June 18, 2007

IN THIS ISSUE

Editor's Column: The Clinton Health Plan
Presidential Hopefuls Proffer Health Plans
Michigan Central In AMA Smoking Ban Activity
State Works To Retain Medical Residents
Henry Ford Physician Earns Unique Fellowship
AMA Looks To Curb Physician Penalties
Docs Sound Off On Medicare Payment Woes

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Editor's Column: The Clinton Health Plan

By JOSEPH WEISS, MD
The main features of Senator Clinton’s health care plan are:

1. cut health care spending by 120 billion through prevention programs

2. coordinate treatment of chronic disease

3. accelerate the change to computerized record keeping

4. allow imports of drugs

5. encourage use of generic drugs

6. have the federal government negotiate the prices of drugs covered under Medicare

7. allow individuals to join health plans free of the penalty for pre existing conditions

The problem with the Clinton Health Program is that each proposal requires an initial outlay of billions of dollars. The savings in preventive care are potential. It will take years to know if the expected gains were fact or fiction.

The promise of the Clinton Health Program is that the plan to coordinate chronic care will move action in that direction. If Sen. Clinton’s plan creates coordination of medical manpower and technology, then this country will reap great gain.

What we need is not only more money but a reorganization of how physicians deliver that care. At present, increasing sophistication of medication and technology, means patients with 5-6 conditions under the care of 6-8 physicians may live for years. The country needs both a system that organizes care for these patients and an approach that considers the increasing complexity of that care as ill individuals age and the consequences of their ills multiply.

When the candidates talk about health care, we should encourage them to continue to speak. Eventually the Clintons, Obamas and Edwardses will reach our perspective: its not just about cost, but about coordination.

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Presidential Hopefuls Proffer Health Plans

The following two items report recent thinking by 2008 presidential canditates on health policy.

Giuliani Pushes Private Insurance, Offers Tax Breaks
Former New York City Mayor and presidential candidate Rudy Giuliani (R) recently indicated he soon will announce specifics of a health care proposal that would shift tens of millions of US residents from employer-sponsored health insurance plans to private coverage, Long Island Newsday reports. His health care proposal intends "to build on his recent efforts to draw sharp distinctions between his free-market approach to government and what Giuliani labels the Democrats' big-government style," according to Newsday.

Giuliani said he would give families a $15,000 tax credit to purchase private insurance policies and allow them to keep whatever credit remains as an incentive to purchase cost-effective plans. "If we can empower 30 million, 40 million, 50 million and eventually 100 million Americans to be able to go out and make these choices, you're going to have the free market accomplish the thing that only a free market can accomplish -- and that is, lower costs and better quality," Giuliani said in a recent radio interview.

Giuliani "makes no mention of covering everyone," according to Newsday. His proposals "mirror those made by" President Bush in 2006, including expanding the use of health savings accounts, Newsday reports. Giuliani said during the radio program that on Tuesday in New Hampshire he will "lay out an agenda for the future" on several topics. However, "aides downplayed the possibility that he would talk about his health care proposal," according to Newsday (Gordon, Long Island Newsday, 6/8).
Romney Defends Massachusetts Law
Former Massachusetts governor and presidential candidate Mitt Romney (R) recently defended the recently enacted Massachusetts health insurance law, the Nashua Telegraph reports. Massachusetts' law, which was signed into law in 2006 by Romney, requires most state residents to obtain health coverage by July 1. The law "has been attacked by some conservatives as reminiscent of the failed universal health care program" proposed in 1993 by then-first lady and presidential candidate Sen. Hillary Rodham Clinton (D-N.Y.), according to the Telegraph.

Romney said the Massachusetts law is "the conservative, small-government, personal responsibility plan," while the "current approach" is the "big-government approach" where "people with no insurance show up at a hospital, and we all pay. My plan stops that." Romney said if elected he would not propose a "one-size-fits-all" national health care plan but would encourage states to craft their own proposals (Halliday, Nashua Telegraph, 6/7).

Edwards outlines cost-saving measures
Democratic presidential candidate John Edwards recently announced the cost-saving measures in the universal health care plan he released in February. Edwards claims his plan would save an average family $2,000 to $2,500 annually and eliminate $130 billion a year in wasteful spending.
“Americans today aren’t getting the quality of healthcare they pay for and can’t afford the cost of the care they do receive,” said Edwards, a former North Carolina senator. “To fix our healthcare crisis, we need a fundamental change.”
The plan seeks to bring down costs by setting national accounting standards; requiring insurers to spend at least 85 percent of their premiums on patient care; creating patient-centered “medical homes;” and requiring healthcare markets and public plans to proactively monitor the health of patients with chronic ailments to reduce complications and hospitalizations.
In addition, his plan would support safe reimportation of prescription drugs from Canada and would create a central organization within the Institute of Medicine to test new devices and drugs and disseminate best practices nationally. Like fellow Democratic presidential candidates Barack Obama and Hillary Rodham Clinton, Edwards would seek adoption of electronic medical records.  

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Michigan Central In AMA Smoking Ban Activity

The AMA recently joined the Michigan State Medical Society and public health advocates to urge Michigan lawmakers to protect the health of residents, workers and visitors from the dangers of secondhand smoke.

AMA President-elect Ron Davis, MD, a WCMSSM member, preventive medicine specialist and director of the Center for Health Promotion and Disease Prevention at Henry Ford Health System, offered testimony in strong support of a bill before the Michigan House of Representatives (HB 4163) that would prohibit smoking in all indoor public places and worksites, including bars and restaurants.

"Exposure to secondhand smoke is a proven health hazard," said Dr. Davis. "The overwhelming weight of evidence shows that secondhand smoke causes lung cancer, heart disease, asthma episodes and other respiratory diseases and conditions."

On a daily basis, the staff and patrons of tobacco smoke-filled bars and restaurants inhale more than 4,000 different hazardous chemicals and more than 50 cancer-causing agents. Secondhand smoke causes about 50,000 deaths each year in the U.S., and in Michigan alone it kills up to 2,900 people each year.

A report last year from the U.S. Surgeon General determined there is no safe level of exposure to secondhand smoke, and the toxic and cancer-causing chemicals in it cannot be eliminated by ventilation.

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State Works To Retain Medical Residents

More than a quarter of Michigan's medical residents say they plan to stay in Michigan, while another 42 percent remain undecided, according to just-released results of the 2006 MDCH Survey of Physicians.

Keeping those new physicians in Michigan is a priority, said MSMS President AppaRao Mukkamala, MD. "Physicians in medical training programs play a critical role in the current delivery of patient care," Doctor Mukkamala said, "and they are key to meeting the demand for physicians in Michigan in the future." MSMS has predicted a 6,000 physician shortage by 2020, according to its 2005 survey.

The recent MDCH survey--conducted annually--provides comprehensive data on the physician workforce in Michigan, and also contains new information on resident physicians, who were asked about their plans following completion of their residency:

--Approximately 26 percent said they plan to stay in Michigan; 30 percent plan to move to another state; and 42 percent have not yet decided.

--69 percent say they have not yet started their job search.

--55 percent say they plan to enter a partnership or group practice; 20 percent plan to do further subspecialty training.

For those planning to move away from Michigan, a "desire to be closer to family" and "weather" are the factors reported most often as contributing to this decision, followed by "entertainment/recreational opportunities," "job opportunities for spouse/partner," and "economic outlook of the state," the survey indicates.

Earlier this year, the Practice Michigan Advisory Council was formed to promote Michigan as a great place to live and practice for physicians and those considering medical school. The Council includes the four Michigan medical schools, regional graduate medical education consortiums, the Michigan State Medical Society, the Michigan Osteopathic Association, the Michigan Recruitment and Retention Network, the Michigan Health Council and the Michigan Economic Development Corporation. The first initiative will familiarize residents with Michigan from coast to coast and help them get involved with activities outside of their training. The group also will hold  regional resident receptions to highlight local communities and job opportunities.

 "We know from the survey data that about 66 percent of physicians in graduate medical training programs did not grow up in Michigan," said Janet Olszewski, MDCH Director. "We also know that 26 percent of them attended a medical school in Michigan. It is important that we continue to educate medical students and residents about the benefits of practicing in Michigan."

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Henry Ford Physician Earns Unique Fellowship

Andrew Chen, MD, a senior staff physician in Plastic Surgery at Henry Ford Hospital, was awarded a first-ever Young Surgeon Traveling Fellowship by the American Foundation for Surgery of the Hand and Health Volunteers Overseas.

Under this unique fellowship, Dr. Chen will train at a hand surgery site in a developing country and learn a range of surgical pathologies not commonly seen in the United States.

Dr. Chen received his medical degree from the Harvard Medical School and completed a residency in general and plastic surgery at Washington University’s School of Medicine/Barnes Jewish Hospital. He completed a fellowship in hand and upper extremity surgery at the University of Pittsburgh.

The American Foundation for Surgery of the Hand is dedicated to advancing the care of hand and upper extremity disorders. The Health Volunteers Overseas trains health care professionals in more than 25 resource-poor nations.

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AMA Looks To Curb Physician Penalties

The American Medical Association is trying to stop a major insurance company's policy that fines doctors if their patients go outside of their health plan's network for laboratory services, reported the Chicago Tribune June 14.

The move could save patients money when they choose an in-network lab, but the AMA is worried about the possibility of other insurers instituting penalties when their patients go outside of networks. The AMA may lobby for federal legislation to stop all such practices.

The Tribune reported that the AMA specifically mentioned Minneapolis-based UnitedHealth Group, which earlier this year notified doctors of a policy that threatened such penalties as a way to keep a lid on lab costs, which can be expensive if patients seek care out of network.

The AMA and several state medical societies already have asked United to rescind the policy, but it now appears the Chicago-based national doctors group wants the issue put on its national legislation agenda because the insurer has no plans to do so.

Later this month a delegation of Michigan doctors will ask the AMA's 555-member policymaking House of Delegates at its annual meeting in Chicago to "oppose any penalties implemented by insurance companies against physicians when patients independently choose to obtain out-of-network services."

The resolution, if it passes, would effectively put the AMA's considerable lobbying clout behind federal legislation aimed at opposing such insurance-industry practices. The AMA says it interprets the penalties to be anything from cutting a doctor's payments to taking them out of the health plan's network.

But UnitedHealth said no doctors have been penalized thus far and most of the more than 500,000 doctors in its networks abide by its policies.

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Docs Sound Off On Medicare Payment Woes

Results of an AMA Member Connect^® Survey released recently illustrate the disastrous effects a scheduled 10 percent cut in Medicare physician payments for 2008 would have on America's seniors.

The survey, completed by nearly 9,000 physicians, found that looming cuts in Medicare physician payments over the next nine years—totaling about 40 percent—will have a deep impact on access to care and physician practice. Survey findings showed that 60 percent of physician respondents plan to limit the number of new Medicare patients they treat if payments are cut by 10 percent in 2008. Worse, if scheduled cuts totaling 40 percent are instituted over the next nine years, 77 percent of physician respondents would limit the number of new Medicare patients they treat.

The release of the survey marked the beginning of a unified national campaign to stop cuts in Medicare payments to doctors. The AMA seeks to secure a positive payment update of 1.7 percent for 2008 to keep up with practice costs, as recommended by the Medicare Payment Advisory Commission.

“In six short months the Medicare cuts will begin, unless Congress intervenes,” said AMA Board Chair Cecil B. Wilson, MD. “We can’t sit idly by and let America's seniors pay the price for a short-sighted government payment policy with reduced access to care—Congress must act.”

View http://www.ama-assn.org/ama1/pub/upload/mm/31/highlights.pdf for a summary of the survey results.

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