Wayne County Medical Society of Southeast Michigan

October 29, 2007

Editor's Column: Blunt Talk, But Use A Soft Voice
Crunch Time On Medicaid
DMC Earns $300,000 Grant
UAW, Chrysler Workers Approve Contract, VEBA
WSU Among Top Five Presenters
AMA: Physician Rankings Must Put Quality First
CDC Immunization Update

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Editor's Column: Blunt Talk, But Use A Soft Voice

By JOSEPH WEISS, MD
As readers know, Michigan has almost, but not quite, worked out of its state budget woes. Still to come are cuts in state services; Medicaid looms large as vulnerable to reductions that may go into the hundreds of millions. If somehow Medicaid escapes this year, the same threat of cuts faces the program in 2009.

A timely article by Christine Ferguson in the September issue of Health Affairs addresses the issue of speaking to the administrators and politicians who will fashion the Medicaid budget for 2008 and beyond. She spent seven years as director of human services for Rhode Island, and held the equivalent job in Massachusetts for two years. Ms.Ferguson presently is an associate professor in the Department of Public Policy at George Washington University.

She points out that the public, including its politicians, divides the needy into two groups: the "deserving" and the "undeserving." The deserving are those whose health needs are the result of `an act of God,' and include individuals with cancer, children and the aged. The undeserving, according to popular opinion, are those people who should have made better choices, such as alcoholics, drug abusers, the obese, single mothers and the poor.

To successfully defend Medicaid from budget cuts, physicians must address the attitude that divides the needy into deserving and undeserving. We can point to our medical journals. They repeatedly present us with information on genetic linkages to overeating and alcoholic behavior. If the medical profession cannot say where heredity ends and personal choice begins, then the legislators should also withhold judgment on personal responsibility and instead concentrate on assistance for those in need.

Ms. Ferguson points out that the problem of preserving Medicaid funds becomes further complicated by legislators' attitudes that (1) treating the needy seldom leads to cure, and (2) the better a Medicaid program a state develops, the more hangers-on come into the state to take advantage of the liberal benefits. As an aside, Ms. Ferguson notes that statistics to date do not confirm such migratory behavior by the needy.

The same bias and misconceptions that she faced in Rhode Island and Massachusetts, we meet in Michigan.

Physicians need to explain medical perspectives. In treatment our goal is not always cure. Most of what we aim for with patients, whether needy or not, is not resolution but change for the better. We want the obese individual to lose weight, not become slim. We don't expect the bipolar patient to reach freedom from extremes, but to experience fewer episodes of mania or depression. We anticipate that improved child health will lead the student to do better in school but that improvement cannot be equated to winning scholarships.

We need to bring forward what we understand: that medical care for the needy, as for anyone, does not cure but sustains. Unfortunately, we have no measure of how much society benefits from the assistance Medicaid brings. But we understand society gains. As occurs so often in medical practice, we sense what treatment is appropriate when evidence-based documentation does not exist to support our actions. We practice well with such limitations; we need to convince the legislators to do the same.

We should bring out our experience calmly but with conviction. We are negotiating to save both individuals and ideas and we must be prepared for dialogues that will continue into the foreseeable future.

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Crunch Time On Medicaid

The state legislature has until October 31 to balance the FY 2007-08 budget. That means time is of the essence in urging them to prevent any cuts to health care, particularly Medicaid.

FOUR DAYS LEFT TO TAKE ACTION! Use the MSMS Action Center (www.msms.org/action (http://www.msms.org/action) ) to send a pre-written, customizable message to your state lawmakers, urging them to protect access by preserving Medicaid, graduate medical education funding, and the Healthy Michigan Fund.

At Risk of Being Cut...

--Medicaid physician payments

--Medicaid eligibility for 19- and 20-year-olds --Medicaid eligibility for caregiver relatives --Graduate medical education funding --Healthy Michigan Fund (for preventive health measures) SURVEY RESULTS: ACCESS WILL DECLINE WITH MEDICAID CUTS MSMS's recent member survey shows that more than two-thirds of physicians indicated that they would be forced to make the difficult decision between dropping out of the Medicaid program altogether or limiting the number of Medicaid patients they will be able to accept if more cuts are made. Find complete survey results online at www.msms.org/medicaid (http://www.msms.org/medicaid) .

For more information, contact Colin Ford at MSMS at 517-336-5737 or cford@msms.org.

US Senate Needs to Stop Medicare Cuts Now

MSMS, the AMA and AARP are increasing and intensifying efforts to push the US Senate to replace projected Medicare cuts (10 percent in 2008 and five percent in 2009) with positive payment updates of 0.5 percent in both years and to fix the flawed Sustainable Growth Rate payment formula. IMPACT ON MICHIGAN - Visit www.msms.org/medicare

(http://www.msms.org/medicare) to find out how the projected Medicare cuts would affect Michigan physicians.

TAKE ACTION NOW – Use the MSMS Action Center (www.msms.org/action

(http://www.msms.org/action) ) to send a pre-written, customizable message to our US Senators, asking them to support a Medicare payment increase and to replace the "un-sustainable" growth rate formula. Or call them using the AMA Grassroots Hotline: 800-833-6354. For more information about federal legislative advocacy, contact MSMS Executive Director Kevin A. Kelly at 517-336-5742 or kkelly@msms.org.

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DMC Earns $300,000 Grant

The Detroit Medical Center (DMC) has been awarded $297,000 in funding through the Fiscal Year 2007 Urban Areas Security Initiative

(UASI) Nonprofit Security Grant Program (NSGP).

The grant proposal was a collaborative venture submitted by the Detroit Medical Center on behalf of Children's Hospital of Michigan, Detroit Receiving Hospital and Harper University Hospital, three of the nine hospitals operated by the DMC. The NSGP is administered through the United States Department of Homeland Security and the funds will be disbursed in three installments of approximately $98,000 per hospital.

This grant program provides more than $24 million to eligible nonprofit organizations who are deemed high-risk of a potential international terrorist attack. Terms of the grant require funds to be used for training, purchasing or installation of security equipment and or inspection screening systems, on property owned or leased by the organization. Dollars may also be utilized for security related training courses and programs.

Children's Hospital of Michigan will use the funds to purchase additional state-of-the-art exterior cameras, updated security monitors, battery backup units, and various other security items. Monies will also be used to pay the installation and labor fees of security engineers and technicians, as needed.

Detroit Receiving Hospital plans to use the funds for transportable radiation monitors, 16-channel real time digital video recorders, high-resolution security monitors and battery backup units. Security officers will also receive additional training in emergency preparedness and critical incident response.

Harper University Hospital's funds will be used for infrared cameras, high-resolution security monitors, weatherproof camera housing and image intensifier color cameras, as well as installation and labor fees.

Additional training for security officers will also be included.

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UAW, Chrysler Workers Approve Contract, VEBA

United Auto Workers officials on Saturday said that Chrysler Group employees represented by the union approved a four-year contract that will establish a voluntary employees' beneficiary association, the Detroit Free Press reports (Higgins, Detroit Free Press, 10/28). Under the contract, Chrysler will contribute $8.8 billion to a VEBA managed by UAW, a move that would shift retiree health care liabilities from the company to the association. Chrysler will pay about $1.5 billion in 2008 and 2009 for retiree health care liabilities before the VEBA assumes them in 2010. The contract also will establish a two-tier wage system similar to the one established at General Motors. Some UAW members at Chrysler reportedly opposed the new wage system and the lack of production guarantees at U.S. manufacturing facilities (Kaiser Daily Health Policy Report, 10/26).

UAW members at Chrysler approved the contract with the support of 56% of production employees, 51% of skilled-trade workers, 94% of clerical employees and 79% of engineering workers, union officials said in a statement (Detroit Free Press, 10/28). According to USA Today, the contract will "help maintain [the] standard of living" for UAW members at Chrysler but will reduce their level of health insurance, limit their physician visits and increase their copayments (Silke Carty, USA Today, 10/29).

Ford Contract Negotiations Continue
UAW on Saturday began final negotiations with Ford Motor on a similar contract, the AP/Boston Herald reports (AP/Boston Herald, 10/28). According to individuals familiar with the negotiations, although UAW President Ron Gettelfinger did not attend, he has followed the discussions closely (Aguilar, Detroit News, 10/27). Gettelfinger said that the Ford contract likely would follow a similar pattern as the GM and Chrysler contracts. He added that Ford likely will seek more concessions because of the weaker financial condition of the company in comparison with GM and Chrysler. "It is unclear how difficult negotiations with Ford will be," the Wall Street Journal reports (Boudette et al., Wall Street Journal, 10/29).

UAW and Ford have reached a "broad agreement" on much of the contract, but "gaps remain on key issues," the News reports. For example, Ford seeks a larger discount on VEBA contributions than GM and Chrysler received, according to individuals familiar with the negotiations (Hoffman, Detroit News, 10/27).

David Gregory, a labor law professor at St. John's University, said that the contract would follow the "essence of the pattern" but added that "there's going to have to be more flexibility because of Ford's predicament." He said that Ford "may have to make extravagant promises that it really can't fulfill" (Maynard, New York Times, 10/28).

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WSU Among Top Five Presenters

For the third consecutive year, the Wayne State University Multiple Sclerosis Center was named among the top five U.S. multiple sclerosis centers at the annual meeting of the largest MS academic body. More than 5,000 attendees participated in the meeting earlier this month in Prague from all over the world.

More than 50 U.S. university and hospital-based academic neurology departments and MS centers presented papers at the meeting. The top five centers in terms of the numbers of papers presented included: State University of New York-Buffalo with 16 papers, WSU with 12 papers, Brigham & Women’s Hospital, Harvard Medical School, with 11 papers, Mayo Clinic with 10 papers and the Neuroimmunology Branch, a National Institutes of Health branch, with 9 papers.

Six of WSU’s 12 papers were investigator initiated, and six were as a result of multi-center phase II and III clinical trials. Several related publications are already in press or being peer-reviewed for publication. Omar Khan, M.D., professor of Neurology, is director of the Multiple Sclerosis Clinical Research Center & Neuroimaging Laboratory at Wayne State University School of Medicine.

Robert Zalenski M.D. honored for CAPE program

The Board of Trustees of the Hospice of Michigan Foundation recently honored Robert Zalenski M.D., and the Center to Advance Palliative Care Excellence. Dr. Zalenski, who serves as the center’s associate director for clinical practice, received a Crystal Rose Ball at a recent dinner cruise on the Ovation Yacht. The award is given annually to community partner organizations that exemplify a strong dedication and commitment to Hospice of Michigan. Previous winners include the Ford Motor Co., Dow Automotive and the Alzheimer’s Association.

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AMA: Physician Rankings Must Put Quality First

Nancy H. Nielsen, MD, PhD, AMA President-elect

“On behalf of the American Medical Association, I would like to commend New York Attorney General Cuomo for his groundbreaking agreement with CIGNA. Physicians greatly appreciate your leadership and your commitment to our shared goal of enhancing the quality of care and ensuring patients are provided with reliable information that is meaningful to them.

“The AMA also commends CIGNA for leading the industry by renouncing physician evaluations and rankings based solely on economic factors, and agreeing to a balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician.

“The AMA expects this agreement will influence other states to implement careful and independent oversight and evaluation of physician performance measurement projects to assess their integrity and fairness.

“This agreement is important because it establishes a process that seeks to guard against some of the risks inherent in physician performance programs run by health insurers. A lack of scrutiny has allowed health insurers to unfairly evaluate aphysician’s individual work using an insufficient number of patient cases, questionable quality measures and poor adjustments for risk. Consequently, patients could be presented with skewed and inaccurate information on caring physicians who were unfairly evaluated.

“Patients should always be able to trust that the information they receive on physicians is valid and reliable, but the integrity of this information can be undermined by a health insurer’s corporate profit motive. This conflict of interest can erode confidence and trust in physicians, and disrupt patient’s longstanding relationships with physicians who know them and have cared for them for years.

“Given the potential risks to patients, the AMA believes state lawmakers and regulators have an important public responsibility to establish proper oversight of health insurers to ensure that physician performance measurement is used primarily to enhance the quality of care.

“Attorney General Cuomo is the first state official to establish fundamental protections that strike a fair balance among the interests of patients, doctors, and insurers – while also providing room for further evolution in the future. We congratulate him for addressing the complex challenges and evolving needs of physician performance measurement with insightful procedures and requirements.

“As a New Yorker, I am proud to be here today with the New York Attorney General’s office. I urge him to continue his efforts to protect the patient-physicians relationship, and I offer the AMA's assistance in ensuring his unprecedented agreement is successfully implemented.”

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CDC Immunization Update

The Centers for Disease Control and Prevention’s (CDC) Immunization Works Monthly Immunization Update is provided to professional organization partners for broad distribution to their members and constituencies. The information provided is non-proprietary.

Coverage Rates for Recent Influenza Seasons: Influenza Vaccination coverage rates are low among recommended groups, according to three recent reports in CDC’s Morbidity and Mortality Weekly Report that examine vaccination coverage rates across populations and seasons.

First, a report on Influenza Vaccination Coverage Rates among Children 6-23 Months during the 2005--06 influenza season indicates that only 31.9% of children in this age group received at least 1 dose of influenza vaccine and 20.6% were fully vaccinated according to Advisory Committee on Immunization Practices (ACIP). The 2005--06 influenza season represents the second season after ACIP recommended annual influenza vaccination for all children 6--23 months. The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health-care providers and caregivers about the effectiveness of influenza vaccination among young children.

Second, a report on Influenza Vaccination Coverage Among Children 6-59 Months demonstrates that less than 30% of children aged 6--23 months and less than 20% of children aged 24--59 months were fully vaccinated. Vaccination coverage data from national and state surveys for an influenza season generally are not available until the next influenza season, but this report uses data from six immunization information system (IIS) sentinel sites. Rapid assessment of influenza vaccination coverage can help direct activities of state and local public health agencies aimed at increasing the number of children fully vaccinated against influenza.

Third, a report on State-Specific Influenza Vaccination Coverage among Adults shows that vaccination coverage in each age and risk group has declined significantly for the 2005--06 influenza season compared with the 2003--04 season. Among adults 18-49 years old with identified high-risk conditions, the estimated influenza vaccination coverage for the 2005--06 season was 30.5%, and 18.3% among all other persons aged 18--49 years. Among adults aged 65 years or older, influenza vaccination coverage for the 2005--06 season was 69.3%. Comprehensive measures are needed to improve influenza vaccination coverage among adult populations in the United States. These measures include increasing the adoption of recommended adult immunization practices by health-care providers, raising public awareness about influenza vaccination, vaccinating throughout the influenza season, and ensuring stable supplies of readily available vaccine.

The low vaccination rates in these studies serve as a reminder for private providers, community providers, and state and local public health agencies to be vigilant about protecting individuals in high-risk groups from influenza in the current season.

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