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September 4, 2007 |
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IN THIS ISSUE
Editor's Column: Moore Is Less
State
Leaders Go To Bat For SCHIP
News From MSMS
CMS Issues Final 'Stark'
Regulations
Uninsured Population On The Rise
AFL-CIO
Supports Universal Health Care
Continuing Education |
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Editor's Column: Moore Is Less
By JOSEPH
WEISS, MD
Physicians in Southeast Michigan could provide Michael Moore, the
writer, director and producer of the film Sicko with enough material
for Sicko 2, Sicko 3, and beyond. WCMSSM members seeing Sicko will
not learn anything they do not already know about gaps in health
care and the influence of insurance and pharmaceutical companies on
what is paid, how much is paid, and to whom.
The problem
physicians will encounter on seeing Sicko is not what the film
exposes, but what it promotes. Without reservation, Moore takes as
self- evident that government-run health insurance will provide
prompt, equitable care that is technologically at the cutting edge
and at the same time, personal, heart warming, and practical. Except
for a fleeting reference to the word “taxes,” he makes no mention
how the government will pay for this bounty.
Moore also
misrepresents Americans as being afraid of government, and betrays
American physicians with his depiction of us as indifferent to our
patients’ health cost plight and unhappy with present care only
because it does not profit us to our satisfaction.
Moore heaps
praise on the English, Cuban, Canadian and French health care
systems. He does not peek, let alone look deeply, into their
problems of reconciling cost, technology, patient expectations and
physician working conditions.
Few among us
expect great change in the delivery of health care in the
foreseeable future; the accepted notion is that expansion of care
will come in increments and over years. Sicko could change that time
line. Moore’s movie not only adds to the critiques of the way
America provides health care to its people; what Moore does well in
this film is to bring public opinion to a boil. If he reaches a wide
enough audience, the next market place revolt we see may be our
transformation to a national health insurance country. A portion of
the effort we put into changing the Medicare Sustainable Growth Rate
formula possibly should go into planning how to adapt to a national
health insurance system.
As an aside, I
should add that not only does Michael Moore not help solve the
problem of providing health care to all Americans, he adds to the
dilemma. His hulk is in almost every frame. He is a perfect example
of a man with metabolic syndrome. His probable hypertension, obesity
and possible diabetes likely will eventually cost his health
insurance carrier a far greater amount beyond what his premiums
bring in. Filmmaker, for all our sakes, cure thyself.
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State Leaders Go To Bat For SCHIP
By JASON RISKE
In less than two months, the State Child Health Insurance Program (SCHIP),
known as MIChild in Michigan, will expire. Several state leaders and
children’s advocates met on the Detroit Medical Center campus Aug.
15 to urge the federal government to support the reauthorization and
expansion of the SCHIP program. SCHIP, signed into law in 1997,
provides states with federal funding to provide coverage for
children living in families earning too much for Medicaid but too
little for private insurance. SCHIP provides coverage to 6 million
children annually.
Speakers
included: Patricia R. McCarthy, Moderator, Cover the Uninsured
Communications; Dr. Herman Gray, President & CEO, DMC Children’s
Hospital of Michigan; Mr. David Morse, Senior VP, Robert Wood
Johnson Foundation; Michelle & LaYonna McCullough, MIChild Family;
Dr. Ronald Davis, President, American Medical Association; Mr.
Michael Duggan, President and & CEO, Detroit Medical Center;
Honorable Jennifer M. Granholm, Governor, State of Michigan; and Dr.
John J.H. Schwarz, Fmr. U.S. Congressman, State of Michigan.
Speakers
delivered a brief message on why it is crucial to get SCHIP
reauthorized. Michelle and LaYonna McCulluogh told their story of
how they experienced, first hand, the saving grace of the MIChild
program. Through the program, she was welcomed with open arms into
Children’s Hospital of Michigan, and found a physician willing to
personally take on the challenge of treating her ill child. Hers was
a powerful and positive story that was sure to tug at the hearts of
those in attendance. However, without the reauthorization of the
SCHIP program, many similar stories will end on a much sadder note.
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News From MSMS
Settlement in
Love vs. Blue Cross & Blue Shield Association
The Board heard a report on the settlement of the Love vs. BCBSA
case, a physician-initiated class action suit alleging that Blue
Cross plans had, among other things, misrepresented/failed to
disclose the use of edits to unilaterally “bundle,” “down code,”
and/or reject claims for medically necessary covered services. In
July, Michigan physicians should have received by mail a Notice of
Class Action & Proposed Settlement and a claim form. Physicians will
have the option of donating their portion of the settlement fund to
certain charities, which in Michigan includes the Michigan Health &
Safety Coalition. Assuming no other changes occur, the payments will
follow after a November 14 final settlement hearing. MSMS legal
counsel has prepared a Legal Alert (www.msms.org/yourpractice)
for members about this settlement. For more information, contact
Julie Novak at 517-336-5768 or
jnovak@msms.org.
Federal Grant
Needs to Support Streamlined Credentialing System
As part of the MSMS Future of Medicine initiative, the
Administrative Simplification Work Group is pushing for best use of
a federal grant received by the State of Michigan to set up a
separate credentialing system for Medicaid. MSMS holds that the
application and verification of information steps should be common
to all parties in order to reduce wasted resources. MSMS is
concerned that the grant would create a new silo for credentialing
and would go against Future of Medicine principles and current
efforts to simplify and streamline the process. MSMS has contacted
the Director of MDCH, expressing its concerns and requesting a
meeting with all stakeholders. For more information, contact Julie
Novak at 517-336-5768 or
jnovak@msms.org. Also, visit
www.msms.org/future.
Reporting
Initiative Offers Physicians 1.5% Increase in Medicare Payments
The Physician Quality Reporting Initiative (PQRI), managed under the
US Centers for Medicare & Medicaid Services (CMS), offers financial
incentives for eligible physicians to participate in a voluntary
reporting program. Eligible physicians who successfully report a
designated set of quality measures on claims for dates of service
from July 1 to December 31 may earn a bonus payment, subject to a
cap, of 1.5% of total allowed charges for covered Medicare Physician
Fee Schedule services. CMS periodically will hold national
conference calls on a variety of topics related to the PQRI.
For more
information, visit
www.msms.org/pqri or contact Stacie Saylor at 517-336-5722 or
ssaylor@msms.org.
Medicaid
Budget Priorities
The Board approved a motion that MSMS seek to increase physician
fees to help provide targeted relief to physicians caring for
Medicaid patients. It won’t be clear whether there will be
additional money available in the budget until the agreement on new
revenue is reached. However, it is imperative that MSMS have a
strategy for increased funding that can be understood by legislators
and have some demonstrable effect in improving access for Medicaid
patients. It is anticipated that the amount of money needed to fix
the structural deficit is between $1.4 and $1.8 billion, and given
that Medicaid already is approximately $1 billion under-funded, the
vulnerability of the program is clear and MSMS will continue to make
it a top priority for the organization, and urge the legislature to
do the same. For more information, contact Colin Ford at
517-336-5737 or
cford@msms.org.
Auto No-fault
Coverage
The Board approved a measure to oppose House Bill 4702, sponsored by
Rep. Joe Hune (R-Fowlerville), and HB 4792, sponsored by
state Rep. Virgil Smith (D-Detroit), which would reduce the
obligation of insurers to pay for benefits to patients injured in
auto accidents and would create Personal Injury Protection choice
and fee schedules, respectively. Collectively, these bills represent
an attempt by the insurance industry to limit their exposure for
medical care by allowing patients to limit their benefits and by
arbitrarily reducing physician fees to reflect the fee schedules
used by workers’ compensation. TAKE ACTION NOW – Use the MSMS
Action Center (www.msms.org/action)
to urge lawmakers to oppose these bills.
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CMS Issues Final 'Stark' Regulations
The CMS has posted to its Web site the long-awaited final rule on
Stark law prohibitions applying to financial relationships between
physicians and the hospitals they refer patients to.
The document, which represents the third and final phase of the
rule, creates no new exceptions but rather makes “certain
refinements that could permit or, in some cases, require
restructuring of some existing arrangements,” according to a CMS
news release. The text is slated to be published in the Federal
Register Sept. 5 and become gospel 90 days later, replacing the
Phase 2 draft of the regulations in place since 2004.
“I think the industry is going to have to be paying attention
because the rules are shifting,” said Robert Homchick, a partner in
the law firm of Davis Wright Tremaine in Seattle.
Homchick and other healthcare lawyers scrutinizing the document say
one hot spot in the rule is a change in what has been fairly broad
leeway for indirect compensation, which referred to arrangements in
which payment flows to a professional corporation rather than
directly to physicians.
“That affects a lot of contracts,” said Gerald Griffith, a partner
in the Chicago office of Jones Day. Under Phase 3, many arrangements
that used to be considered indirect will be looked at as direct,
making it much more difficult to structure them as safe under Stark.
The section includes a grandfather clause that allows the terms of
current contracts to play out before they would have to be
restructured.
Another area with significant “refinements” attempts to clarify how
hospitals are allowed to recruit physicians to relocate to their
area. The section also addresses practice restrictions that
physicians’ groups can place on the recruited doctor to protect
their business if he or she decides to leave the group but stay in
the area.
The CMS has posted two versions of the rule. A 516-page version
includes substantial background material, comments and responses. A
131-page version is a redlined take on the Phase 2 draft.
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Uninsured Population On The Rise
The number of people in the United States without health insurance
coverage increased to 47 million in 2006, or 15.8 percent of the
population, up from 44.8 million, or 15.3 percent, in 2005,
according to the U.S. Census Bureau. It’s the second consecutive
year the number of uninsured rose, said David Johnson, chief of the
bureau’s housing and household economic statistics division.
The percentage and number of children under 18 years old without
health insurance also increased. In 2006, 8.7 million children, or
11.7 percent of the population, were uninsured, according to the
agency. In 2005, 8 million children, roughly 10.9 percent of the
population, went uncovered.
Additionally, individuals covered by both employer-based insurance
and government health programs slightly decreased in 2006, according
to the Census Bureau’s annual Income, Poverty and Health
Insurance Coverage in the United States report.
“When millions of hardworking men and women do not have health
insurance themselves and cannot cover their children, it raises
serious clinical, economic and moral concerns about how we as a
nation will meet the needs of the people,” said Risa Lavizzo-Mourey,
president and chief executive officer of the Robert Wood Johnson
Foundation, in a statement.
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AFL-CIO Support Universal Health Care
The AFL-CIO launched a campaign to achieve universal health
insurance by 2009. “America isn’t running the way it should. Health
care costs are pushing people to the edge and now 47 million have no
coverage,” said AFL-CIO President John Sweeney at a news conference
to announce the initiative. Sweeney said the labor federation was
making the 2008 elections a “mandate on fixing the broken system.”
While it’s not endorsing any specific plan or presidential
candidate, the AFL-CIO said it would fight for reforms that would
control rising costs and give families the “opportunity and
responsibility” for preventive care and the right to choose one’s
own doctor. The labor group is also asking the government and
employers to do their fair share to restore balance to the system.
“The first big push” of the campaign will be in early September,
when union members will hold President Bush responsible for his
failure to support reauthorization of the State Children’s Health
Insurance Program, Sweeney said. The administration wasn’t the only
target at the news conference. The number of uninsured has risen 22
percent since 2000, yet the top five highest-paid chief executive
officers in both health care and the pharmaceutical industry
combined command a quarter of a billion in salaries each year, said
Heather Booth, who will direct the AFL-CIO’s new campaign. “As part
of our health care campaign, during the 2008 shareholder season, the
AFL-CIO will focus on engaging public companies over health
insurance and extravagant CEO pay in the healthcare industry,” Booth
said.
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Continuing Education
Continuing Education Events
September 2007
Society for Academic Emergency Medicine Midwest Regional Meeting
8:30 a.m - 4 p.m., Sept. 20
Contact: Gloria Daniel at (313) 933-2529
Activity Director:Kerin A. Jone, M.D.
Credit Hours: up to 5.50 hrs.
Location: Detroit, MI
4th Annual ECNS
Conference & ISNIP Joint Meeting
Neuroimaging and
Neurophysiology of Personality, Anxiety, and Substance Abuse
Disorder
For more information, visit
http://www.ecnsweb.com/cn_ecns_conferences.htm.
8 a.m - 8 p.m., Sept. 19-23
Contact: Talmage Crossley at (313) 577-0221
Activity Director:Nashaat Bourtros, MD
Credit Hours: up to 15.50 hrs.
Location: Montreal, Canada
October 2007
The Coming Pandemic: Preparing for a Worldwide Outbreak of Influenza
7:30 a.m. - noon, Oct. 5
Contact: Office of Special Events and Services at (313) 993-8368 or
ses@lists.wayne.edu
Credit Hourse: up to 3.75
Location: Scott Hall
7th Annual Neurology for the Non-Neurologist Conference
8 a.m. to 1:30 p.m., Oct. 27
Contact: Nancy Jennett at (313) 577-5410
Activity Director: Seemant Chaturvedi, M.D.
Credit Hours: up to 4.0 hrs.
Location: Troy, Mich.
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