June 4, 2007

IN THIS ISSUE

Editor's Column: Dire State
Lawmakers Hear Medicaid Message
Congress Stymies GME Cuts...Sort Of
Riverview ER To Remain Open
AMA 'Links' With Online Physician Community Giant
WSU Dean Among Oakwood Board Appointees
St. John Lands $150,000 Grant

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Editor's Column: Dire State

By JOSEPH WEISS, MD
The word is out to Congress: Change or Die. That means that either Congress changes or we die.

The stream of trained internists exiting for sub -specialties has become a flood. Residencies in family practice, both allopathic and osteopathic, are so unfilled that closing of many residencies is already underway.

The problem is money. At present the Sustainable Growth Rate (SGR) formula determines the reimbursement for general internists and family practice physicians. In turn, Medicare rates set the benchmarks for the private health plans that pay the  bills for  Americans covered by health insurance.

At present, these reimbursement rates are at year 2000 levels and without congressional intervention will decrease by nearly 10 percent in 2008. If this present payment pattern does not change, the number of physicians leaving internal medicine and family practice will surely accelerate.

What Congress needs to do is (1) end the SGR formula now and (2) at the least, increase reimbursement for physicians by 1.7 percent, that rate being determined by the Medicare Economic  Index (MEI) as the increase in cost for physicians in 2006.

In addition, Congress should require that the Centers for Medicare & Medicaid Services (CMS) order the AMA to restructure the RUC (Relative Value Update Committee) The RUC decides on the figures that determine the dollar reimbursement that physicians receive. Now the RUC meets every five years. Congress should insist the RUC convene every two years. Furthermore, the composition of the RUC should reflect better than it does now the importance of general internists and family practice physicians as contributing members.

If Congress does nothing, and losses of physicians continue, American business will fill the void. The few clinics we see now in drugstores and malls run by nurse practitioners will mushroom in number and expand in scope. Health information technology will become a tool used by an army of graduates from two- and four-year colleges trained in “Human Health Science.” Business will put on an intense campaign to convince the public that it does not take a physician to practice scientific medicine.

We must increase our efforts to rid ourselves of the SGR. The profession we save will be ours, the people we protect will include our own.

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Lawmakers Hear Medicaid Message

The state legislature heard organized medicine’s clear message of the human consequences of Medicaid cuts, and responded by nixing proposed payment cuts of up to six percent to Medicaid physicians and other providers. The Senate and House passed the 2007 budget measure, and Gov. Jennifer Granholm is expected to sign it into law when it arrives on her desk. The legislature is expected to vote on further portions of the overall agreement on the budget negotiations, as well as on a budget and tax plan for fiscal 2008. MSMS thanks everyone who used the online MSMS Action Center to contact lawmakers. Watch e-mail, Medigram, and www.msms.org for further details on state budget issues. For more information, contact Colin Ford at (517) 336-5737 or cford@msms.org.

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Congress Stymies GME Cuts...Sort Of

Below is an edited excerpt from an article about the federal government's recent about-face on Medicaid funding for graduate medical education from the Alliance of Academic Intenal Medicine.

Almost as soon as the Centers for Medicare & Medicaid Services (CMS) proposed a rule to end federal support for graduate medical education (GME) through the Medicaid program, Congress placed a moratorium on any rule that would restrict Medicaid GME payments. Language in the supplemental appropriations bill, approved by Congress and signed by President George W. Bush, dictates that the CMS proposed rule, issued May 23, 2007 and reported by DMN Online, can not take affect for at least one year.

According to the proposed rule, CMS does “not believe that it is consistent with the Medicaid statute to pay for GME activities either as a component of hospital services or separately.” Under current statute, the federal government matches state funds for expenditures relating to health services. Presently, most states include expenditures for GME in the total amount of expenditures for health services. However, CMS is arguing that GME is not a health service and should not be included in state expenditures for matching. If CMS eliminates federal funding for GME through Medicaid, federal GME funding would decrease by approximately $1.8 billion over five years.

Despite the moratorium, the federal government could continue to pursue cuts to GME through Medicaid. If federal matching funds for GME are eliminated, it will be up to academic institutions to work with their local government and advocate for continuing the state’s role in supporting GME. The Alliance for Academic Internal Medicine encourages leaders in academic internal medicine to actively advocate in their states to ensure continued support for GME regardless of whether federal matching funds are eliminated. (The more things change, the more they stay the same –ED)

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Riverview ER To Remain Open

The following is an edited note to “all providers” from Jenny Atas, MD, Deputy Medical Director of the Detroit East Medical Control Authority, whose protocols govern the EMS system for Detroit and surrounding areas.

On May 18 Dr. Brooks Bock and I received a letter confirming the closure of St John Detroit Riverview Hospital May 31 and the stoppage of inpatient admissions.

In addition in this letter they also confirmed that they will be continuing operations of emergency department at Riverview and reaffirmed their desire to receive priority 3 EMS transports beginning at 12:01 am on June 1st, 2007.

This department will continue to operate in its existing location utilizing the same physician group that currently staffs that department.

Per the consensus of the board members at the May 15th 2007 DEMCA meeting Dr. Bock and I have discussed this issue and have approved their request in the Detroit East Medical Control Area to receive priority 3 EMS transports beginning at 12:01 a.m. on June 1, 2007.

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AMA 'Links' With Online Physician Community Giant

The American Medical Association (AMA) and Sermo announced May 30 a collaborative agreement The AMA hopes the joining will help it address important professional and public health issues including Web technology. The AMA calls the agreement a “multi-phase, multi-year alliance aimed at improving medical practice, physician advocacy, and patient care.” Sermo bills itself as “a highly intellectual, vibrant, live community for doctors.” The company’s tagline is, “Know more. Know earlier.”

"The Sermo community represents an innovative forum for physicians to share their voice with the AMA and discuss emerging issues on the front lines of medicine," said Cecil B. Wilson, MD, chair of the AMA Board. "Engaging with Sermo's virtual community adds to the resources the AMA can call upon to rapidly assess and respond to the issues and concerns of physicians across the Unites States."

Membership is free. Sermo can be found online at www.sermo.com. At its Web site, the company emphasizes that it credentials and re-credentials contributors to its data base and carefully screens all entries. Entries are “medical observations” submitted by physicians.

The AMA reports that its alliance with Sermo will:

Create a direct line of communication between physicians and AMA leadership by allowing AMA to pose questions, get feedback, and observe real-time discussions on Sermo about medical practice, treatment options, and the latest advances in clinical care.

Include a "Discuss on Sermo" link in AMA print and online publications, including the AMA's award-winning American Medical News, which reach more than 350,000 physicians. This new link will allow physicians nationwide to immediately discuss, survey, and corroborate opinions about the latest health care news and research.

Leverage Sermo to help AMA policy development around public health issues.

Create a special home in the Sermo community specifically designed for AMA's physician members.

Amplify the most hotly debated issues among physicians within the Sermo community by producing a "Top Postings" column in the weekly AMA eVoice e-newsletter, which reaches more than 100,000 physicians nationwide.

Nearly 75 percent of office-based physicians work alone or in small group practices, with few opportunities to interact with peers or their professional organizations. Physicians are further burdened by increasing case loads, medical liability, reduced Medicare reimbursement, unprecedented numbers of uninsured patients, and managed care pressures on physician-patient relationships. In this environment, today's physicians must manage more responsibilities with less time and resources - all while trying to deliver the best possible care for patients.

"Sermo shows how new technologies can make a direct impact on the practice of medicine," said CEO of Sermo, Daniel Palestrant, MD. "We've established an entirely new information exchange never before possible that is empowering physicians and giving them a collective voice they've never had. Now the AMA will have a direct line to the physician community at large and can instantaneously see trends and issues challenging physicians nationwide. This relationship opens the flood gates for hundreds of thousands of physicians to work together on Sermo and apply their collective thinking to revolutionize medical practice and better serve the public health."

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WSU Dean Among Oakwood Board Appointees

Oakwood Healthcare System (OHS) and Oakwood Healthcare, Inc. (OHI) recently appointed three new members to the Board of Trustees. Recently, Timothy Love, MD, was appointed to the Oakwood Hospital & Medical Center(OHMC) board, Robert Mentzer, MD, was appointed to the OHI board and John Daly was appointed to Oakwood Southshore Medical Center board.

Dr. Love specializes in critical care medicine and internal medicine. After receiving his medical degree from the University of Texas Medical Branch, he completed both his internship and residency at OHMC in Dearborn. Love resides in Dearborn with his wife and children.

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St. John Lands $150,000 Grant

St. John Health Foundation won a $150,000 grant from the McGregor Fund to help provide medical and dental services at the Advantage Family Health Center (AFHC).

The AFHC is a recently renovated facility located within St. John Health's Conner Creek Village at 4777 E. Outer Drive in northeast Detroit. It is a Federally Qualified Health Center that receives a federal grant from the Health Resources and Services Administration Bureau of Primary Health Care through Section 330 of the Public Health Service Act.

AFHC opened in May 2006 as a result of a collaboration among Advantage Health Centers, St. John Health, the Detroit Department of Health and Wellness Promotion and several nonprofit funding agencies. Advantage Health Centers manages the 15,442 square-foot facility, providing the primary care, while St. John Health offers secondary and tertiary care.

The $150,000 grant from the McGregor Fund will support completion of the renovations to the Advantage Family Health Center. Current services provided at AFHC include family medicine, colposcopy and internal medicine specialty clinics, pediatrics, breast and cervical cancer screenings, HIV/AIDS primary care, treatment for sexually transmitted diseases, behavioral health, radiology, medications, laboratory and social work services. AFHC's goal is to provide a full continuum of clinical and dental care to the insured, uninsured and underserved persons in northeast Detroit and the surrounding service area. Since its inception, AFHC has served more than 2,000 patients, with over 4,800 encounters.

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