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June 16, 2008
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IN
THIS ISSUE
Editor's Column:
Blue Cross And The Double Cross
Henry Ford Hospital, Hurley Medical Form
Partnership
DMC Rehabilitation Institute President
Retires
AMA Objects To 'Secret Shoppers'
Analysts Weigh In On Health Care IT
MGMS Urges CMS To Go Slow On Stark
Changes
Newspapers Highlight
Presidential Health Plans
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Editor's
Column: Blue Cross And The Double Cross
By
JOSEPH WEISS, MD
At the MSMS House of Delegates a quiet meeting in a small conference
room unleashed a bombshell with potentially nuclear-like power. The
meeting, hosted by BCBS, introduced physicians to a draft of a policy
that BCBS plans to implement this October.
The
policy states that a physician should not bill for services
that are the result of the physician’s error. BCBS used
the following examples of services for which the physician
should not bill:
- Surgery
performed on the wrong body part
- Surgery
performed on the wrong patient
- Wrong
surgery performed on any patient
Procedures
necessitated by error such as retrieval of a sponge left
in a surgical wound or a return to the operating room to
tie off a blood vessel previously inadequately closed would
also come under the no-reimbursement policy.
Their
draft did not limit the not-to-bill rule to the examples
mentioned. The policy document contained examples of errors
but did not delineate that these were the only errors that
would come under the not-to-bill rule.
The
BCBS approach differs from the approach from the Centers
for Medicare and Medicaid Services (CMS). Medicare will
not reimburse hospitals for their expense incurred for
urinary tract infections, falls, retrieving foreign bodies,
etc. However, physicians’ charges are honored. Not so with
BCBS, who will not pay the physicians associated with the
medical error.
The
problem is: When the tactic not paying physicians for medical
errors begins, where does this strategy end? The BCBS draft
doesn’t state that only surgeons are at risk and only for
extreme errors. Rather, BCBS leaves open the possibility
that any physician’s supposed error can trigger the not-to-bill
rule.
BCBS
says this not-to-bill policy arose because of the pressures
coming from corporate customers; BCBS states that it intends
a limited application of this new rule.
We
will know in time whether this BCBS policy will wither
from neglect or bring us to a quagmire of doubts, struggles,
legal battles and dubious medical practice. Likely, we
will not need to wait long to see other carriers create
variations of the not-to-bill idea and turn it into a not-to-win
rule for physicians.
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Henry
Ford Hospital, Hurley Medical Form Partnership
Henry
Ford Hospital's Transplant Institute provides kidney transplant
services to patients with debilitating kidney disorders
in the Flint area under a partnership with Hurley Medical
Center.
Under
the partnership, Henry Ford's surgeons will evaluate patients
for transplantation and coordinate and perform surgery
at Henry Ford, while Hurley's nephrologists will continue
to manage their patients before and after surgery. Henry
Ford also works with other private-practicing referring
nephrologists in the Flint area.
The
hospitals say the partnership provides patients with clinical
excellence and care close to home.
"We
welcome the opportunity to partner with Hurley Medical
Center in providing an exceptional level of support and
coordinated care before, during and following transplantation," says
Marwan Abouljoud, MD, director of Henry Ford's Transplant
Institute.
"Our
patients will continue to receive high quality, convenient
care close to home from the Nephrology staff here at Hurley,
while receiving the expertise gained from one of the most
experienced kidney transplant teams in the country. This
is a win-win situation," says Sayed Osama, MD, chairperson
and chief of Nephrology at Hurley.
Henry
Ford, one of only two multi-organ transplant centers in
Michigan, performs heart, kidney, liver, lung, pancreas
and bone marrow transplants. More than 2,100 kidney transplants
have been performed since the program's inception in 1968.
The
Hurley partnership comes one year after Henry Ford opened
a liver transplant clinic at the in. Henry Ford specialists
evaluate and work with referring physicians in the Kalamazoo
area to manage potential liver transplant patients.
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DMC
Rehab Institute President Retires
Terry
A. Reiley is retiring after nearly 19 years of service
to Detroit Medical Center, most recently as president of
DMC Rehabilitation Institute of Michigan (RIM). Reiley
will officially leave the DMC on July 5. She is retiring
to Colorado, where she began her career as a physical therapist.
Under her direction for the past eight years, RIM has flourished
as one of the leading rehabilitation centers in the nation
with ongoing research and innovative treatment practices
that exceed conventional standards.
Reiley, who was appointed RIM’s first female president in 2000, presided
over a major hospital renovation, the addition of RIM’s Brasza Outpatient
and Fitness Center, a new radiology suite, and the world renowned
Center for Spinal Cord Injury Recovery.
This year alone, RIM became home to the Mike Utley Center for Human
Performance which features a state-of-the-art biofeedback laboratory.
RIM also received a $1 million endowment gift from Urban Science,
to fund its spinal cord injury programs.
Since joining the DMC, Reiley has served as clinical services administrator
and chief operating officer for RIM, as well as president of Michigan
Orthopaedic Specialty Hospital in Madison Heights. Reiley holds a
master’s degree from Wayne State University and a bachelor’s degree
in physical therapy from the University of California, San Francisco
Medical Center.
DMC’s Rehabilitation Institute of Michigan is one of the nation’s
largest hospitals specializing in physical medicine and rehabilitation.
The Institute is home to many innovative programs, including the
Southeastern Michigan
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AMA
Objects To 'Secret Shoppers'
Using "secret
shoppers" to evaluate the way physicians manage relationships
with patients could get in the way of providing needed
care to actual patients, according to more than 12 doctors
who testified before an American
Medical Association panel, the Chicago
Tribune reports. AMA on Sunday held its
annual House
of Delegates meeting in Chicago. According to
the Tribune,
the use of secret shoppers "is becoming part of the
consumer health information wave," spurred by insurers,
employers, consumers and others seeking to "ensure
they are making informed choices about the kind of care
and service they will receive."
The group's Council
on Ethical and Judicial Affairs has asked that
the 565-member House endorse the practice, noting that secret shopper
evaluations would focus on professional relationships with patients,
not on clinical practices (Japsen, Chicago
Tribune, 6/16). AMA information released on Friday
stated that secret shoppers would be "individuals hired to act
as patients to monitor service quality." It added, "Secret
shoppers have been used to evaluate most of the steps of the patient
experience, from the ease of making an appointment over the phone,
to the environment and flow of patients in the waiting room, to the
encounter with the physician" (Snowbeck, "Medical
Hotdish," St.
Paul Pioneer Press, 6/13).
Rex Greene, a member of the ethics panel, said secret shopper evaluations
can "highlight things that we are not aware of that can benefit
our practices." He said, "We would like certain parameters
where ethically appropriate," adding, "This is a practice-management
tool." However, physicians testifying before the panel disagreed.
Howard Chodash, an associate professor of gastroenterology at Southern
Illinois University School of Medicine and an AMA delegate,
called the practice "grossly unethical." George Anstadt,
an AMA delegate representing the American
College of Occupational and Environmental Medicine, said, "This
goes against the grain of the doctor-patient relationship," adding, "We
should use real patients as sources of real information we need about
quality of care." The physicians also expressed concerns that
information gathered by secret shoppers could be used to cut physician
payments or used by trial lawyers in medical malpractice lawsuits.
The proposal could be endorsed, rejected or referred for more study
when the AMA House of Delegates votes this week (Chicago
Tribune, 6/16).
AMA
President
In a speech before the AMA House of Delegates on Saturday, AMA President
Ronald Davis, MD, told physicians to "never take away someone's
hope" when treating patients with deadly or terminal diseases.
Davis, a doctor of preventive medicine, has been diagnosed with stage-4
pancreatic cancer. He said, "I know the survival statistics
for someone with stage-4 pancreatic cancer," but "if the
five-year survival is 5%, that is not zero. And as someone with relative
youth, good functional status, outstanding health care, love and
support from family and friends, and a thirst for life that feeds
into a strong mind-body connection, then who knows what the future
holds for someone in my situation."
Davis also said physicians should take a leading role in advocating
healthy lifestyles, better patient information, expansion of health
coverage to all U.S. residents and a reduction of medical errors
(Japsen, Chicago
Tribune, 6/15). Davis added that AMA should support
additional federal taxes on tobacco and work to stop Medicare physician
payment cuts (Babwin/Johnson, AP/Arizona
Republic, 6/15).
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Analysts
Weigh In On Health Care IT
Health
IT Now! Coalition on Friday at a Capitol
Hill briefing asked lawmakers to pass legislation that
would subsidize health care providers for the adoption
of electronic health records, ensure interoperability
among health care information technology platforms
and address privacy concerns, CongressDaily reports
(CongressDaily,
6/13).
At the briefing, RAND researcher
Richard Hillestad cited a study he led that found implementation
of an interoperable health care IT system by 90percent of the US
health care system would save $80 billion annually after 15 years.
He added that preventive care and chronic disease management efforts
that use health care IT could prevent 400,000 deaths and add 40 million
workdays annually (Wyckoff, CQ
HealthBeat, 6/13). Hillestad also said that use
of health care IT could prevent more than 2.2 million adverse events
related to medications annually (CongressDaily,
6/13).
RAND researcher Allen Fremont said that use of health care IT to
collect and sort data could help determine the causes of health care
disparities. Health care IT "is, in the short term, about errors," former
Rep. Nancy Johnson (R-Conn.), a co-chair of the Health IT Now! Coalition,
said, adding, "But in the long run, it's going to increase the
intellectual capacity and treatment capability in the American health
care system" (CQ HealthBeat,
6/13).
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MGMA
Urges CMS To Go Slow On Stark Changes
The
Medical Group Management Association has urged the CMS
to review the Stark law rules on physician self-referral
before the agency implements additional changes.
In its
comments about the CMS’ proposed inpatient prospective
payment system rule,
the Englewood, Colo.-based MGMA—which represents medical
group practices and has more than 21,500 members—said the
rules named after Rep. Pete Stark (D-Calif.) have become
so complex that “even routine business and clinical arrangements
now require development and review by high-priced lawyers
and consultants,” which, in turn, adds to the cost of practice
and leaves groups uncertain about their compliance status.
“Less
than five months from the effective date of the long-awaited
Phase III Stark rules, groups are now confronted with another
set of complex proposals—some with specific regulatory
language proposed for amendment and some simply preamble
musings on what options for change may be under consideration—dealing
with just a few aspects of this hydra-headed monster,” MGMA
President and Chief Executive Officer William Jessee wrote
in a letter to
acting CMS Administrator Kerry Weems.
The purpose
of a review would be to simplify administrative responsibilities,
according to the MGMA, which said it would “commit its
resources” to helping the CMS in the review process.
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Newspapers
Highlight Presidential Health Plans
In
broader pieces on the economy and taxes, two newspapers
recently addressed parts of the health care proposals
of presumptive Republican presidential nominee Sen. John
McCain (Ariz.) and presumptive Democratic nominee
Sen. Barack
Obama (Ill.). Summaries appear below.
§ Los
Angeles Times:
The Times examined
how, as the "faltering economy has catapulted
to the top of the presidential campaign agenda," McCain
and Obama "have both said they want to make
health care more affordable" and accessible,
but they "have laid out far different paths
to achieving these goals." According to the Times,
Obama "is calling for government to do more
to address the nation's ills," and "McCain
is embracing the traditional GOP faith in free-market
solutions," a difference that "gives
voters a stark choice." The Obama proposal "leans
hard on government action to make insurance more
affordable and, ultimately, universally available," and
the plan would "make coverage mandatory for
children, expand federal subsidies for the uninsured
and impose new funding requirements on employers," the Times reports. In contrast, "McCain, in his health
plan, shuns that infusion of government money and
authority" and "instead would rely on
market competition to drive down costs," through
the establishment of "new tax incentives for individuals to get their own health insurance" and
by reducing the "incentives for people to
get insurance through their employers," according
to the Times (Hook, Los
Angeles Times, 6/15).
§ San
Francisco Chronicle: The Chronicle examines
how Obama and McCain "offer voters a stark if
orthodox choice on the economy" and health care.
The current "economic situation ... may leave
orthodox remedies outdated," as "escalating
health care spending for an aging population will
pitch the next president into choices not nearly
as palatable as either candidate's campaign promises
imply," according to the Chronicle.
According to the Chronicle,
the tax increases that Obama has proposed "would
raise $700 billion over a decade," but "that
may not cover Obama's other still-vague economic
plans, such as expanding health insurance to everyone
who needs it." In contrast, McCain has proposed
tax reductions that would "reduce revenue by
$600 billion over 10 years," a plan that "ignores
the government's voracious need for taxes to pay
for government health care programs," the Chronicle reports
(Lochhead, San
Francisco Chronicle, 6/15).
Editorials
Summaries of two recent editorials related to health care in the
presidential election appear below.
§ Los
Angeles Times: Obama and McCain,
despite the current economic downturn and federal
budget deficit, "aren't even paying lip service
to curbing the deficit" or the cost of entitlement
programs, according to a Times editorial. Both "men's campaigns have laid
out strategies for addressing the budget problems," but
those proposals are "just not that credible," as
economists "agree that the rising costs of debt
service and entitlements -- particularly retiree
benefits and health insurance for the poor -- are
at the heart of the problem and that they'll become
completely unmanageable within a few decades if left
unchecked," the editorial states. According
to the editorial, "in the time-honored tradition
of presidential campaigns, neither McCain nor Obama
has called for curbs on Social Security, Medicare
or Medicaid," and both have "made dubious
assertions that health care reform would also slow
entitlement spending" (Los
Angeles Times, 6/15).
§ St.
Louis Post-Dispatch: Obama "didn't
come to St. Louis to walk the fault line in modern
medicine," but "that's essentially what
happened" when he visited with heart patients
at Barnes-Jewish
Hospital last week, according to a Post-Dispatch editorial.
The editorial states, "One of those problems" of
the "incredible technological prowess of modern
medicine" is cost, which was "at the center
of Mr. Obama's public remarks and of the Republican
response," the editorial continues. According
to the editorial, Obama "touted his voluntary
national health insurance plan that he said would
make care more accessible and affordable to millions
of middle-class Americans," a proposal that
McCain has "criticized ... as expensive and
unwieldy." The editorial states, "Insurance
works best when it allows the greatest number of
people to pool their risks," which is "why
a national health insurance program like Medicare
makes sense," but "Obama's plan falls short
of that" because the proposal "wouldn't
provide universal coverage." However, "his
idea of widening the insurance pool and protecting
the growing number of families who face economic
disaster should serious illness strike is a big step
in the right direction," the editorial concludes
(St. Louis
Post-Dispatch, 6/15).
Opinion
Pieces
Summaries of several recent opinion pieces related to health care
in the presidential election appear below.
§ David Broder, Washington
Post: "Sixteen years after
he shook up American politics by launching an impromptu
campaign for president, Ross Perot is about to dip
a toe back into the public debates" on the cost
of entitlement programs and other economic issues, Post columnist
Broder writes. Those "who go to http://www.perotcharts.com will
find the Dallas billionaire waiting to challenge
them on one of his favorite subjects -- the' ruin'
he says America is courting with its spendthrift
ways," Broder writes, adding, "Perot is
not offering any solutions," but "he is
clearly pointing to what he says are the culprits,
the big entitlements -- Social Security, Medicare
and Medicaid." The Web site cites the need to
address the cost of entitlement programs, Broder
writes, adding, "So far, John McCain and Barack
Obama are not doing that" (Broder, Washington
Post, 6/15).
§ Sandra Day O'Connor/James Jones, Washington
Post: The United States must "consult
our young" on the "approaching tsunami
of retirement and health care spending ... precipitated
by a combination of aging baby boomers and abnormally
high health costs," O'Connor, a retired associate
justice for the US Supreme Court, and Jones, a former
ambassador to Mexico, write in a Post opinion
piece. The authors write, "The Government Accountability
Office and many, many others have documented the
magnitude of the Social Security, Medicare and Medicaid
bills that will come due over the next several decades," and
the "more troubling outcomes" include "shifting
even greater burdens onto the young and endangering
the living standards of everyone else in the process." According
to the authors, the "larger and more urgent
task" than efforts to reduce the cost of Social
Security "is health reform." The authors
write, "In the interests of effective cost control,
Medicare beneficiaries in particular must be prepared
to embrace sensible limits on the way their health
care is provided," adding, "Halting runaway
medical inflation represents a potential victory
for all generations" (O'Connor/Jones, Washington
Post, 6/16).
§ Ellen Lutch Bender, Boston
Globe: "No single reform would
do as much to improve the wealth of our nation and
the lives of Americans as a comprehensive overhaul
of our health care system," Bender, president
and CEO of Bender
Strategies, writes in a Globe opinion
piece. However, the "best chance of swift and
major reform may have died with the end" of
the campaign of former Democratic presidential candidate
Sen. Hillary Rodham Clinton (N.Y.), according to
Bender. She adds, "Clinton kept health care
on the front burner, promising action in her first
term," and, since she suspended her campaign,
the issue "has already slipped as the top domestic
concern, a position it held earlier in the campaign
for the first time since the last Clinton campaign
in 1992." Bender writes that Obama and McCain "have
reform plans that take divergent paths, neither of
which is as comprehensive as Clinton's." She
adds, "There are three areas the next president
must focus on, and all three must be in balance:
making sure every American has health insurance,
improving the quality of care and controlling costs" (Bender, Boston
Globe, 6/16).
§ Merrill Matthews, Washington
Times: "While much of the
health care reform debate centers on the 47 million
uninsured Americans, there is an equally important
subgroup that must be part of the solution -- the
uninsurable," Matthews, executive director of
the Council
for Affordable Health Insurance and a resident
scholar with the Institute
for Policy Innovation, writes in a Washington
Times opinion piece. "What critics
almost never say is that very few people are ever
denied coverage -- or can be, for that matter" --
as "the vast majority" of US residents
receive health insurance through their employers
or public programs, Matthews writes. "If an
individual can buy health insurance at any time,
many would wait until they need health care to buy
coverage," which is "one of the reasons
... Clinton wanted to force everyone to buy coverage," according
to Matthews. He adds that the "public policy
challenge is to find a way to provide coverage to
the uninsurable without destroying the individual
health insurance market." According to Matthews,
the "best solution is to let the health insurance
market work for the vast majority of Americans and
create a safety net for those who can't get coverage," which
is "what ... McCain's 'Guaranteed Access Plan'
(GAP) tries to do." He writes, "If we want
a market-based health care system, and John McCain
apparently does, high-risk pools are the most effective
way to address the safety-net problem of the uninsurable," and
the "debate should be over how to make the pools
better because a heavy-handed government-run system
is not a good or affordable alternative" (Matthews, Washington
Times, 6/16).
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