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August 18, 2008
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IN
THIS ISSUE
Editor's Column:
Loose Talk Sinks Us Too
Ballot Proposal Puts Tort Reform At Risk,
Support Justice Taylor
Dr. Benjamins Named 'Health Care Hero'
CMS Adds To 'No-Pay List,' AMA Disappointed
ICD-10 Clears Tech Hurdles, Offers
More Detail
New Jersey Blues Seek For-Profit Status
Medicare Demo Shows IT Can Reduce Cost
Inkster Schools Need Your Help!
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Loose
Talk Sinks Us Too
By
JOSEPH WEISS, MD
Newspapers must fill their pages and advertisements are not always
at hand. Instead, one approach to creating fillers is an article
that bashes physicians. The New York Times ran an article entitled “Doctor
And Patient, Now At Odds” in its July 29 edition.
The
article begins with the statement: “The once-revered doctor-patient
relationship is on the rocks.” The writer declares that
patients no longer trust their physicians, with the relationship
being more like two opponents facing off against each other.
But
trust is not the issue. The greatest difference between
the patient in the past and now is the amount of information,
whether accurate or not, that the patient brings to the
appointment today as compared with the past. That information
becomes the driver for an exchange between patient and
physician that far exceeds what was previously possible.
The patient is prepared for dialogue and discussion rather
than simply following orders.
We
should not accept what the press states is our deteriorating
relationship with patients. What is now evolving is an
exchange that takes into account wider access to medical
information and a more knowledgeable and medically sophisticated
patient. Physicians should not carry a niche for nostalgia
but continue to adapt medical tradition to modern times.
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Ballot
Proposal Puts Tort Reform At Risk, Support Justice
Taylor
A coalition is seeking to amend a significant portion of
the Michigan Constitution this fall. The group’s ballot
campaign, called Reform Michigan Government Now (RMGN),
recently received enough signatures to appear on the ballot
in November. The RMGN proposal aims to, among other things,
amend the Michigan Constitution to reduce the size of the
Supreme Court by removing the two justices with the least
seniority: Justices Steven Markman and Robert Young. Many
political observers theorize that the reconfiguration of
the court is the key element of this proposal and is included
with a number of “populist” reforms in order to appeal
broadly to the electorate.
If
this reduction were to happen, it could negatively impact
the hard-fought tort reforms that were enacted in 1994.
The Supreme Court currently includes a majority of justices
who hold a strict constructionist philosophy—including
Justices Markman, Young, and Chief Justice Cliff Taylor,
who is up for re-election this fall. Many of the cases
that have affirmed the tort reform laws in Michigan are
decided by a vote of 4-3 with the majority including Justices
Markman and Taylor, for example. Therefore, the elimination
of these positions would be devastating in future rulings
related to medical liability.
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Dr.
Benjamins Named 'Health Care Hero'
David
Benjamins, MD, assistant professor of Pediatrics and Neurology
for the Wayne State University School of Medicine, has
been named a 2008 Health Care Hero by Crain’s Detroit Business
for his work in assisting developmentally disabled children
and their families.
The
business publication awarded Dr. Benjamins honorable mention
in the Physical Achievement category.
His
specialty is pediatric neurology, and he cares for children
at the Detroit Institute for Children.
“Dr.
Benjamins has been an outstanding neurologist serving the
Detroit community for decades,” said Bonita Stanton, MD,
professor and Schotanus Family Endowed Chair of Pediatrics,
pediatrician-in-chief of the Carman and Ann Adams Department
of Pediatrics at Children's Hospital of Michigan and the
Wayne State University School of Medicine. “He has focused
his career on providing top quality, accessible care for
all children in need of neurologic services. With his quiet
and warm demeanor, he has served the community selflessly,
and has been an extraordinary role model and mentor for
the many medical students, residents and fellows who have
trained with him.”
He
served as the medical director of the Detroit Institute
for Children from 1985 to 1990, and remains on the staff
there. The mission of the institute, which was founded
in 1904, is to care for children with physical or developmental
disabilities and neurological or behavioral special needs “so
that the children can maximize their potential within their
families and the community.” The institute offers a variety
of services and programs.
Dr.
Benjamins, who completed his undergraduate studies at Albion
College and received his medical degree from Wayne State
University in 1965, is now laying the groundwork for the
establishment of a new developmental clinic for children
with neurological impairments. He and the institute are
developing funding for the clinic, which would be the only
one of its kind in Detroit.
Once
the new clinic is established, Dr. Benjamins, whose subspecialty
interests include learning disabilities, attention deficit
disorders, hyperactive disorder and cerebral palsy, would
direct the facility.
Dr.
Benjamins also was named a “Top Doc” by Hour Magazine in
2000.
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CMS
Adds To Medicare 'No-Pay List,' AMA Disappointed
The
AMA expressed disappointment with the recent announcement
that the Centers for Medicare & Medicaid Services (CMS)
will no longer pay hospitals for care provided for three
additional medical conditions that patients acquire in
hospitals, saying the decision puts patient care at risk.
CMS announced its decision July 31. The conditions no longer covered
are surgical site infections following certain elective procedures,
extreme blood sugar derangement and deep vein thrombosis or pulmonary
embolism following total knee or hip replacement procedures.
“We
are working hard to improve quality and efficiency, but
simply not paying for complications or conditions that,
while regrettable, are not entirely preventable is not
the way to do it,” AMA President-elect J. James Rohack,
MD, said. “It is unacceptable that this program is being
expanded beyond the original eight conditions identified
last year for nonpayment when the first phase of the program
has not even begun.”
Visit http://www.ama-assn.org/ama/pub/category/18817.html to
view Dr. Rohack’s full statement.
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ICD-10
Clears Tech Hurdles, Offers More Detail
HHS
issued a proposed rule that set an Oct. 1, 2011 deadline
for adoption of the ICD-10 series of diagnosis and procedure
codes to replace the ICD-9-CM codes in wide use today for
the electronic processing of claims, remittance advices,
eligibility inquiries, referral authorizations and other
electronic transactions.
The movement to the ICD-10 code sets, which have achieved wide adoption
around the world but whose rollout had been delayed in the United
States due to the high cost of switching existing information technology
systems to accommodate them, will allow clinical IT systems to record
in codified form a much more specific and rich diagnosis than ICD-9
codes. According to HHS, the ICD-10 codes contain more than 155,000
codes and can describe far more diagnoses and procedures than the
ICD-9 series, which contain 17,000 codes.
The regulation would update the Health Insurance Portability and
Accountability Act to require the use of the International Classification
of Diseases, Tenth Revision for diagnosis coding and for inpatient
hospital procedure coding, according to an HHS announcement, replacing
related International Classification of Diseases, Ninth Revision,
codes.
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New
Jersey Blues Seek For-Profit Status
New
Jersey’s largest insurer, Horizon Blue Cross and Blue Shield,
filed an application with the state’s attorney general
and Banking and Insurance Department to convert from not-for-profit
to for-profit corporation.
The
Newark-based insurer said in its application that the switch
will give Horizon financial flexibility and greater access
to capital for information technology and pay-for-performance
initiatives and for business operations. The Blues plan
said investment during the next five years will exceed
its annual $35 million budget by an estimated $20 million
to $30 million per year. Conversion will allow the insurer
to remain competitive and maintain its credit strength,
the application said. Horizon holds 46 percent of New Jersey’s
market, according to the document.
“Our
board of directors has decided to reconsider conversion
at this time because our nation’s healthcare system is
undergoing a rapid transformation,” William Marino, Horizon’s
president and chief executive officer said in a written
statement. “Many reform proposals at the state and federal
levels are calling for significant changes in healthcare
in the near future.”
New Jersey’s
banking and insurance commissioner and its attorney general
must approve the deal, which will transfer Horizon’s market
value to a not-for-profit healthcare foundation, as required
by law. The commissioner and attorney general have 60 days
to review the application for missing information. After public
hearings, the commissioner must reject or approve the deal
within 45 days.
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Medicare
Demo Shows IT Can Reduce Costs
A Medicare pay-for-performance demonstration project that
relies on health IT to hold down health care costs and
improve quality has resulted in extra earnings of $16.7
million for 10 large group medical practices nationwide.
The
project also has delivered $5.8 million to the Medicare
Trust Fund, which got more than 20 percent of the savings
achieved by providing better, more coordinated care for
the patients at the group practices over the last two
years.
The
Centers for Medicare and Medicaid Services reported these
results today from the second year of the four-year demonstration
project.
“We
are paying for better outcomes and we are getting higher
quality and more value for the Medicare dollar,” Acting
CMS Administrator Kerry Weems said in a statement. “And
these results show that by working in collaboration with
the physician groups on new and innovative ways to reimburse
for high-quality care, we are on the right track to find
a better way to pay physicians.”
Although
the demonstration is not designed as a health IT demonstration,
the medical groups needed to use IT to support better
management of their patients’ chronic diseases and to
report their performance. “What we’re seeing is the opportunity
with health information technology of using it to monitor
and improve quality,” John Pilotte, project director
in the CMS Office of Research, Development and Information,
said in an interview.
Pilotte
said not all of the 10 practices use e-health records,
but many do. “There are various levels of [IT] sophistication
among the organizations,” he said. The focus of the pay-for-performance
demonstration is on outcomes, and CMS will not carefully
investigate what tools the practices use.
Besides
EHRs, many of the practices have developed registries
of their patients with the illnesses they and CMS were
tracking. Those illnesses are diabetes, heart failure
and coronary artery disease.
Most
of the practices are relying on the IT systems they had
in place before the demonstration project began, according
to a study published by CMS, but often they have enhanced
those systems to meet the project’s needs.
The
project determined the expected costs to Medicare of
caring for beneficiaries at each practice, then measured
what the costs are in actuality with better care coordination.
The savings are split approximately 80-20.
Dr.
Douglas Reding, an executive of one of the participating
clinics, the Marshfield Clinic in Wisconsin, told a House
subcommittee in July that health IT was the key to his
clinic’s success in the demonstration. He urged Congress
to promote the adoption of health IT nationwide.
“We
have shown through participation in the CMS Physician
Group Practice Demonstration that our electronic medical
record and the associated databases empower our physicians
and their staff to improve patient care outcomes and
reduce costs to the Medicare program,” Reding said.
Costs
are being reduced through avoiding hospitalizations and
other intensive services that become necessary when patients’ conditions
spiral out of control.
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Inkster
Schools Need Your Help!
Inkster
Schools will be giving free physicals exams to students
Aug. 21. Volunteers are needed for various time slots.
For details, please click here to see volunteer sign-up
form.
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