Wayne County Medical Society of Southeast Michigan

December 8, 2008

President's Column: Buy American For Your Patients' Sake
Chiropractic Scope Bills Hit Fast Track: Immediate Response Needed!
WSUSOM Student Publishes Journal Article
New National Health Care Team Wants Your Opinion
Auto Bailout Could Feature Tough Times For Hospitals
Obama Stimulus To Include Medicaid, Health IT Funds
National Influenza Vaccination Week Is Upon Us
Kennedy Drops Judiciary Assignment To Focus On Health Care

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President's Column: Buy American For Your Patients' Sake

By E. CHRIS BUSH, MD
Traditionally Michigan's workforce has enjoyed enhanced private health insurance benefits compared to other states. The reason for the difference has been the contracts worked out between the United Auto Workers and the auto companies.

Physicians and other health providers have benefited over the years as most employees have had rich benefits and low deductibles and copayments.

Those days are over with the near-collapse of the auto industry, the massive loss of jobs and exodus of many of Michigan's citizens. Most of the patients seen by physicians in Southeast Michigan are employees or retirees from the auto industry or its suppliers. The local steel industry is also highly dependent on sales to the auto plants.

Now, more than ever, our patients need our help. We need to reach out to them and assist them to get the care they need as well as our emotional support. The physicians of the Wayne County Medical Society of Southeast Michigan have always risen to the challenge to help our patients in need.

In addition, the Big Three need to sell some cars and trucks. The 4,000-plus members of WCMSSM need to visit local dealerships and buy or lease a Ford, General Motors or Chrysler product. Eight thousand new purchases would be a shot in the arm to our economy and would be a gesture our patients would appreciate. Now is not the time to debate the value of domestic versus foreign makes. Clearly, all of the automakers are global in scope. Nevertheless, the profits made by the Big Three go to headquarters located in Auburn Hills, Dearborn and Detroit instead of Tokyo, Stuttgart or Seoul.

As UAW President Ron Gettelfinger recently remarked: "The data is clear: Domestic auto plants create more jobs in this country than overseas producers who locate here."

I hope to see you in the near future pulling into the doctors' lot in your GMC, Ford or Chrysler automobile.

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Chiropractic Scope Bills Hit Fast Track: Immediate Response Needed!

The Michigan Senate announced Dec.4 that instead of being assigned to a committee, the "Chiropractic Scope-of-Practice Bills" (HB 5759 and 6201) that just passed the House will head directly to the Senate floor, where they can be acted on at any time once the Senate reconvenes on Wednesday, Dec. 10.

THESE BILLS WILL PASS IF PHYSICIANS DON'T ACT! Senate leadership has told MSMS that senators are hearing from chiropractors on this issue, but not from physicians. In order to prevent this dangerous and potentially costly scope-of-practice expansion,we need you to use the prewritten message below to urge your own senator and Senate Majority Leader Mike Bishop to stop the bills from passing.

In addition, we need you to make FOUR IMPORTANT PHONE CALLS to key senators using prepared talking points:

1) Call Senate Majority Leader Mike Bishop: 517-373-2417

2) Call (incoming) Senate Minority Leader Mike Prusi:
517-373-7840

3) Call Senate Judiciary Committee Chair Wayne Kuipers:
517-373-6920

4) Call your own senator (www.senate.mi.gov, click on "Find Your Senator")

NOTE: If you call outside of their office hours PLEASE LEAVE A MESSAGE. They will take note of how many calls/messages they receive.

HB 5759 and 6201 seek to change the existing language in the Michigan Public Health Code to expand chiropractic scope of practice from the "spinal column" to the "musculoskeletal system." Click to view the December 3 House roll call votes on HB 5759 (63-46) and HB 6201 (59-50).

Introduced by current House Health Policy Committee Chair Rep. Kathy Angerer (D-Dundee)--who will take over as Majority Floor Leader in January--the bills specifically would add "differential diagnosis" and "physical modalities and rehabilitative services" to chiropractors' scope. In addition, this would allow chiropractors to order MRI, CT scans, PET scans, and almost any other imaging test.

In addition to concerns regarding patient safety, the legislation carries a potentially massive cost in terms of the increased use of imaging technologies by chiropractors. It is the standard of care within chiropractic to order an x-ray prior to treatment with manipulation. Increasing the areas of the body to treat increases the number of images needed prior to treatment, which causes costs to rise.

MSMS believes there is no valid reason to increase scope of practice for a profession that has not increased its training or education to be commensurate with their scope of practice expansion. MSMS and nearly 30 other organizations have formed the "Educate, Don't Legislate" coalition to fight this unwarranted scope of practice expansion.

For more information, contact Colin Ford at MSMS at 517-336-5737 or cford@msms.org.

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WSUSOM Student Publishes Journal Article

Berkin Ulgen, a first-year student at the Wayne State University School of Medicine, has published a paper in Neurosurgery Online, the official journal of the Congress of Neurological Surgeons.

The paper, “Augusta Déjerine-Klumpke, MD, (1859-1927): a historical perspective on Klumpke's palsy,” was published in the August 2008 issue. The paper is a biography of Dr. Klumpke, an early and important contributor to the descriptions and treatments of neurological diseases. Klumpke’s palsy was first described by her in 1885.

Integrated into the biography are three works she wrote, including her 1885 paper on lower trunk brachial plexus palsy. The papers were only available in their original French. Ulgen said his research team translated them for an English audience for the first time.

“What is perhaps most remarkable about Dr. Klumpke’s story, especially from a non-medical perspective, is the timing of her achievements,” Mr. Ulgen said. “Dr. Klumpke reached the highest echelons of academic medicine in a time when such opportunities were absolutely closed to women. In her biography we explore how her studious upbringing and her intellect paved the way for succeeding at every academic level, culminating in her becoming the first woman accepted to the highly competitive positions needed to practice academic medicine in late 19th century France.”

Mr. Ulgen, 23, is originally from Ann Arbor. He completed his undergraduate studies at Johns Hopkins University. He became interested in medicine during a Summer Science Academy program while in high school. The two-week program at the University of Michigan introduced him to the field of medicine.

“This was my first real exposure to medicine as a career, and what I came away with from this experience is the intrinsic meaningfulness of the medical profession, i.e. the ability to help others, that in my opinion most other career paths lack,” he explained.

Mr. Ulgen is president of the School of Medicine’s Board of Student Organizations (BSO), which serves as a liaison to the Student Senate and administration on behalf of student organizations. The entity also works to create opportunities for intra-organization cooperation, including such events as the Student Orgs Fair during New Student Orientation, the student group sponsoring of Orientation Week social events and the Ethnic Fair, he said.

The BSO this year created a website – www.med.wayne.edu/bso/ -- for student organization leadership, created a database of contact information of all organizations and worked to streamline intra-organizational events.

In addition, Mr. Ulgen is treasurer of the World Health Student Organization, and serves on the Social Work Committee for the Student Run Free Clinic, which organizers hope to have open and running by fall 2009.

While unsure of his career pursuits after graduation, he is interested in cardiology and surgery. “What draws me to cardiology is the need for qualified cardiologists to deal with the high morbidity rates of heart disease that plagues our country. I also think that the heart is just a fascinating organ.”

After graduation, he plans to devote time each year caring for underserved patient populations at home and abroad. He hopes to work with Doctors Without Borders.

Mr. Ulgen selected Wayne State University for his medical training for a variety of reasons. “The School of Medicine is a fabulous research institution as evidenced by its ranking in the top 25 of medical schools in terms of National Institutes of Health funding,” he said. “Another reason is the top-notch clinical training at affiliated hospitals, which provide diverse learning environments and a chance to serve the underserved populations of Detroit.”

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New National Health Care Team Wants Your Opinion

President-Elect Obama's Transition Team Solicits U.S. Residents' Opinions on Health Care in Nationwide Campaign
[Dec 08, 2008]

Former Senate Majority Leader Tom Daschle (D-S.D.), head of President-elect Barack Obama's health transition team and likely nominee for HHS secretary, on Friday announced a nationwide campaign to gather public input on improving the U.S. health care system, the Denver Post reports (Riley, Denver Post, 12/7). At a health care summit in Denver organized by Sen. Ken Salazar (D-Colo.), Daschle encouraged U.S. residents to hold community meetings and house parties from Dec. 15-31 to discuss their health care concerns and experiences. The Obama transition team will gather the information from those meetings and post it on the Web site change.gov (Freking, AP/USA Today, 12/6). Daschle said he will attend at least one house party and prepare a detailed report for Obama (Connolly, Washington Post, 12/6).

Daschle said, "President-elect Obama has made health reform one of his top priorities," adding, "I'm here to tell you that his commitment to changing the health care system remains strong and focused" (Levey, Los Angeles Times, 12/6). According to Daschle, "There is no question the economy is going to be directly related to our ability to reform the health care system in the years ahead." He said, "Health care is going to destroy many of our manufacturing industries unless we fix the system" (Carey, CQ HealthBeat, 12/5). With more than half of U.S. residents receiving health care coverage through their employer, the rising unemployment rate makes overhauling the health care system "so urgent and so much a part of the economic recovery process," Daschle said (Marcus, Bloomberg, 12/5). He added, "Once we get started, it would be a big mistake to put it aside and move on to something else. Once we get started, let's get it done."

Among the principles that will guide the Obama administration's efforts to overhaul U.S. health care are increasing access to care for low-income and uninsured residents, shifting incentives that undercut preventive care, and changing the way the health care system tracks medical information and keeps records (Denver Post, 12/7). Obama in a statement on Friday said, "In order for us to reform our health care system, we must first begin reforming how government communicates with the American people," adding, "These Health Care Community Discussions are a great way for the American people to have a direct say in our health reform efforts" (Washington Post, 12/6).

New Approach
According to the Los Angeles Times, the plan to hold community discussion "appears designed to avoid the appearance that the new administration is developing a sweeping agenda behind closed doors," a perception "widely believed to have helped doom the Clinton administration's health care reform efforts in the early '90s" (Los Angeles Times, 12/6). John Rother, public policy director for AARP, said that Obama and his transition team "are clearly trying to do it differently and help the American public see the case for reform in human terms" (AP/USA Today, 12/6).

"This effort would be an extension ... of the Obama transition team's forays into harnessing that vast grassroots network it built during the campaign as it tries to channel the diffuse but palpable energetic forces into a newly formed, broader-based good," the New York Times' "The Caucus" reports (Phillips, "The Caucus," New York Times, 12/5). Recently the transition Web site change.gov hosted an online health care discussion that collected about 10,000 entries to which Daschle responded in a short video (Rhoads, Wall Street Journal, 12/6).

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Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/healthpolicy . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved."

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Auto Bailout Could Feature Tough Times For Hospitals

Lawmakers To Vote on $15B, Short-Term Financial Assistance Package for Big Three Automakers
[Dec 08, 2008]

Lawmakers this week likely will vote on a $15 billion financial assistance package for the Big Three automakers, although passage of such legislation remains uncertain, the New York Times reports (Vlasic, New York Times, 12/8).

On Tuesday, officials for the automakers presented to lawmakers individual proposals that included requests for as much as $34 billion in financial assistance, as well as revisions to their obligations to a fund that will provide health benefits to United Auto Workers retirees. Under contracts negotiated last year, the automakers agreed to contribute about $56.5 billion to a voluntary employees' beneficiary association, which UAW will manage. The VEBA, which will take effect in 2010 and remain operational for 80 years, will reduce retiree health benefit liabilities for the automakers by about $100 billion.

In addition, UAW on Wednesday agreed to allow the automakers to delay their contributions to the VEBA and make other concessions to help the companies obtain financial assistance from the federal government (Kaiser Daily Health Policy Report, 12/5).

Senate Banking Committee Chair Chris Dodd (D-Conn.) said that congressional Democrats hope to pass a short-term, $15 billion financial assistance package for the automakers and that any long-term package would require the companies to take significant steps to restructure their operations. The $15 billion would come from a Department of Energy program designed to promote the development of fuel-efficient vehicles, he said.

Sen. Carl Levin (D-Mich.) on "Fox News Sunday" said that lawmakers and the Bush administration have moved "very close to a deal" on a financial assistance package for automakers but added that passage of such legislation is a "much more complicated question." Levin said that the Senate likely will vote on such legislation on Wednesday.

UAW Concessions
UAW President Ron Gettelfinger during an appearance on ABC's "This Week" on Sunday discussed the agreement to allow the automakers to delay their contributions to the VEBA. However, lawmakers have asked UAW to accept smaller contributions or take some of the payments in stock rather than cash -- "concessions the union hasn't been willing to make," the Detroit News reports (Shepardson/Trowbridge, Detroit News, 12/7).

Detroit Hospitals Prepare for Decline in Revenue
Detroit area hospitals are "bracing for major changes and deep work force cuts" following restructuring plans by the Big Three automakers, the News reports. According to the News, layoffs by automakers and plant closings could reduce the number of people seeking care from area hospitals, "which have long thrived" because of the Big Three's generous health benefits. The reduction in revenue could force hospitals to implement additional efficiency measures, as well as reduce staff and spending on new medical technologies and close underused facilities.

In addition, automaker layoffs could prompt an enrollment increase in government-sponsored health coverage programs -- such as Medicare and Medicaid, which pay less than commercial insurers -- and lead to a rise in uncompensated care at the hospitals. According to Dean Smith, a public health professor at the University of Michigan, such a scenario "would require a very different health system than we have now."

Bob Hoban, chief strategy officer for St. John Health, said, "You could have a scenario where there is a fair amount of surplus in the industry and that could lead to some facilities closing," adding, "Whether or not we get into a situation of that magnitude, it's still too early to tell." Some hospitals are considering greater collaboration to reduce overlapping services and spread out the financial burden of an increase in the number of uninsured patients, according to Smith. He said, "We may end up with a more efficient system and more cooperation so there isn't so much competition." He added that hospitals also will have to reevaluate any long-term building plans (Rogers, Detroit News, 12/5).

In related news, Detroit's no-cost health clinics already have experienced an increase in patients because of the current economic recession, the News reports. As a result of the increase, people seeking care at the clinics can wait weeks for an appointment or for several hours as a walk-in (Stolarz, Detroit News, 12/5).

Editorials

§ Philadelphia Inquirer: UAW "is showing it understands the seriousness of the crisis" for the automakers with the agreement to allow the companies to delay their contributions to the VEBA and make other concessions, but those steps "probably don't go far enough to ensure the companies' return to profitability," an Inquirer editorial states. The editorial concludes that lawmakers must require "stringent goals for more fuel-efficient cars and leaner operations as conditions for this bailout" (Philadelphia Inquirer, 12/7).

§ Philadelphia Inquirer: The agreement by UAW to allow the automakers to delay their contributions to the VEBA and make other concessions makes the financial assistance package a "reasonable risk to take," an Inquirer editorial states. However, "American cars will never be able to compete in the global marketplace until U.S. automakers no longer are burdened with the costs of health care for their current and retired workers, which right now add about $2,000 to the cost of each car" (Philadelphia Inquirer, 12/8).

§ Springfield Republican: UAW "at long last" is "stepping up to offer some concessions intended to demonstrate that the automakers -- from the top to the bottom -- are serious about changing their ways," a Republican editorial states. The agreement by UAW to allow the automakers to delay their contributions to the VEBA and make other concessions "will not in itself secure federal funds for the Big Three, but it marks a real and surprisingly big step," the editorial states (Springfield Republican, 12/5).

§ Washington Post: UAW, in addition to the agreement to allow the automakers to delay their contributions to the VEBA and suspend a jobs bank program, must "agree to bring wages and benefits of its active members into line with those of nonunion workers at foreign-owned plants, immediately," to prevent bankruptcy at GM, according to a Post editorial. "If GM, the union and the bondholders don't get it done by March 31, then the government would get its money back and the company would go bankrupt," the editorial states (Washington Post, 12/7).

Broadcast Coverage
ABC's "This Week" on Sunday included comments from Gettelfinger about a possible financial assistance package for the automakers (Stephanopoulos, "This Week," ABC, 12/7).

" Fox News Sunday" on Sunday included comments from Levin and Sen. Richard Shelby (R-Ala.) about such legislation ("Fox News Sunday," Fox News, 12/7).

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Obama Stimulus To Include Medicaid, Health IT Funds

Obama Says Stimulus Package Will Include Funds for Medicaid, Health Care IT
[Dec 08, 2008]

President-elect Barack Obama on Saturday during his weekly radio and Internet address released additional details about his economic stimulus package, which he said would include funds for Medicaid and health care information technology, Long Island Newsday reports (Brune, Long Island Newsday, 12/8). Among other measures, the package would seek to provide hospitals and physicians with access to electronic health record systems and other new medical technology (Shear, Washington Post, 12/7). Obama said that such a measure could help improve health care delivery and reduce costs (Nicholas/Hook, Chicago Tribune, 12/7).

Obama did not provide details about the total cost of the stimulus package (Schouten, USA Today, 12/8). Estimates of the cost of the package have reached as high as $1.2 trillion (Long Island Newsday, 12/8).

Prospects
According to CongressDaily, congressional Democrats acknowledge that a "deal with Republicans and the Bush White House remains unlikely before January," an indication that "any action on a stimulus package is not expected next week" (Hunt/Sanchez, CongressDaily, 12/5). Top economic advisers to Obama and congressional Democrats hope to complete work on the package in January to allow Obama to sign the legislation when he takes office on Jan. 20, 2009.

However, on Saturday, "congressional sources expressed skepticism ... that a program of such size and scope could be passed in the two weeks after Congress returns to Washington on Jan. 6," the Washington Post reports. According to the Post, "Democrats said that even if a recovery act quickly passed the House early next year, it could take longer in the Senate, where fiscally conservative Republicans have expressed concern about adding to the soaring deficit with a massive new round of government spending" and where "Republicans could easily hold up a final vote" (Washington Post, 12/7).

NBC's "Meet the Press" on Sunday included an interview with Obama during which he discussed details of his stimulus package (Brokaw, "Meet the Press," NBC, 12/7).

Editorials

§ Denver Rocky Mountain News: The "goal of a stimulus package should be to, well, stimulate the economy -- or at least stabilize rattled markets so that a recovery seems possible" and "should not primarily be a way to balance state budgets," a News editorial states. According to the editorial, a "number of governors and lawmakers are pushing for tens of billions more to help support programs such as Medicaid," but states "can't just be given a blank check," as the "danger here is that Congress may simply throw additional bundles of taxpayer money at the financial crisis -- all of which amounts to long-term debt -- without adopting policies that lead to a sturdy recovery" (Denver Rocky Mountain News, 12/7).

§ Orlando Sentinel: "States have a good case to make for federal help" through a stimulus package, as they likely will have to reduce spending for health care and other programs to address a combined $24 billion budget deficit for the current fiscal year, a Sentinel editorial states. According to the editorial, a temporary increase in federal funds for state Medicaid programs "would help close the gap in their budgets without sparing them the necessity of taking a hard look at other, less vital programs." The editorial adds, "More cuts inevitably would drain more money from programs that serve the most vulnerable members of society -- the young and old, the poor and sick -- just as the bad economy is increasing the need for those programs" (Orlando Sentinel, 12/8).

§ Washington Times: States have asked Congress for $40 million in additional federal funds for their Medicaid programs, as well as $136 million in other funds, and they "should be required to put forth their plans to cut spending and trim their bureaucracies" before they can receive any funds, according to a Times editorial. The editorial states, "The wake-up call for governors is that it is in their states' best interest in the short and long term to make the tough calls" (Washington Times, 12/7).

Opinion Piece
Comprehensive health care reform -- "specifically, universal health care" -- should "top the list" of measures included in a stimulus package because a "bold embrace of universal health care offers policymakers the chance at a fiscal triple-play: Universal coverage would stimulate the economy, it would boost the financial security of ordinary Americans and it would break the health care reform log-jam," Chris Farrell, a contributing economics editor for BusinessWeek, writes in an opinion piece. He writes, "Universal coverage would boost the economy in the short term," adding, "Targeting fiscal stimulus toward universal coverage would help ordinary workers rather than Wall Street tycoons" and "relieve a major source of economic insecurity for anyone handed a pink slip during the recession." In addition, Farrell writes, "To be sure, this kind of universal health care isn't good enough for the long haul," but "once the economy recovers, Washington can debate how to create a more cost-effective and cost-efficient health care system" (Farrell, BusinessWeek, 12/5).

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National Influenza Vaccination Week Is Upon Us

To help raise awareness of the seriousness of influenza and the importance of continuing influenza vaccinations throughout December, January and beyond, the federal Centers for Disease Control and Prevention (CDC), the US Department of Health and Human and other agencies have designated Dec. 8-14 National Influenza Vaccination Week.

Although flu season usually does not peak in the United States until January or February, the number of people getting vaccinated tends to decrease substantially after November. Because many people who should get the flu vaccine this year are still unvaccinated , the CDC is encouraging public health partners and health care providers to conduct vaccination clinics and other activities to promote influenza vaccination during Vaccination Week and throughout the rest of the flu season.

Each year, on average, 5-20 percent of people in the United States are infected with influenza virus; more than 200,000 of them are hospitalized from influenza complications. CDC recommends annual flu vaccinations for the following groups:

Children 6 months of age to age 19 years
Pregnant women
People older than 50 years
Those with chronic health conditions such as asthma, diabetes or heart disease
And adults who live with or care for children younger than 5 years and especially younger than 6 months; adults 50 years of age and older; or children or adults with chronic health conditions
Health care workers
Anyone else who wants to decrease their risk of influenza

Additional information, including printable information for distribution to patients is available online at: http://www.cdc.gov/flu/

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Kennedy Drops Judiciary Assignment To Focus On Health Care

Sen. Edward Kennedy To Step Down From Seat on Senate Judiciary Committee To Focus on Health Care
[Dec 08, 2008]

Sen. Edward Kennedy (D-Mass.) announced Friday that he will step down from his seat on the Senate Judiciary Committee in the 111th Congress to concentrate on health care reform, CQ HealthBeat reports. "As chairman of the Senate Health, Education, Labor and Pensions Committee, I expect to lead a very full agenda in the next Congress, including working with [President-elect] Obama to guarantee affordable health care, at long last, for every American," Kennedy said. A top aide said health care overhaul will be "priority one, two and three" for Kennedy.

CQ HealthBeat reports that Kennedy has been coordinating with the Obama team on potential health care reform plans and has worked with other Democrats, such as Senate Finance Committee Chair Max Baucus (D-Mont.). According to CQ HealthBeat, Kennedy and Baucus are planning to introduce health care overhaul legislation early in the 111th Congress, either separately or under a "one bill" approach pushed by Kennedy.

Kennedy currently is chair of the Judiciary Subcommittee on Immigration, Refugees and Border Security. According to an aide, Kennedy will keep his seat on the Senate Armed Services Committee and will continue to be chair of its Seapower subcommittee (Armstrong/Perine, CQ HealthBeat, 12/5). The Boston Globe's "Political Intelligence" blog reports that Kennedy's action honors a request made last month by Senate Majority Leader Harry Reid (D-Nev.) for Democratic caucus members to relinquish some of their committee assignments to allow for opportunities for the eight new Democrats elected to the Senate (Smith, "Political Intelligence," Boston Globe, 12/5).

Kennedy expects to return to the Senate full-time in January after an absence following his diagnosis of brain cancer in May (CQ HealthBeat, 12/5). A Judiciary Committee spokesperson said it is too early to know who will replace Kennedy on the committee (Friedman, CongressDaily, 12/5).

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