January 28, 2008

IN THIS ISSUE

Editor's Column: Health And Happiness
St. Joe, St. Mary Announce Merger
Dr. Silbergleit Earns Teaching Award
Senate Kicks Off Blues Hearings
Blues Launch National Insurance Reform Policy
The State Of Health Care

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Editor's Column: Health And Happiness

By JOSEPH WEISS, MD
In the January issue of Health Affairs, Carol Graham writes on Happiness and Health. With the best analytical tools available from the fields of psychology and statistical economics, she confirms what physicians take for granted: Health leads to happiness, and happiness leads to health.

Studies indicate that health and happiness are strongly influenced by education and employment. Higher education leads to better health and happiness, while unemployment leads to depression, and ill health. These feelings are not driven by physician availability or high standards of public health but are associations shared by people living in India, Gabon, Germany, the United Kingdom. and the United States.

Studies show that happiness decreases as one ages. People, in general will accept shorter life spans for a healthier and presumably happier life. The same holds for health spending and happiness, no correlation exists, likely because spending more money for medical care usually means the person is battling ill health.

The relationship between happiness and health is stronger for psychological rather than physical health. Obviously, serious illness or injury diminishes a sense of happiness, but certain people adapt. These individuals lower their expectations of what constitutes good health; in turn the level of happiness turns upward. In contrast, people with depression are less likely to adapt to increased physical impairment.

In people with obesity, the health-happiness relationship varies considerably, and depends on the society the obese person keeps. Unhappiness with obesity is great in white-collar professions, but less in poor African-Americans and Hispanics. In any country, people with health insurance are happier than the average and this finding is independent of wealth and higher education. Groups subject to inequality report less good health and a lower level of happiness compared to neighbors not facing discrimination. 

What do these findings mean to us? First, the health-happiness relationship is only partly within our ability to support, expand, and repair. Many of the causes of declining happiness such as poverty, limited education and discrimination are beyond the control of the medical community.

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St. Joe, St. Mary Announce Merger

Effective Feb. 1, 2008, Saint Joseph Mercy Health System, based in Ann Arbor, and St. Mary Mercy Hospital in Livonia will join to form an expanded regional health care system in southeast Michigan. Saint Joseph Mercy Health System (SJMHS) will now be comprised of St. Mary Mercy Hospital in Livonia, St. Joseph Mercy Hospital in Ann Arbor, Saint Joseph Mercy Livingston Hospital in Howell and Saint Joseph Mercy Saline Hospital - all members of Trinity Health, based in Novi, Mich.

The newly expanded system will serve patients in the southeastern Michigan counties of Washtenaw, Livingston, western Wayne and southwestern Oakland. Collectively, the health system includes nearly 8,500 employees, 1,600 physicians and serves more than 1.5 million.

The hospitals in the new system will share best practices, medical breakthroughs, physician and professional expertise, technology advancements, quality and innovation, electronic medical records and excellence in the patient care experience.

Growth and Expansion
Both organizations have recently constructed new facilities to respond to community growth and need. St. Joseph Mercy Hospital in Ann Arbor recently opened a new 11-story East Tower that includes 356 private patient rooms, each 300 sq. ft. with personal bathrooms, patient media systems and the latest medical technology for staff. Within the last two years, the hospital has opened a new Surgery Pavilion, launched the use of CyberKnife®, a revolutionary cancer care treatment.

St. Mary Mercy Hospital in Livonia recently opened the Our Lady of Hope Cancer Center, which provides a coordinated setting for cancer patients, including physician offices, chemotherapy, radiation therapy with IMRT technology, clinical research trial options, and a one-of-a-kind Image Recovery Center. The new Heart & Vascular Center provides the latest cardiac catheterization and interventional radiology technology available. 

A second new seven-story North Tower at St. Joseph Mercy Ann Arbor Hospital A new patient tower providing all private rooms at St. Mary Mercy Hospital in Livonia Expanded Emergency Center, Surgical Services and Radiology at St. Mary Mercy Hospital Expansion of the Saint Joseph Mercy Center for Advanced Medicine and Surgery at the Canton Health Center.

More information can be found at http://www.sjmercyhealth.org/ and http://www.stmarymercy.org/.

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Dr. Silbergleit Earns Teaching Award

Professor of surgery Allen Silbergleit, MD, PhD, was among residency program directors recently awarded the Accreditation Council for Graduate Medical Education’s (ACGME) 2007 Parker J. Palmer Courage to Teach Award.
The award is named after Parker J. Palmer, PhD, a sociologist and educator who wrote “The Courage to Teach,” a book of reflections on the intellectual, emotional, and spiritual aspects of teaching. Each year the ACGME chooses recipients from among numerous nominees submitted to the council. The award honors program directors for their exemplary teaching of residents and leadership of innovative and effective residency programs.

“For a person who believes that the greatest calling in life is teaching and who believes in his work with every fiber of his being, the Parker J. Palmer Courage to Teach Award might as well be the Nobel Prize,” said Dr. Silbergleit. “What could be more important than the advancement of civilization by the young men and women we imbue with the spirit of humanism and inquiry?”
Winners were honored at a dinner during the ACGME’s winter Board of Directors meeting.

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Senate Kicks Off Blues Hearings

The state Senate Health Policy Committee held an informational hearing on January 23 in Lansing to learn more about the individual health insurance market before proceeding on a package of bills being pushed by Blue Cross Blue Shield of Michigan (BCBSM) that aims to reform the current market in Michigan. Two of the bills, House Bills 5282 and 5283, specifically would allow BCBSM to do the following (among several other things): set its own rates; create a guaranteed access pool administered by BCBSM and funded by insurers to cover those who cannot afford to buy insurance and who are denied coverage by other plans; remove Michigan Attorney General oversight; and end consumer challenges to proposed rate hikes.

Senate Health Policy Committee Chair Sen. Tom George, MD (R-Portage), explained that the Committee plans to approach these bills very deliberately and carefully, beginning with “educational testimony” about the individual health insurance market from expert Rod Turner, chief actuary for America’s Health Insurance Plans, a Washington, DC, association representing more than 1,000 commercial and not-for-profit insurers (including BCBSM) across the country.

Senator George said, “My goal is to find a solution that allows access and affordability.”

During his testimony, Sen. George asked Mr. Turner if he saw specific changes in the individual market on the horizon or trends that point to future growth in the market. Mr. Turner replied, “Everyone who is uninsured is eligible for coverage in the individual market. As that number grows, that is the possible growth you can expect to see.”

Senator George said that he plans to convene several more committee hearings before scheduling a vote. The next hearing tentatively is scheduled for January 30, and is expected to include testimony about a specific topic within the bill package, although no further details have been given. (To find future hearing dates, visit www.msms.org/advocacy to find a link to Michigan Senate Committee schedules.)

During its January meeting, the MSMS Board of Directors expressed concerns about HB 5282 and 5283 in their present form, and committed to working constructively with Sen. George and the Senate Health Policy Committee to seek changes to the language already approved by the House.

The Board heard from BCBSM President & CEO Daniel Loepp, who said that the legislation would benefit individuals, as well as physicians and other health care providers, by stimulating the individual market. "We need to change the regulatory environment in Michigan to allow for more competition in this segment," he said.

The MSMS Board position focuses on assuring that health insurance is accessible and affordable and that the playing field is level for all insurers.

For more information about the bills, contact Colin Ford at 517-336-5737 or cford@msms.org. Also, visit www.msms.org/advocacy.

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Blues Launch National Insurance Reform Policy

A wide-ranging, five-point proposal to cover at least 35 million of the nation’s uninsured was released by the Blue Cross and Blue Shield Association.

The plan would mandate e-prescribing under the Medicare program; establish tax-credit options, in particular for workers in small businesses; and create an independent institute to support research on the effectiveness of procedures, drugs and devices. It also includes measures to enroll more low-income people in some form of insurance, such as extending public coverage, and to require states to have high-risk insurance pools to ensure access.

Ultimately, the goal is to extend coverage to all Americans, said Scott Serota, Blues president and chief executive officer, at a news conference announcing the plan. A revenue source has not yet been identified for the tax-credit proposals, he added. A Blues spokeswoman said a cost estimate for the plan hadn’t been calculated and would depend on how the plan’s provisions were specifically adopted.

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The State Of Health Care

As President Bush prepares to address the top domestic and foreign policy issues facing the nation, American voters consistently cite health care as a top domestic priority. While there is much good in the delivery of health care, there are also areas in need of great improvement, notably providing all Americans with health care coverage and reforming Medicare.

The American Medical Association (AMA), through its national health care policy agenda, has identified the priority health issues facing our nation, and calls on Congress, the Administration, and candidates for national office to support proposals that will help improve the health care system.

“Every American deserves health care coverage, and we need to build on the strengths of our system to make that happen,” said AMA President Ronald M. Davis, MD. “As the nation’s largest physician organization, the AMA is leading the fight to get all Americans covered through our Voice for the Uninsured campaign.”

Through the Voice for the Uninsured campaign the AMA is reaching out to presidential candidates and members of Congress with its proposal, and to voters to urge them to vote with the issue of the uninsured in mind.

Anyone can visit the AMA website to sign the AMA’s petition in support of the plan to cover the uninsured, so that legislative progress can be made in 2009. The AMA proposal to cover all Americans relies on a system of tax credits that will enable individuals to buy their own health insurance, which they would keep regardless of job changes. The AMA is also a strong advocate for long-term renewal of SCHIP, the government program that provides health care coverage to children in need.     

“Congress made a promise to America’s seniors to provide them with health insurance through Medicare, but that promise means little if seniors can’t get in and see the doctor,” said Dr. Davis. An AMA survey found that 60 percent of physicians would be forced to limit the number of new Medicare patients they can treat if the 10 percent cut occurs this July. “Medicare’s physician foundation is at terrible risk because of a short-sighted payment plan that will cut physician payments 15 percent over the next year and a half, beginning this July.”

Before the cut begins in July, Congress must take action to replace 18 months of cuts with payment increases that reflect medical practice costs. This will give Congress time to begin creating a new Medicare physician payment system that is based on medical practice costs. The current payment system is a barrier to improving the quality of patient care, as it prevents many physicians from purchasing new health information technology or spending extra quality time with patients on important preventive measures that can improve health and wellness.

Recent polls show that Americans are increasingly worried about health care costs. “As a nation, we now spend more than $2 trillion per year on health care costs, which translates to about $7,000 per person, and we need to ensure that we are getting high value for our health care spending,” said Dr. Davis. The AMA has identified four broad strategies to contain health care costs and achieve greater value for health care spending: reduce the burden of preventable disease; make health care delivery more efficient; reduce non-clinical health system costs that do not contribute to patient care; and promote value-based decision-making at all levels.  

A leading cause of rising health care costs is treatment for patients with chronic conditions such as diabetes and hypertension. “We need to make an investment in helping patients quit smoking, avoid alcohol abuse, improve diet and increase exercise levels, as these lifestyle changes will not only lead to healthier lives, but lower health care costs,” advised Dr. Davis. “National rates of obesity and diabetes have doubled over the past 25 years, if we can get folks off the sofa and away from the pantry we can reduce these growth rates.”

Other key issues the AMA is committed to addressing in the year ahead include helping physicians use promising new technology to improve the quality of patient care, creating new quality measures that help physicians provide high quality care, and eliminating disparities in care.

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