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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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