E-DMN - August 11, 2008

August 11, 2008

Editor's Column: More On Patient Rights And Physician Rights
DMC Works To Speed Up Heart Attack Response
Congressman Conyers, WSUSOM Plan Meeting On Health Care Reform
New Drug Therapies Researched At WSU Help Treat Hypertension
Dr. Murali Guthikonda Elected To Society Of Neurological Surgeons
Blues, Oncologists Work To Improve Cancer Care
Senate Panel Considers Change To Employer Health Benefit Tax Break
Nader Promotes Single-Payer

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More On Patient Rights And Physician Rights

Several Columns Back (June 30) I criticized a BCBS effort to create a contract between patients and physicians. The BCBS document was condescending to patients and ignored the duty to patients that the profession already places on physicians. BCBS put this contract in written form so that a falling out between patient and physician could readily lead both parties to court.

A brochure sent out by the University of Michigan Office of Patient Affairs titled: Patient Rights and Responsibilities represents a model for a patient-physician relationship.

The brochure lists 28 distinct patient rights including:

The right of proper physician assessment and management of pain
The right to speak privately to any physician or medical staff member
The right to know who is rendering care and his or her professional title
The right to decide upon and review the plan of care
The right to see the medical record
The right to request information not be given out
The right to have information provided in an understandable manner
The right to express any concerns regarding care
The right to know details about all items on the bill

In addition, the brochure lists nine patient responsibilities including:

Providing a complete medical history
Telling physicians of all prescriptions, over-the-counter medications, treatments and interventions
Following the treatment prescribed
Informing physicians of difficulties involving the plan of care
Providing correct information about sources of payment and ability to pay the bill

The University of Michigan gives this list of rights and responsibilities to each new patient and has extra copies in its clinics and hospital waiting rooms; patient and medical staff can readily find and read the brochure. No one signs the document.

The University of Michigan brochure allows patients to know their responsibilities and the patient rights section defines forthrightly the duties of physicians. This patient-physician contract is a model that an individual physician can modify to fit his or her practice.

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DMC Works To Speed Up Heart Attack Response

The Detroit Medical Center at its Detroit Receiving and Harper hospitals is announced plans to staff cardiac units with cardiologist-led on-site teams 24 hours a day in hopes of reducing treatment time from a national average of 90 minutes to 45 minutes, according to published reports.

According to report appearing in the Detroit Free Press, a University of Michigan study in 2006 revealed that one-in-five hospitals meet American Heart Association standards and most of the 365 hospitals surveyed 100 minutes or longer to perform angioplasty to clear artery blockages.

Most hospitals use on-call rotations of cardiologists and pagers on weekends and evenings.

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Congressman Conyers, WSUSOM Plan Meeting On Health Care Reform

U.S. Congressman John Conyers (D-Detroit) will conduct a town hall meeting on health care reform on Aug. 18 at the Wayne State University School of Medicine.

Conyers will moderate the conversation on “Access to Health Care” from 11:30 a.m. to 1:30 p.m. in Graduate Classroom 2268 at Scott Hall, 540 East Canfield, Detroit. A panel of experts will present the problems and possible solutions to the growing number of under- and uninsured residents in America. Audience participation will be encouraged.

For more information and to register, visit https://events.wayne.edu/rsvp/access-to-health.

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New Drug Therapies Researched At WSU Help Treat Hypertension

African-Americans have a higher risk of developing high blood pressure, the leading risk factor for cardiovascular disease, than other ethnic groups according to the American Heart Association. A research study performed at Wayne State University has found a new combination of drugs, a calcium blocker and an Angiotensin II Receptor blocker (ARB), to have the most significant drop in blood pressure in the first large-scale clinical trial in blacks.

John Flack, MD, MPH, chair of the Department of Internal Medicine at WSU’s School of Medicine and lead investigator of the research project, presented his findings to the National Medical Association on July 26. Dr. Flack spoke on a clinical trial for the combination of amlodipine and valsartan. The study showed significant decreases in high blood pressure for patients of African heritage.

“In the Ex-STAND Study involving almost 500 blacks, mostly from the U.S., including 17 percent of Hispanic origin, we showed in a randomized trial that the combination of amlodipine and valsartan lowered blood pressure more effectively than amlodipine monotherapy both before and after the optional addition of the diuretic hydrochlorothiazide,” said Dr. Flack. “This is an important trial for black populations given that many will need combination therapy to attain blood pressure control and frequently in persons with diabetes and/or chronic kidney disease, a blocker of the renin angiotensin will also be needed.”

The long available combination of calcium blockers with angiotensin converting enzyme inhibitors has not been well-tolerated by these patients because of severe side effects including angioedema (swelling of the skin and mucosa) and cough caused by the ACE inhibitor component. In Flack’s new study, these side effects did not exist.

The study showed that black patients treated with the drug combination experienced a significantly higher reduction in systolic blood pressure than those on amlodipine alone. This marked the “most significant” blood pressure drop seen to date in such clinical studies, said the drug manufacturer, Novartis.

“The large blood pressure reductions seen in this trial were experienced by severe patients who have the most difficulty getting their blood pressure to healthy levels,” said Flack. “These data may have a real impact on helping patients who are most at risk.”

“Wayne State University is one of the eight Centers for Urban and African American Health selected by the National Institutes of Health,” commented Dr. Hilary Ratner, vice president for Research at WSU. “Wayne State researchers across our campus collectively contribute to research devoted to improve the health of African Americans. Dr. Flack’s leadership in this Center, along with his recent research findings, truly exemplifies Wayne State’s commitment to the community, health disparities and our urban mission,” Ratner added.

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Dr. Murali Guthikonda Elected To Society Of Neurological Surgeons

Founded in 1919, the Society of Neurological Surgeons, also known as the “Senior Society”, is the American society of leaders in neurosurgical residency education and is the oldest neurosurgical society in the world. Membership is limited to 200 active members which include academic department chairman, residency program directors and other key academic practitioners.

The society is charged with continuing to develop the field of neurological surgery and education, to insure that patients with nervous system disorders receive the highest possible care, and to support research in the neurosciences.

Membership in the Society of Neurological Surgeons is one of the highest honors a neurosurgeon can receive. Only eight neurosurgeons were elected this year nationally. “I am very proud of this achievement. It is an honor for me and for our department to be part of such an elite group,” he said.

Dr. Guthikonda was also recently promoted to Professor in the Department of Neurosurgery. He is now the L. Murray Thomas Professor and Chairman, honoring Dr. L. Murray Thomas, former Chairman. Dr. Guthikonda also serves as Program Director of the neurosurgery residency.

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Blues, Oncologists Work To Improve Cancer Care

More than 180 oncologists in 11 physician groups across the state are partnering with Blue Cross Blue Shield of Michigan to gather data to improve care for cancer patients in Michigan.

The oncologists are submitting information to a national database established by the American Society of Clinical Oncology to help physicians identify what works best in cancer care. BCBSM is providing funding to defray data collection costs and to encourage physician participation.

Michigan physician organizations with specialists participating in ASCO's Quality Oncology Practice Initiative® will be eligible for additional payments from BCBSM for submitting cancer care treatment data to the national registry and using that data to compare their practices with those nationally, as well as for implementing improvements that lead to improved quality, coordination and efficiency in treating cancer patients.

The number of Michigan physicians participating in the oncology database is the largest of any state. The Michigan oncologists treat an estimated 16,000 cancer patients annually.

The Quality Oncology Practice Initiative is one of a series of quality improvement initiatives underway between BCBSM, hospitals and/or physician groups. Other BCBSM quality improvement initiatives with hospitals or physician groups have been launched in the areas of angioplasty, bariatric surgery, cardiac imaging, general/vascular surgery, cardiac surgery and breast cancer treatment under a statewide, multi-year program called Value Partnerships.

"Blue Cross and physician groups believe this program has tremendous potential for improving care for thousands of cancer patients. The improvements we make can spread throughout the health system in Michigan and beyond," said Thomas Simmer, MD, senior vice president and chief medical officer for Blue Cross Blue Shield of Michigan.

The following 11 physician organizations are participating in the Quality Oncology Practice Initiative with BCBSM:

Southeastern Michigan — Ann Arbor: University of Michigan Health System, Faculty Group Practice; Bingham Farms: United Physicians; Dearborn: United Oakwood Providers (UOP); Detroit: Henry Ford Medical Group; Royal Oak: Oncology Physician Resource (OPR); Quality Partners of Michigan; Warren: St. John HealthPartners; Waterford: Oakland Physician Network Services.

Mid-Michigan — East Lansing: Michigan State University Health Team; Sparrow Family Medical Services.

West Michigan — Battle Creek: Integrated Health Partners.

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Senate Panel Considers Change To Employer Health Benefit Tax Break

Economists at a Senate Finance Committee hearing July 31 discussed how tax code changes to employer-sponsored health insurance premiums could fund health care coverage for the uninsured, CQ HealthBeat reports. Committee Chair Max Baucus (D-Mont.) referred to the tax subsidies for employer-sponsored health benefits, which exclude premiums paid by employers from taxable income for employees, as "the third largest government entitlement for health care" after Medicare and Medicaid.

Massachusetts Institute of Technology professor Jonathan Gruber told the committee that the exclusion is "leading to over-insurance for most Americans" and estimated that because of the exclusion, the federal government forgoes $250 billion annually in tax revenue -- "an enormous sum of money" that "could be more effectively deployed elsewhere, especially through alternative approaches to increasing insurance coverage."

Gruber cautioned that "many employers currently only offer health insurance because of this 'tax bribe,' and ending the exclusion would lead to a large erosion of employer-sponsored insurance," adding that changes to the tax code could result in "a large new set of uninsured who cannot afford, or cannot obtain at any price, non-group insurance." Gruber offered a variety of options for addressing that issue.

Joint Committee on Taxation Chief of Staff Edward Kleinbard noted problems with the subsidy but acknowledged the advantages of group health plans offered by employers, who have "superior negotiating power" with insurers compared with individuals.

Baucus said that ending the employer role in providing health care "might be too much change," but "all of us recognize that our system is unsustainable." Baucus added, "We cannot continue on our current path. But we must strike a balance. We need to fix what's broken, without breaking what's working" (Reichard, CQ HealthBeat, 7/31).

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Nader Promotes Single-Payer

Presidential candidate Ralph Nader (I) July 31 criticized the United State's two-party political system, which he says has been beholden to corporate interests that are preventing residents from accessing health care through a universal health care system, the Salt Lake Tribune reports. Nader, who is on the ballot in about 20 states, "heaped criticism on the health care industry," citing an Institute of Medicine study that found that 18,000 U.S. residents die annually because they are uninsured. Nader said, "Once we have a low expectation of the political system and what it should deliver, (the corporation's) work is done" (Gehrke, Salt Lake Tribune, 8/1).

Nader on July 30 posted an online video highlighting his proposal for a single-payer, Canadian-style health care system. In the video, Nader calls the plans by presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) and presumptive Republican presidential nominee Sen. John McCain (Ariz.) "pay or die" plans because they would continue the current commercially based system (Rhee, "Political Intelligence," Boston Globe, 7/30).

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