October 1, 2007

IN THIS ISSUE

Editor's Column: Time To Put the Cart Before The Hoarse
Health Info Exchange Needs A Few Good Docs
Reid Leaves Strong Legacy At WSU
AMA Pushes Congress To Preserve Medicare Money
WSU Med Student Earns NIH Fellowship
Recovering The Soul
Children's Hospital Hosts Psych Lectures

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Editor's Column: Time To Put The Cart Before The Hoarse

By JOSEPH WEISS, MD
Everyone talks about universal coverage, even the Mayo Clinic is forwarding its own plan. The New York Times reported in its Sept. 15 edition that Mayo sponsored a meeting of health care experts who concluded that in this country every individual should have health care insurance.

The Mayo group, like the individuals running for president, advocates  that the premiums should come from a combination of the individual, the employer, and the government. Among politicians, the Mayo recommendations are the most popular. Others running for president, such as Mitt Romney, say that health insurance should be a state initiative. Rudy Giuliani, believes tax refunds are the way to encourage universal coverage.

All this is hoarse talk. Left untouched is the question: what plan does the individual need? We have not yet arrived at a consensus on what constitutes a “basic” health plan. Until either the candidates or the expert committees present the elements of a health insurance plan that provides necessary coverage, we cannot dialogue about cost, who will pay the cost, let alone how plans for care fit our expectation of access and quality.

At the state level, MSMS has a taskforce working to define the features of a basic health care insurance plan that will provide adequate care. No doubt, other bodies are grappling with the same issue. But, as yet, no group has come forward with the features of the “basic” plan.

Common sense tells us, that everyone can’t have coverage for the diagnosis, treatment or prevention of every sickness and/or mishap that mankind risks. However, we know that the market is full of cut rate plans that cost $100 a month and cover nothing but administrators’ salary and advertising space. We need individuals covered not with paper pages, but with substantive insurance.

We need to hear from people who understand what we can afford for care, and at what time in an individual’s life those aspects of care that need attention.

The politicians should stop shouting themselves hoarse on how to divvy up the cost of care. Instead, expert panels should convene to determine what should be contained in the insurance plans to provide adequate and appropriate coverage for each individual.

We first must fill the cart and then we can decide how heavy the horse to carry the load.

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Health Info Exchange Needs A Few Good Docs

By PAUL NATINSKY
“There are physicians and there are physicians,” WCMSSM Executive Director Adam Jablonowski told an audience of about 100 at a kickoff meeting for the Southeast Michigan Health Information Exchange (SEMHIE) Thursday at the Hospice of Michigan in Detroit.

That there were only about four doctors in the audience underscored his point: The nascent health information sharing movement in Michigan, and particularly Southeast Michigan, needs physician participation. It needs practicing physicians who treat patients on a daily basis and not just administrative physicians who represent large organizations.

SEMHIE is one of nine regional health information exchanges across the state, and one of seven funded by a $4.5 million start-up grant. The start-up money is intended to facilitate concrete plans to share health information between “stakeholders” that include doctors, hospitals, employers and government agencies.

The benefits of such collaborations range from instant access to patient medical histories and drug allergies in emergencies to better and more accurate research and recordkeeping. Barriers to sharing information center on trust issues between the parties that accumulate and control such information and privacy laws that present a much greater challenge for the health care industry than, say, the banking and finance industries, which have long been able to quickly and accurately been able to share consumer credit information.

In health care, patient information resides in “silos,” or independent data bases maintained by doctors’ offices, hospitals, insurers, employers, government agencies and others. While the information is plentiful, it can only be accessed easily by the parties that collect it.

Part of the stimulus for information sharing comes courtesy of an urgent effort by the Bush administration to achieve “transparency” in the US health care system by the year 2010. While Bush’s timeline is regarded by most as unrealistically aggressive, federal dollars are flowing toward the cause and progress is being made.

Key aspects of a health information exchange include a self-sufficient business model, a system that is “patient-centric” (benefits patients by making info exchanges directly beneficial to them) and interoperable (easy to integrate with one another).

The $4.5-million grant represents a first step toward actually executing a health information exchange. SEMHIE currently labors under “operating rules,” a placeholder for an actual board of directors, set of bylaws and formal organizational status as a corporation or 501(c)(3). Speaker after speaker at the kickoff meeting issued a clarion call for participants in the 12-month process that will ultimately lead to independent status and a formal request for proposals to bring in a vendor who will create the health information exchange.

University Bank (Ann Arbor) President Stephen Ranzini said barriers to a successful health information exchange are political and social, not technological. He analogized the evolution of ATMs in which an idea emerging in Denver spread through the uniting of regional standard-producing organizations resulting in the establishment of fluidly functioning system that has become part of the cultural fabric of the United States.

The only functioning health information exchange in Michigan exists in the northern part of the state (Marquette). Establishing such a system in Southeast Michigan is considerably more complicated because of the size of the population and number of stakeholders involved.

Enter Altarum Institue, an Ann Arbor-based, non-profit health care research firm that specializes in “health informatics.” Altarum controls $1.1 million of the $4.5 million statewide grant and, with the Greater Detroit Area Health Council and other stakeholders, is charged with facilitating the process that will result in an independent health information exchange for Southeast Michigan.

Physicians, who were intentionally squeezed out of Hillary Clinton’s health care reform plans in the 1990s are virtually being begged to participate in this groundbreaking effort. Last November, seven months before the grant money was awarded, the stakeholder search was expanded and specifically widened to include WCMSSM and the Oakland County Medical Society. Jablonowski and OCMS Executive Director Donna LaGosh chair key workgroups and are eager to recruit physician members to SEMHIE.

Despite the state of Michigan’s economy and the embarrassing prospect of an imminent government shut-down, the state is actually well ahead of the curve in its pursuit of operational health information exchanges. Ranzini said so as did national expert Janet Marchibroda when she visited Michigan in June.

To participate, please contact Adam Jablonowski at arj@msms.org or visit www.semhie.org

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Reid Leaves Strong Legacy At WSU

By PAUL NATINSKY
In an interview with DMN last fall, Wayne State University School of Medicine Dean Robert Mentzer, MD, spoke of a new direction being carved by the Medical School. After many years in the “top 40” research institutions (based on grant money from the National Institutes of Health and other kingmakers) WSU now faces a reshuffling in the annual award of grant dollars. It has to reestablish itself in the competitive world of research institutions.

The Medical School had applied for a grant to start an initiative within the current vein of grant-making zeitgeist – translational medicine. Translational medicine is a fancy term for moving research science into clinical practice quickly, an effort by NIH to expedite research progress into clinical practice.

WSU’s School of Medicine got the grant. It just initiated a call for proposals and the chips will fall where they may. But, the School of Medicine needn’t have worried. Irvin Reid had their back. Despite a steady stream of higher education cuts, a casualty of Michigan’s recent economic woes, Reid told Dean Mentzer he’d come up with the funds if the feds didn’t.

That play was not at all out of character for Reid, who along with his wife, according to the Detroit Free Press, personally pledged $600,000 to the university. Reid also wasn’t afraid to ask others to pony up. Under his decade-long tenure fund-raising, also according to the Free Press, grew from $27 million annually to $80 million.

So far, Reid is not saying where he is going or what he is doing, or even why he is stepping down (“It is time” is hardly a credible reason for a man making $374,000 a year as a well-liked university president). Stay tuned for further details, but wherever he winds up and for whatever reason he is leaving, medicine in Southeast Michigan will be sorry to see him go.

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AMA Pushes Congress To Preserve Medicare Money

The American Medical Association (AMA) National House Call campaign visited Kansas City Thursday and urged residents to help press Congress to stop scheduled Medicare cuts that threaten patients’ access to care. Unless Congress intervenes, Medicare will slash physician payments 15 percent over the next two years beginning on Jan. 1, 2008.

A recent AMA survey found that 60 percent of physicians say they will be forced to limit the number of new Medicare patients they treat when the government cuts payment rates beginning next year.

“Payments to physicians aren’t keeping pace with the costs of practicing medicine, and our concern is that, as shown in the government’s own data, seniors are already finding it more difficult to find a new physician,” said AMA Immediate Past President William G. Plested III, MD. “According to MedPAC, the government commission that advises Congress on Medicare issues, 24 percent of Medicare patients who are looking for a new primary care physician are having trouble finding one.”

“We need the Senate to act now. Kansas Senators Pat Roberts and Sam Brownback have been supportive in the past, and we appreciate that support. But the Medicare patients in Kansas they represent need them to fix this problem now by working in the Senate for a solution that provides urgently needed relief,” Dr. Plested said.

“The AMA encourages patients to get involved through the AMA’s Patients Action Network. So far, more than a million have signed on.

We’re asking them to urge the Senate to take action to provide meaningful relief from drastic Medicare physician payment cuts,” said Dr. Plested.

The toll free number is  (888) 434-6200.

“Congress needs to act to preserve seniors’ access to care and put Medicare on a firm foundation for the future. Congress must keep its promise to America’s seniors,” said Dr. Plested.

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WSU Med Student Earns NIH Fellowship

John Lillvis, a student in the WSU School of Medicine MD/PhD program, recently received a prestigious fellowship from the National Institutes of Health. The grant covers Lillvis’s stipend, National Research Service Award-level tuition and health-care costs for six years. The title of the project is “Immunity and the Pathogenesis of Abdominal Aortic Aneurysms.”

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Recovering The Soul

Edward R. Heil Symposium

An Integrated Approach to Health & Wellness

Friday, October 26, 2007
7:30 a.m. - 1:30 p.m.
University of Detroit, Mercy
4001 W. McNichols Road
Detroit, MI 48221

Click here to Register Online 
(Link will open in new window)

Come hear internationally recognized Larry Dossey, MD, speak on Recovering the Soul and Barbara Dossey, PhD, RN, AHN-BC, FAAN speak on The Healing Environment: What do we mean? Both are authors and mind-body medicine experts who will discuss how healing is promoted by attending to the delicate interaction of body, mind and spirit, and how centuries-old concepts can be successfully applied in the care of patients and everyday living.

Four breakout sessions will be offered:

1. Healing Body, Mind and Spirit: Interventions for Healthcare Providers
2. The Importance of Hope in Healing: The Importance of Spirituality in Recovery 
3. Appreciative Presence®: Using Touch to Support the Body, Mind & Spirit 
4. Spiritual Assessment: An Interdisciplinary Approach

This half-day conference, which is pending approval of four CME and CEU credits, is geared to special interests to physicians, nurses, clergy and spiritual care providers, social workers, residents and healthcare students. Click here to see the agenda. Symposium fee $60.

For more information, please call (313) 966-3510.

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Children's Hospital Hosts Psych Lectures

October 9, 2007  -  Jocelyn McCrae, PhD, of Children's Hospital of Michigan, will be presenting, "Psycholgical Aspects of Pediatric Sickle Cell Disease: Assessment and Intervention" 1:30pm - 2:30pm at Children's Hospital of Michigan - Main Auditorium.  Lunch provided at 1:15pm.  Free

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