E-DMN - September 4, 2007

September 4, 2007

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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