August 18, 2008

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.”

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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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