E-DMN - July 28, 2008

July 28, 2008

Editor's Column: Why Health Care Costs So Much
Henry Ford Partners With Chrysler LLC To Open Health Clinic
Karmanos Cancer Institute Buys Patient Management Software System
Henry Ford Tests Medical Treatment At North Pole
Dr. Sakr Appointed Chair Of Pathology At WSUSOM
Update On Medicare Claims Processing
Leavitt To Announce E-Prescribing Initiiative
Doctor Held Liable In Low-Percentage Case

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Editor's Column: Why Health Care Costs So Much

In the AARP ( American Association of Retired People) magazine issue of July/August 2008, Shannon Brownlee wrote and article titled: Why Does Health Care Cost so Much? Her article’s answer is that huge extra expense occurs because doctors overtreat. She asserts that the overtreatment in turn creates side effects that cause additional and unnecessary expense.

According to Ms. Brownlee, doctors overtreat and obtain extra testing and MRIs to avoid fights with patients or because of fear that not complying with a patient’s wishes, will lead the patient to go to another doctor. Doctors order extra tests to avoid a malpractice suit. Brownlee adds the Wennberg argument, namely, that the more hospital beds, MRI machines and specialists available, the more doctors will use hospital beds, MRI imaging and make additional referrals to specialists. The final reason, according to Brownlee, for doctors wasting health care dollars, is that by the present method of payment, physician profit comes by doing more.

She adds insult to physicians by noting that “many physicians don’t even know what better care is.”[1] She adds that the procedures doctors perform and tests they order are: based on medical tradition or unproven and faulty assumptions. [2]

This is the information provided the public by the AARP magazine, a publication that bills itself as: “The World’s Largest Circulation Magazine.”

Ms Brownlee is in error. Certainly, her criticisms are not unheard of but clearly don’t represent the standards of the medical profession. The cost of medical care is rising, but not because physicians are acting from ignorance or iniquity. Rather, medical expense soars because of unproven but compelling technology, the expectation of patients that for every ill there is a cure and finally, the unintended consequence of prolonged old age—that change alone heaps up the cost of chronic care.

Ms. Brownlee reveals the weakness of her position in her advice for strategies for patients to use to protect their health and their pocketbook. She urges patients to:

-find a doctor who explains ailments

-make sure the doctor gets copies of medical records

-find the right specialist

-ask why the doctor orders a test or imaging procedure

-weigh benefits with risks

Such is hardly the advice that will lead to resolution of the rising cost of medical care.

The problems of health care do not stem from inadequacies of doctors, but from the conditions under which doctors’ work. Accusing us of venality hides the need for change by either reform or revolution. For now, doctors must ignore critics such as Ms. Brownlee.

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Henry Ford Partners With Chrysler LLC To Open Health Clinic

Chrysler LLC and Henry Ford Health System announced plans to open an onsite health clinic and pharmacy inside Chrysler LLC’s Auburn Hills headquarters, extending the collaboration between the two companies, while providing nearly 12,000 Chrysler employees and contractors with convenient access to high-quality medical care. In hosting the clinic, Chrysler joins a growing number of progressive employers throughout the United States who are bringing health care onsite or near the workplace.

The onsite clinic and pharmacy, which is scheduled to open in the fall, will offer diagnosis and treatment of chronic conditions in addition to common ailments, such as strep throat and ear infections. The clinic will be staffed by Henry Ford Medical Group physicians and professionals. Preventive services will also be provided.

“The onsite clinic and pharmacy allow Chrysler to continue its mission of promoting a healthy work environment,” said Kate Kohn-Parrott, Director - Integrated Health Care and Disability, Chrysler LLC. “We are proud to partner with Henry Ford Health System in providing convenient access to high-quality, cost-effective medical care to our employees and contract workers directly in the workplace.”

Treatment costs will be billed through the individual employee’s health care plan, with the same applicable co-pays and deductibles. Because the facility will be independently operated by Henry Ford Health System, patient confidentiality will be maintained just as it is at any traditional free-standing Henry Ford facility.

“The onsite clinic and pharmacy is a wonderful opportunity for Henry Ford Health System to deliver easily accessed, high-quality health care to people working at Chrysler headquarters,” says Nancy Schlichting, Henry Ford Health System President and CEO. “It is a model we believe could be successful with many Michigan employers in the future.”

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Karmanos Cancer Institute Buys Patient Management Software System

Barbara Ann Karmanos Cancer Institute in Detroit has bought a clinical and patient management software system and support services from Eclipsys Corp., Atlanta, in a multimillion contract, said George Yacoub, Karmanos’ chief information officer.

“This will enhance the patient experience and make information easier to work with because all the services are integrated into one application,” Yacoub said.

Eclipsys’ Sunrise Enterprise, a clinical, patient management and accounting electronic system, is designed to create an integrated information platform for inpatient and outpatient oncology services, Yacoub said.

It will integrate patient scheduling, registration, radiology services, offsite prescribing and physician ordering and billing. The system is expected to be fully operational in 2011.

The Eclipsys system, which will replace two standalone systems from Cerner Corp. of Kansas City, Mo., and Siemens in New York, also will help Karmanos manage its growing outpatient services business, Yacoub said. Outpatient care now represents about 85 percent of Karmanos’ $216 million annual revenue.

The information system will complement Karmanos’ outpatient center growth strategy. The cancer center is in the process of adding two outpatient centers in Novi and in Rochester Hills. It is expected to announce other joint ventures with physicians and hospitals over the next several months.

Over the next three years, Yacoub said, the system is designed to create electronic medical records on all inpatients and outpatients, allowing doctors in their homes and offices to view patient records and order tests and prescriptions.

“We will be doing away with paper records. This will speed up the process, improve accuracy and allow patients to be more conveniently seen in any outpatient setting within Karmanos,” Yacoub said.

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Henry Ford Tests Medical Treatment At North Pole
WHAT: Henry Ford Hospital surgeon Scott Dulchavsky, M.D., will test the
ability of non-physicians stationed in Devon Island in the Arctic
Circle to diagnose and treat appendicitis.
Dr. Dulchavsky will train and guide the non-physician Christian Otto to
perform a laparoscopic appendectomy on an inanimate model inside a tent
on Devon Island, the largest uninhabited island on Earth, where
temperatures don’t get above 50 degrees Fahrenheit and can plunge as
low as minus 58 degrees Fahrenheit in the winter.
The test, to be conducted via telemedicine, represents the latest
procedure in an ongoing study led by Dr. Dulchavsky, chair of
Surgery at Henry Ford, to examine whether non-physicians can
learn to treat medical emergencies in remote areas.
In the first experiment, Dr. Dulchavsky and NASA scientists
developed a technique to acquire ultrasound images of
astronaut crew members aboard the U.S. Space Station in 2004.
More recently, Dr. Dulchavsky diagnosed lung problems using
ultrasound in climbers at Advanced Base Camp on Mt. Everest. He also
has teamed up with the U.S. Olympic Committee and General Electric to
study the benefits of ultrasound imaging to prevent injury and enhance
performance for athletes at the 2006 Winter Games and for the upcoming
Summer Games in Beijing.
WHEN: 10 a.m. – 1 p.m.
Thursday, July 24
WHERE: Henry Ford Hospital
2799 W. Grand Blvd.
Detroit, 48202

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Dr. Sakr Appointed Chair Of Pathology At WSUSOM

Robert M. Mentzer Jr., MD, dean of the Wayne State University School of Medicine and senior advisor to the President for Medical Affairs, announced the appointment of Wael A. Sakr, MD, as Chair of the Department of Pathology, pending approval by the WSU Board of Governors.

“Dr. Sakr’s educational and research background, as well as his leadership experience, proves him eminently qualified to lead our Department of Pathology,” Dean Mentzer said.

In 2000, Dr. Sakr was promoted to professor in the Department of Pathology and the Cancer Institute. In 2006 he was named president of the medical staff at Karmanos Cancer Center, a position he continues to hold. He was appointed specialist in chief of Pathology for the Detroit Medical Center in 2007. Dr. Sakr was named Vice Chair for Anatomic Pathology for the School of Medicine in 2003, and director of University Pathology Research Services in 2002. He served as the staff pathologist and director of the Immunohistochemistry Laboratory for Harper Hospital. In addition, he has served in numerous leadership roles within the department of pathology and the Barbara Ann Karmanos Cancer Institute.

Dr. Sakr is a widely recognized anatomic pathologist. He is a member of the U.S. and Canadian Academy of Pathology, the International Academy of Pathology’s Arab Division, the International Society of Urologic Pathology, the American Cancer Society and the College of American Pathologists. He has served on the editorial boards of The Prostate, Journal of Urologic Pathology and Clinical Prostate Research.

“Dr. Sakr’s vision is one that is expansive and will build upon the strengths and excellence of the department,” Dean Mentzer said. “Please join me in offering your support and congratulations to Dr. Sakr, and extending sincere appreciation to Dr. Kenneth Palmer for his outstanding service as Interim Chair of Pathology during this transition.”

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Update On Medicare Claims Processing

By statute, Medicare electronic physician claims may not be paid sooner than 14 days after the date of submission, nor can “clean” electronic claims be paid any later than 30 days after the date they are submitted. (Paper claims are paid after the 29th day.)
The Secretary of Health and Human Services announced on June 27 that the Centers for Medicare and Medicaid Services (CMS) had instructed its carriers not to process any physician or non-physician practitioner claims for the first 10 business days of July. According to HHS, this “hold” on claims meant that no payments reflecting the 10.6 percent pay reduction that took effect on July 1 would occur before July 15, at the earliest.
CMS also indicated that it did not have the capacity to hold more than 10 days of claims. The hold was a rolling 10-day hold; therefore, with claims submitted the first days of the hold being processed on the 11th day of the hold, claims submitted the second day being processed on the 12th day, etc. The first payments on claims that physicians would have received reflecting the 10.6 percent reduction would occur on or after July 15.
Now that Congress has passed a law reversing the cuts retroactive to July 1st, Medicare carriers are switching their systems back to the June 2008 rates (and increasing rates for certain mental health services). Some carriers may already have posted the new, correct rates, but others could take a week or more. CMS has stated that it will automatically reprocess any claims paid at the reduced rates and provide the balances due to physician practices that are shortchanged, most likely as a single batched check.
The new law makes other important changes as well, such as reinstating the therapy caps exceptions process as of July 1st. Claims submitted with the therapy cap exception modifier will be processed as soon as the new payment rates have been activated. Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement. In addition, the Durable Medical Equipment Competitive Bidding Program, which affects 10 competitive bidding areas, has been delayed. Medicare beneficiaries may use any Medicare-approved supplier for Durable Medical Equipment.

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Leavitt To Announce E-Precribing Initiative

HHS plans to announce a new initiative to encourage physicians to adopt electronic-prescribing tools.

HHS Secretary Mike Leavitt is scheduled to join CMS acting Administrator Kerry Weems and James King, president of the American Academy of Family Physicians, in a news teleconference today to discuss this step toward the adoption of e-prescribing.

The initiative is part of the administration’s broader efforts to accelerate the adoption of health information technology and the establishment of a healthcare system based on value, the department announced.

A new Medicare law that went into effect last week establishes a rewards-penalties system for adopting e-prescribing. Physicians under the new statute will be able to receive bonus payments for adopting e-prescribing over a five-year period, starting in 2009. At the outset, doctors would be eligible for a 2 percent bump in reimbursement dollars, which would gradually trend downward over time as the technology becomes more common and less expensive. Conversely, doctors will get docked up to 2 percent for not adopting and using the technology starting in 2012.

The law also requires a comprehensive study on the effectiveness of e-prescribing to come from the Government Accountability Office by late 2012.

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Doctor Held Liable In Low-Percentage Case

The state's highest court ruled July 23 that doctors can be held liable for negligence that reduces a patient's chance of survival, even if the patient's prospect for recovery was already less than 50 percent, according to the Associated Press

Medical malpractice lawyers said the decision from the Supreme Judicial Court could help patients who previously had little chance of collecting damages from physicians.

"The SJC has finally recognized the rights of victims of medical malpractice to be compensated for…the loss of that person's chance to survive a horrible medical condition that should have been properly diagnosed in the first place," said David Angueira, a Boston lawyer.

The SJC recognized for the first time a doctrine known in medical malpractice cases as "loss of chance," which allows a patient whose odds of recovery are 50 percent or less to receive damages for any negligence that reduced those odds. The court established a formula for juries to award damages proportionate to the reduced survival rate caused by the doctor's negligence.

"Where a physician's negligence reduces or eliminates the patient's prospects for achieving a more favorable medical outcome, the physician has harmed the patient and is liable for damages," the court said in a decision written by Chief Justice Margaret Marshall.

The ruling came in a closely watched case in which a jury had awarded a $1 million judgment to the family of a man whose stomach cancer was overlooked by a Norwood doctor. Kimiyoshi Matsuyama, 46, of Sharon, died of gastric cancer in 1999.

A Norfolk Superior Court jury found in 2004 that Matsuyama repeatedly complained to Dr. Neil Birnbaum about stomach pains, beginning in 1995. Birnbaum diagnosed him with gastrointestinal reflux disease and recommended over-the-counter medications, but did not order any diagnostic tests until May 1999. After the testing, Matsuyama was diagnosed with gastric cancer and died five months later.

In Birnbaum's appeal, he argued there was no evidence that his actions or omissions substantially contributed to his patient's death.

The high court upheld the jury's judgment.

Max Borten - the lawyer who represented Matsuyama's wife, Robin - praised the ruling.

"This is something that has a dramatic impact," Borten said. "It takes a whole class of patients that had no rights before, and grants them some rights."

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