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October 8, 2007 |
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IN THIS ISSUE
Editor's Column: Value-Based Insurance Design: Good Idea Or
Another Floater
AMA,
AARP Press Congress On Medicare
UAW/GM Contract Limits
Health Plan Choices
WSU Names New Orthopedics
Chair
Cottage Hospital Joins HFHS
DMC Wins Burn
Center Designation
Tamper-Free Rx Pad Deadline Approaches |
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Editor's Column: Value-Based Insurance Design:
Good Idea Or Another Floater
By JOSEPH
WEISS, MD
Value-based insurance design starts from the premise that copayments
should be set at the value of service, not at its cost. The premise
of VBID is that the value of medication varies with the specific
patient. For example, a beta blocker is useful to the point of
necessity for the post myocardial patient. The same beta blocker is
helpful, but not vital, to the well being of an actor combating
stage fright.
The point of
value-based insurance design is that cost sharing by the individual
should vary according to his or her need for that particular drug.
The University of
Michigan implemented VBID in July 2006, targeting 2,200 university
employees and dependants with diabetes. Copayments for drugs were
reduced for medications the group needed to control blood sugar,
cholesterol, blood pressure and depression. Tier one (generics) were
reduced from $7 to $0, tier 2 (preferred) from $14 to $7, and tier 3
(brand name) from $24 to $18. With this differential copayment rate,
drug compliance has moved 70 percent higher compared to levels
achieved before July 2006.
The real proof of
the value of VBID will be found in the savings that accrue because
of improved health of this group as compared to similar groups that
do not have the incentive of reduced copayments. That calculation is
years away. However, an indication of the effect of value-based
copayment is that sick leave time among the 2,200 employees is down
50 percent in 2006-2007 as compared to the previous year when
value-based insurance design was not in effect.
The next step is
to bring information technology to assist in implementing
value-based insurance design. The purpose of the technology would be
to immediately change a patient’s copayment requirements once that
patient becomes diabetic or experiences congestive heart failure.
Use of electronic prescribing would facilitate this change in
copayment as e-prescriptions have a field for the diagnosis
underlying the particular drug request.
Physicians in
Michigan should become aware of this new concept in copayments that
the University of Michigan is pioneering. The state is likely to be
the first one to participate in a wider application of this idea.
Too often, as
illustrated by aspects of computer order entry, technology only adds
to the complexity of our professional lives. When value-based
insurance design combines with information technology we may achieve
a genuine advance.
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AMA, AARP Press Congress On Medicare
By PAUL
NATINSKY
AMA
President and WCMSSM member Ron Davis, MD, co-authored an op-ed
piece in this morning’s Detroit Free Press (page 14A) with AARP CEO
William Novelli urging the US Senate to approve legislation that
would, among other things, delete a two-year, 15-percent
reimbursement cut to physicians, limit premium increases to seniors
and provide help with drug costs to poor seniors.
The opinion piece
also harshly criticized the Medicare Advantage plan, a Medicare
managed care program that reimburses private insurers and was
intended to save money. Dr. Davis and Mr. Novelli had this to say:
“With Medicare Advantage plans paid more than traditional Medicare –
and only covering one in five Medicare patients – the private
insurance industry is reaping a $54 billion subsidy. That money
comes from the pockets of taxpayers and adds to already high
Medicare premium increases. When the insurance companies started
offering Medicare Advantage plans, they promised that managed care
would help save money. Instead, they’re collecting a windfall.”
The push for a
Medicare remedy comes at a time when states are struggling with
Medicaid programs and on the heals of a veto of the State Children’s
Health Insurance Program (SCHIP). The president applauded the intent
of expanded SCHIP, but said there was no money to fund what Congress
approved.
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UAW/GM Contract Limits Health Plan Choices
The tentative
contract between
United Auto Workers and
General Motors would reduce the number of health plans available
to about 412,000 unionized workers, retirees and their families as
GM tries to reduce the almost $5 billion spent last year on health
care benefits for 1.1 million people, both union and nonunion, the
Detroit Free Press reports. According to the
Free Press,
GM's UAW workers still would have comprehensive health care
coverage, and if the contract is ratified, some benefits would
improve.
The new contract removes all dental HMOs, all but three HMOs and all
PPOs except
Blue Cross Blue Shield of Michigan, the
Free Press
reports. The HMOs offered under the contract would be BCBS,
Health Alliance Plan and
HealthPlus of Michigan. Employees and retirees currently
enrolled in other plans would be transferred to BCBS PPO Traditional
Care Network, according to the UAW contract summary.
GM's UAW workers now pay a $10 copayment for a doctor's office visit
with an unlimited number of follow-up visits annually. Under the new
contract, GM's UAW workers would pay $25 per visit for five doctor
visits annually under the Traditional Care Network plan, and copays
for the other HMOs retained by GM also would be $25.
Some health care executives have expressed concern that GM's new
limits could hurt smaller health plans and reduce competition.
Richard Murdock, executive director of the
Michigan Association of Health Plans, said that removing plans
would "limit competition that encourages high performance and
quality."
Sharon Pultorak -- a senior account executive for
United Concordia, a dental HMO -- said that dental HMOs
typically cover in full for cleanings, examinations and X-rays,
whereas traditional coverage requires copays or full payment from
the patient. Under the contract, GM will cover retiree health care
until 2010, at which time liability shifts to UAW under a voluntary
employees' beneficiary association. Under current projections, the
benefits will not change under a VEBA, but they could be reduced if
projections turn out to be inaccurate (Anstett,
Detroit Free Press,
10/5).
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WSU Names New Orthopedic Chair
Wayne State University School of Medicine named DR. Lawrence G.
Morawa Chair, Orthopedic Surgery Dr. Morawa has served on the
faculty in the School of Medicine's Department of Orthopedics since
1974. He has leadership experience, in multiple clinical settings,
as the Chief of orthopedic and surgical programs since 1978. In
addition to his teaching and research, Dr. Morawa practices medicine
in Dearborn.
He is a graduate of the University of Michigan School of Medicine
and completed his Internship at Oakwood Hospital and Residency at
Wayne State University. Dr. Morawa is Board Certified in Orthopedics
and is a member of the Michigan State Medical Society, the Wayne
County Medical Society, The Association for Arthritic Hip and Knee
Surgery, the Society for Arthritic Joint Surgery, the Academic
Orthopedic Society, the Detroit Academy of Orthopedics, the Mid
American Orthopedic Association and many others.
Dr. Morawa was honored by the American Academy of Orthopedic
Surgeons with the Education Achievement Program. Not only is he a
scholar in the field of Orthopedic Surgery, but he is also active in
his community. He has won several awards from community groups, such
as Variety Clubs International, Freedom Shrine Award, Variety Club
Heart Award, Dearborn Health Council and a special award from the
Spirit of Detroit for his work with juvenile amputees.
Dr. Morawa is an accomplished speaker and is well published. He has
received grant funding for research in the use of myoelectric
controls, computer assisted surgery and the use of other assistive
robotic devices. His research and publications have made him a
sought after speaker at meetings both nationally and
internationally.
Dean Mentzer said "I am confident that Dr. Morawa's talent and
skills; his many years of compassionate practice; and his experience
in medical student education will substantially enrich our
orthopedic surgery program."
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Cottage Hospital Joins HFHS
Cottage Hospital, which has served thousands of
patients from the Grosse Pointes and other eastside communities for
more than 85 years, has rejoined the Henry Ford Health System.
In 1986, Cottage Hospital became affiliated with Henry Ford Health
System. In 1998, Cottage became part of the Bon Secours Cottage
Health Services, along with Bon Secours Hospital. As part of the
joint venture, Henry Ford Health System owned 30 percent of the
joint venture. With Henry Ford assuming full ownership of Cottage,
the joint venture has been dissolved.
Cottage hospital will be staffed by current employees, physicians
from the local community, and members of the nationally-recognized
Henry Ford Medical Group.
The Henry Ford Medical Group is one of the nation's largest and most
experienced group practices, with 1,000 physicians and researchers
in more than 40 specialties who staff Henry Ford Hospital and
outpatient medical centers.
As part of the transition of ownership, Cottage Hospital has
officially been renamed Henry Ford Cottage Hospital, preserving its
legacy and rich heritage in the Grosse Pointes and across
southeastern Michigan.
"Henry Ford Cottage Hospital will be an integral part of Henry Ford
Health System, serving the Grosse Pointes and eastside communities
with the safest and highest quality of clinical care, and superb
personal service," said Nancy Schlichting, president and chief
executive officer of Henry Ford Health System. "We pride ourselves
on being an employer of choice and welcome the Cottage Hospital
employees back to the Henry Ford family."
Eastside patients will benefit from the complete ownership as the
hospital will act as a gateway to the expertise and professionals at
Henry Ford Hospital and the entire health system.
For instance, in the last three weeks, Henry Ford Hospital received
the following honors:
o Alliance of Healthcare Providers selected Henry Ford Hospital as a
2007-2008 Hospital of Choice Award. This award was designed to
identify America's Most Customer-friendly Hospitals.
o For the second consecutive year, the National Research Corporation
(NRC) named Henry Ford Hospital as the winner of the Consumer Choice
Award for Best Overall Quality for the Detroit/Wayne County area.
o Henry Ford Hospital was one of 41 U.S. hospitals named a 2007
Leapfrog Top Hospital, based on results from the Leapfrog Hospital
Quality and Safety Survey, the most complete and current assessment
of hospital quality and safety available.
"Henry Ford Cottage Hospital will be an anchor for the east side
allowing patients to receive hospital services in the community as
well as an entry point into Henry Ford Health System," said Bob
Riney, Henry Ford's executive vice president and chief operating
officer.
Services currently available will remain at the Grosse Pointe Farms
hospital, ranging from the inpatient psychiatric unit,
rehabilitation services, women's diagnostic center and the emergency
department.
"We are looking forward to investing further in the hospital,
including new medical programs and technologies, and continuing to
expand current services," says Anthony Armada, president and CEO of
Henry Ford Hospital and Health Network.
In addition to Cottage Hospital, Henry Ford will also be the sole
owners of:
o Henry Ford Rehabilitation Services - Lowell Park
44800 Delco Blvd, Sterling Heights
o Henry Ford Rehabilitation Services - Warren
3601 E. Eleven Mile Road, Warren
Henry Ford Cottage hospital's leadership team will be comprised of
Anthony Armada chief executive officer; Denise Allar, R.N., chief
operating officer; and Michael Dunn, MD, chief medical officer.
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DMC Wins Burn Center Designation
The Burn Center at
Detroit Receiving Hospital (DRH) has been awarded Burn Center
Verification through a joint committee of the American Burn
Association and the American College of Surgeons.
To become a verified burn center, Receiving's burn team had to
demonstrate advanced expertise in the care of the most severely
injured patients, as well as leadership in research, education,
outreach/prevention and emergency preparedness planning. As a
verified burn center, Receiving will continue to serve the Metro
Detroit region as the hospital of choice for all complex burn cases.
"We are proud that our Burn Center is being recognized for the
exceptional clinical care that we have always strived to provide,"
stated Michael White, MD, medical director of DRH's Burn Center.
"Being a verified burn center is a true mark of distinction and
indicator to many that our center provides unparalleled care through
the entire course of the patient's injury."
"Burn Center Verification is yet another mark of clinical
distinction, reflecting our commitment to medical excellence," said
Iris Taylor, PhD., DRH president. Detroit Receiving is also
Michigan's first Level I Trauma Center, as well as Metro-Detroit's
first certified primary stroke center.
The DRH Burn Center team is comprised of physicians, nurses,
pharmacists and physical therapists, who work together to achieve
maximal clinical outcomes. As Michigan's largest adult burn care
facility, DRH's Burn Center is fully equipped to treat all types of
thermal injuries, including flame, scald, electrical, chemical,
radiation and frostbite. The Burn Center also offers Michigan's only
24/7 hospital-based hyperbaric oxygen therapy program to treat smoke
inhalation and burns.
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Tamper-Free Rx Pad Deadline Approaches
For those of you that may not have heard, the
requirement for tamper-proof prescription pads for Mediciad patients
has been moved to April 1, 2008. Congress passed the bill on
September 27 and President Bush signed it on September 29.
Diane Bristol
MMGMA Legislative Chair
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