Wayne County Medical Society of Southeast Michigan

February 25, 2008

Editor's Column: Competition And Care
Measles Outbreak A Stern Reminder
WSU/DMC: Stakeholders, Policymakers Meet
Henry Ford Cottage Hospital Launches $10M Investment
Wayne State Med Students Mentor Kids
Dr. Sosne Receives Grant

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Editor's Column: Competition And Care

By JOSEPH WEISS, MD
In an article in the Feb. 7 New England Journal of Medicine‘s section, Perspective, Robert Kuttner states that the reason health care costs keep rising in America is because of “our unique pervasive commercialization.” What he means is that the environment of the marketplace with its emphasis on competition and profit is why we cannot control health care expense while countries like Canada, Australia and the United Kingdom can.

Kuttner waves off other causes for our soaring health expense such as an aging population and new, and ever more, new technology. He minimizes the American physician’s concern with malpractice litigation and the extra medical costs that defensive medicine spurs. Kuttner also all but disregards the health problems that arise from bad diets and insufficient exercise. For him, the cost of care is the result of business: marketing, duplication of administrative costs, fragmentation of care and the chase, by doctors, for profits.

He has a point. The expense of administration in some cases is said to reach 33 percent of the premium dollar. Fragmentation of care translates into too many health insurers, each with its own rules and into the four major pharmacy benefit managers, each with its own requirements. In the need for information, we face the necessity to call other physician’s offices, with each office presenting its own strategies for answering calls, and responding to our request to fax information on lab results, imaging reports etc.

However, he misses a point: the for-profit society lives by challenge and hunts for change. That quest will bring the door to stent time down under 90 minutes in acute myocardial infarction. The incentive for profit will eventually bring solutions to the problem of preventive care. Generic substitution is successful because of the profit motive.

The medical home and in-office surgery will become realities when someone with a particular perspective finds a way to make profit from organizing care that way.

Kuttner says that the way to stop soaring health care costs is to end our present way of doing medical care as the business of health, and turn to a single-payer national health system such as the United Kingdom has. However, an alternative exists: let the present manner proceed.

We are at the beginning of important changes that will place a brake on health care costs: the entrance of Wal-Mart in pharmaceuticals, the use of physicians’ bonuses for cost saving care, the consolidation of hospital system in metropolitan areas. Metropolitan Detroit is down to five systems: Ford, DMC-Wayne State, Oakwood, Trinity Health and Beaumont. These groups compete now, but their similar size and resources makes coordination of care as possible tomorrow as their contention seems inevitable today.

The ills of competition will not be solved by the balm of single payer. Rather, the extrons of competition will give way to the splicing enzymes of incentive and gain.

Comments From Dr. Susan Adelman:

I do not know if the continuation of competition will squeeze more costs out of medicine or will add more in marketing costs. On the flip side, I do not know if a nationalized system will squeeze more costs out or add more in bureaucracy. We all know that life is what happens while we travel toward some more distant goal. Perhaps we could at least say that we need to squeeze more costs out of the present system while we wait for the great new shining healthcare system in the sky. Also, the models that we develop meanwhile can be templates for any new system.

Notice that Hillary now proposes a system that looks much like the AMA proposal. Not that I think she really wants that one, but she apparently thinks that is the only one she can sell right now. That in itself is telling.

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Measles Outbreak A Stern Reminder

A California measles case in January led to the infection of 11 unvaccinated children and infants too young to receive vaccine, according to the CDC’s Morbidity and Mortality Weekly Report for Feb. 22.

The index case was a 7-year-old boy, unvaccinated, who had traveled to Switzerland with his family. Two of the other cases were his siblings.

The report pointed out that while measles is largely under control in the United States due to strong vaccination policies, outbreaks still occur in other countries, including developed countries in Europe.

According to the article, all children in the United States are required to be immunized, “However, medical exemptions to immunization requirements for day care and school attendance are available in all states; in addition, 48 states offer nonmedical religious exemptions and 21 states offer” exemptions based on personal beliefs.

Measles can result in serious complications including encephalitis, pneumonia and death. According to the CDC, “Once ubiquitous, measles is now uncommon in the United States. In the prevaccine era, 3 to 4 million measles cases occurred every year, resulting in approximately 450 deaths, 28,000 hospitalizations, and 1,000 children with chronic disabilities from measles encephalitis. Because of successful implementation of measles vaccination programs, fewer than 100 measles cases are now reported annually in the United States and virtually all of those are linked to imported cases…”

Prevention recommendations from the CDC include:

1) Health care professionals considering a diagnosis of measles in all persons who have traveled overseas

2) Use of appropriate infection control practices to prevent transmissions in health care settings

3) Maintaining high coverage with measles, mumps and rubella vaccine (MMR) among children

The CDC further recommends that “Patients with suspected measles should be placed in an examination room, preferably an airborne-infection isolation room, as soon as possible and should not be permitted in patient waiting areas. Until placed in an airborne-infection isolation room, the patient should wear a surgical mask…The door to the examination room should be kept closed, and all health care personnel in contact with the patient should be documented as immune to measles…The examination room should not be used for two hours after the infectious patient leaves. Suspected measles patients should not be referred to other locations for laboratory tests unless infection control measures can be implemented at those locations.”

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WSU/DMC: Stakeholders, Policymakers Meet

On Feb. 19, representatives from MSMS, the Wayne County Medical Society of Southeast Michigan, and the Wayne State University School of Medicine met with several lawmakers in Lansing to discuss the sudden cut of $12 million from the Detroit Medical Center to the WSU School of Medicine for care of indigent patients.

“The meetings went very well,” said MSMS Board Member and WSU anesthesiologist H. Michael Marsh, MBBS, who helped lead the discussions with lawmakers. “I think that they began to understand our issues, and we received word that several legislators are following up, which is good news.”

“MSMS is committed to working the WSU University Physician Group throughout this process,” said MSMS President AppaRao Mukkamala, MD. “Access to health care is continually threatened by a number of factors, and we physicians must do everything in our power to protect our patients – especially those who are most vulnerable. Through a statewide organization like MSMS, physicians can get local issues in front of lawmakers and work toward better health care in Michigan.”

The Detroit Free Press reported on Wednesday (“Expert hired to end DMC pay feud with WSU”) that WSU and DMC will hire an outside consultant to help settle the disagreement and determine the right amount of pay DMC should give WSU School of Medicine for indigent patient care.

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

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Henry Ford Cottage Hospital Launches $10M Investment

As part of its commitment to Grosse Pointe residents, Henry Ford Cottage Hospital announced today that it will invest more than $10 million into the hospital this year.

The plans involve renovated private patient rooms, new technologies and expansion of current services, says Denise Allar, chief operating officer of Henry Ford Cottage Hospital.

“Henry Ford has had a long relationship with Cottage and the Grosse Pointe community,” says Allar. “This investment of $10 million this year is our commitment to the health and well-being of Grosse Pointe residents.”

As part of the financial investment, Allar announced two new services for patients:
• A state-of-the art inpatient unit consisting of 10 newly renovated private patient rooms that offer privacy and comfort. Designed with a home-like setting in mind, the private rooms come with a flat screen TV; soothing colors and modern furniture creating a more comfortable environment in which to receive care. One major advantage of private rooms is that studies have found that hospital-acquired infections in patients drop by 50 percent.
In addition, another 10 private rooms will be opened by the end of March.

“The new unit enables us to provide care to medical and surgical patients requiring a 23 – 72 hour stay,” says Michael Dunn, M.D., Henry Ford Cottage Hospital’s chief medical officer.

• A concierge program for hospitalized patients. Called “Guest Services,” patients and their families will be greeted personally by a guest services representative to attend to their needs before, during and after their stay at Cottage.
Each guest on the new unit will receive a complimentary hotel-like personal amenities kit, bath robe, slippers, a daily newspaper and fresh flowers among other specialty services.

Allar says that other new and expanded services will be announced later this year.

The new patient unit will be staffed by experienced Henry Ford nurses and physicians from the local community, and members of the nationally-recognized Henry Ford Medical Group. The Medical Group is one of the nation’s largest and most experienced group practices, with 1,000 physicians and researchers in more than 40 specialties who staff Henry Ford Hospital and 25 outpatient medical centers.

Additional services and programs offered at the Grosse Pointe Farms hospital continue to include:
• 24 hour emergency care
• Long Term Acute Care unit
• Inpatient mental health unit and day programs
• Inpatient and outpatient rehabilitation services
• Women’s Diagnostic Center
• Ambulatory Surgery
• Integrative Therapy
• Infusion Services
• Wound Care
• Sleep Center
The hospital also features advanced services that focus on Diagnostic Cardiology, Radiation Oncology, Chemotherapy, Women’s Health Services, Orthopaedics and Urology.

In 1986, 153-bed Cottage Hospital became affiliated with Henry Ford Health System. In 1998, Cottage became part of the Bon Secours Cottage Health Services, along with Bon Secours Hospital. Henry Ford Health System owned 30 percent of the joint venture. With Henry Ford assuming full ownership of Cottage last year, the joint venture has been dissolved.

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Wayne State Med Students Mentor Kids

Wayne State University School of Medicine students have banded together to launch a cultural and academic academy for middle and high school students of Detroit.

The Promoting Uplift to Lives of Success and Empowerment (PULSE) Enrichment Academy meets two Saturdays of each month from August to April, bringing Detroit students onto the School of Medicine campus to be taught a variety of cultural and academic subjects by SOM medical students.

The academy, the brainchild of second-year medical students Letacia Sims, Cecelia Calhoun and Dakisha Felder, was established with a Widening the Pipeline Program grant from the School of Medicine’s chapter of the American Medical Student Association. Many of the students volunteering as teachers and tutors are members of the Wayne State University School of Medicine chapter of the Black Medical Association/Student National Medical Association. Ms.Sims, Ms. Calhoun and Ms. Felder are community service chairpersons for the SNMA.

“We saw a need for this type of programming,” said Ms. Sims, a native of Georgia who wants to practice pediatric medicine. “Kids need to expand their horizons in academics and culture. SOM students need volunteer hours, and the children of Detroit need the help, so it’s mutually beneficial. We get to give back to the community.”

The academy’s goals are to promote educational advancement in seventh- through 10th-graders, improve the awareness and health status of youth, and to ensure a future for creative outlets beyond secondary schooling for Detroit students.

The academy meets at the School of Medicine’s Scott Hall two Saturdays a month from 10 a.m. to 1 p.m. In addition to three one-hour classes, participants receive a breakfast snack, and free transportation to the site. Classes range from dance to the exploration of Japanese culture. Tutoring in classroom work and homework assistance, as well as ACT and SAT test preparation, is provided by SOM students volunteering in the academy. For middle school students, tutors assist with Michigan Education Assessment Program test-style questions.

Thirty SOM students now serve as volunteer teachers in the academy. Volunteers rotate based on the subject matter to be taught on upcoming Saturdays. There are 47 students taking classes in the academy. Ms. Feldman said the academy can accept more students.

The Detroit Department of Health and Wellness Promotions Bureau of Substance Abuse Prevention, Detroit Recovery Project and Helping Hands provide van transportation for the academy students from three pickup and drop-off locations.

The academy is open to any middle or high school student in the Detroit area. To participate, students must either find their way to one of the designated pickup points for provided transportation, or a parent must provide individual transportation to Scott Hall.

While the School of Medicine has donated space and supplies to the academy, Ms. Sims said the SNMA continues to seek monetary and supply donations from individuals and businesses.

For more information about the academy, or to make a donation to support the project, call (248) 943-8835, or email dfelder@med.wayne.edu or lsims@med.wayne.edu.

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Dr. Sosne Receives Grant

Gabriel Sosne, MD, of Wayne State University School of Medicine and the Kresge Eye Institute, has been granted a $60,000 Physician-Scientist Award by Research to Prevent Blindness (RPB) for his groundbreaking work studying a molecule that may lead to the healing of damaged eyes.

Dr. Sosne and his group have been studying Thymosin Beta 4, a protein molecule that occurs naturally in the body. Previously discovered to be an agent that accelerates healing, recent studies have shown that it may also be applied to treat previously thought untreatable eye injuries.

“Today there is nothing available, pharmacologically, that stimulates wound healing in the cornea. In cases of damage related to diabetes or alkaline exposure, treatments have focused on creating an environment conducive to healing.” explained Dr. Sosne. “Thymosin Beta 4 may be the key to stimulating wound healing in the eye. It will change the way physicians treat eye injuries.”

Dr. Sosne and his team are conducting clinical trials involving the use of Tymosin Beta 4 for diabetes patients. “Dr. Sosne’s lab has been able to identify a relationship between this molecule and corneal wound healing. This generous award from the Research to Prevent Blindness will enable us to continue our work and one day translate these discoveries into real treatments for patients.”
RPB is the world’s leading voluntary organization supporting eye research. Since it was founded in 1960, RPB has channeled hundreds of millions of dollars to medical institutions for research into the causes, treatment and the prevention of blinding eye diseases.

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