Drug Bill Veto

President Bush indicated Jan. 11 he would veto a bill (HR 4) that would require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit, the New York Times reported.

The White House in a written statement said that the bill, which the House was scheduled to consider on Friday, would create "[g]overnment interference [that] impedes competition, limits access to lifesaving drugs, reduces convenience for beneficiaries and ultimately increases costs to taxpayers, beneficiaries and all American citizens alike," according to a Jan. 12 report in the Atlanta Journal-Constitution.

White House spokesperson Tony Fratto said that the House proposal "looks good on a bumper sticker, but it's not practical," adding, "The evidence is in that the market is working to lower drug costs," according to a Jan. 12 report in the Washington Times.

House Energy and Commerce Committee Chair John Dingell (D-Mich.) said, "The president and his Republican allies have argued that this bill would do nothing. Then why, I must ask, would he bother to veto it?" House Ways and Means Committee Chair Charles Rangel (D-N.Y.) urged Bush to withhold the veto threat and work with Congress to improve the Medicare drug benefit, according to reports in the Atlanta Jornal-Constitution.

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Chinese New Year Is Just Around The Corner

WCMS FOUNDATION'S
ANNUAL CHINESE NEW YEAR

YEAR OF THE PIG

GOLDEN HARVEST RESTAURANT
SUNDAY, FEBRUARY 11, 2007, 5:30 PM

HONOREES FOR OUTSTANDING
COMMITMENT TO THE COMMUNITY:

DR. KIM AND MRS. MADO LIE

EVENT CO-CHAIRPERSONS
LOURDES ANDAYA, MD ROSEMARY BANNON
JANET BUSH DON JENSEN

GREAT FOOD CASUAL ATTIRE CASH BAR
**FABULOUS SILENT AUCTION**

MAKE THIS A FUN EVENING FOR YOUR FRIENDS AND FAMILY.

PLEASE CLICK HERE FOR FLYER AND REGISTRATION FORM.

THE WAYNE COUNTY MEDICAL SOCIETY FOUNDATION IS SPONSORING
THIS EVENT AS A FUNDRAISER FOR ITS SENIOR ABUSE PREVENTION PROGRAM.

 

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