E-DMN - June 9, 2008

June 9, 2008

WSU-DMC Battle Goes To Lansing
Mich. Proton Beam Group Meets First Deadline
Bill Would Delay Reduction In Medicare Physician Reimbursements
Kaiser Permanente, Microsoft Launch EHR Pilot Program
Panel Discusses Expanding Coverage Via 'Early Medicare' Program
AMA Applauds Genetic Anti-Discrimination Law
WSU Docs In The News
CBO Looks At Tranparency As A Health Cost Reducer

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WSU-DMC Battle Goes To Lansing

By PAUL NATINSKY
With much passion and emotion but very little in terms of new developments, the feud between the Wayne State University School of Medicine and the Detroit Medical Center over residency programs and money went statewide last week.

The Senate Health Policy Committee, under the direction of Chairman Dr. Tom George June 5 heard testimony from WCMSSM President E. Chris Bush; Joe Schwarz, MD, a former congressman and state legislator and current chair of a group formed by the Detroit Regional Chamber to assess graduate medical education in Southeast Michigan; DMC CEO Mike Duggan and WSUSOM Executive Vice Dean Robert Frank, MD.

Dr. Bush, who is also MSMS Board Secretary, emphasized the importance of the WSU-DMC relationship in caring for the indigent population in Detroit. He said medical students have told him that they feel unsure about their future. He added that, while 25 percent of WSU/DMC residents remain in the Detroit area upon completion of their residencies, “medical faculty at WSU could easily seek greener pastures elsewhere” but maintain their commitment to the City of Detroit and its patients.

He said the real crisis is not for physicians, who will find other opportunities, but for Detroit’s indigent.

Dr. Schwarz’ remarks echoed those of LA Police brutality victim Rodney King more than a decade ago: “Why can’t we all just get along.”

“I implore the leaders of both institutions to get down to business and resolve this dispute,” said Dr. Schwarz. “It is totally unacceptable that some days these institutions are at each other’s throats, some days ignoring one another. But they clearly aren’t playing in the same sandbox.”

Mike Duggan outlined the history of the dispute with a parallel analysis of his tenure at the DMC. He said that when he first manned the helm at the medical center in 2004, it was on the heels of a $50 million bailout from the State of Michigan following $462 million in total losses from 1998-2003. He said he had 1,000 layoff notices on his desk and recommendations to close Hutzel and Detroit Receiving hospitals.

He said he chose to execute none of this and, instead, to run the place like a business. That included cutting overhead, building patient volume by increasing emergency room visits, adding accountability to the WSU-DMC contract and attracting private doctors back to the DMC (as opposed to faculty physicians. DMC is staffed by about 1,800 private doctors and about 700 WSU faculty physicians).

Regarding the WSU faculty group, Duggan focused his remarks on criticisms of academic medicine, chiding the School of Medicine specifically for postponing a patient’s appointment with a specialist six weeks so that physician could pursue a research project for the dean’s office and sending all of its physicians in certain specialties to a conference at one time, leaving coverage gaps, when the same conference occurred twice each year.

He hammered home that the sticking point for him in the WSU-DMC relationship is accountability, or standards of performance, in the contract with 700 faculty physicians that prevent delays and gaps in coverage for patients.

Duggan emphasized that 14 of 18 WSU/DMC groups remain in the joint agreement and those groups have seen a net increase in pay from $70.3 million in 2006 to $80.9 million in 2007.

“We’re in the black and have hired 1,000 people since January,” he said. “At the end of the day, we’re in the black for five years and caring for (people) in the City of Detroit.

“We can go back to the old way (when we gave the dean $80 million) but we’ll be back to ask you (state government) for a bailout.”

Dr. Frank looked back seven years when, he said, the School of Medicine gave back $25 million in payments to keep the DMC afloat and then watched as the medical center subsequently and unilaterally defunded four residency programs, failed to sign the term sheet (a sort of pre-contract) that resulted from a mediator-brokered deal last fall and then last month arbitrarily docked WSU faculty physicians $12 million claiming that new Medicaid money from the state constituted a double payment for services.

Dr. Frank said DMC was fully aware of the additional state money before signing the term sheet last fall. Further, he said, even with the additional money, WSU faculty physicians are providing services for about 57 cents on the dollar.

Dr. Frank said that despite the difficulties created by the WSU-DMC dispute, the faculty physicians continue to provide the full range and volume of services they provided prior to the $12 million cut.

“The WSU/DMC powerhouse is in peril because the DMC can’t or won’t honor the contract (term sheet),” said Dr. Frank.

In response to an obvious but unasked question, Sen. Dr. George said the committee took up this issue because “There are $675 million a year in state funds spent between these two institutions – it’s our job, that’s why this is on the agenda.” He added that the constitutional requirement for the legislature to provide for the health and welfare of Michigan’s citizens paired with the fiduciary responsibility resulting from the expenditure of state dollars makes this dispute of great interest to the legislature.

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Mich. Proton Beam Group Meets First Deadline

Six Michigan health care systems have met a June 5 deadline set by the state’s Certificate of Need commission, by submitting a letter indicating that they have committed to a consortium approach to bring proton beam therapy to the state.

The six are among the state’s largest health systems, and include the state’s only two National Cancer Institute-designated comprehensive cancer centers.

The letter to the CON commission, required to ensure the consortium effort is moving forward, affirmed that these six health systems have agreed to participate in the collaborative and contribute their share of the start-up costs.

The consortium was formed to mitigate the costs of proton beam therapy – starting with the $160 million needed to build a treatment center. At the same time, a consortium will provide greater economic benefit to Michigan than a single hospital provider, since it will spread an economic benefit across a wide array of providers and communities.

In addition, a consortium ensures the state will have one proton beam center operating at high efficiency, versus multiple centers each operating at low volumes, risking financial and operational viability. One high-efficiency center will also allow providers to gain greater expertise at delivering this technology safely and effectively.

“Working together will ensure health care costs are carefully managed. The state of Michigan and its citizens can’t afford to have individual institutions developing their own proton beam programs. The collaborative will ensure appropriate utilization and cost-management,” says Robert P. Kelch, MD, executive vice president for medical affairs at the University of Michigan and chief executive officer of the U-M Health System, which is part of the consortium.

Proton beam therapy is a type of radiation that is based on high-energy particles called protons, whereas current radiation therapy uses photons, or X-rays. Proton beam therapy appears to be most promising for treating pediatric cancers and certain rare tumors in adults, but more research is needed to fully understand the potential of this treatment. The consortium approach will include a research component to help define which patients will benefit from proton technology.

The consortium will next develop a business plan, which must be submitted to the CON commission by Sept. 6.

The six health systems that have agreed to the collaborative to date are:
• Barbara Ann Karmanos Cancer Center
• Genesys Hurley Cancer Institute
• Henry Ford Health System
• McLaren Health Care (the Great Lakes Cancer Institute-McLaren Campus)
• St. Joseph Mercy Hospital, Ann Arbor (Trinity Health)
• University of Michigan Health System

All high-volume hospital-based providers of radiation therapy services in the state have been invited to join the consortium, and other providers will be invited per state regulations. This will ensure the greatest possible access to care for the most people in the state who are in need of proton beam therapy.

The consortium approach is supported by a large number of providers, purchasers and employers, as well as by the Economic Alliance of Michigan, the Michigan Manufacturers Association and the Small Business Association of Michigan.

For more information about Michigan’s proton beam consortium, visit www.protontherapyformichigan

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Bill Would Delay Reduction In Medicare Physician Reimbursements

Senate Finance Committee Chair Max Baucus (D-Mont.) on Friday introduced a bill (S 3101) that would delay for 18 months a 10.6 percent reduction in Medicare physician reimbursements scheduled to take effect on July 1 and increase payments by 1.1 percent, The Hill reports.

The legislation, which includes a number of other provisions, would cost about $20 billion. The bill includes provisions to promote electronic prescribing and expand rural health care programs. In addition, the legislation would require Medicare to promptly pay pharmacies for medication dispensed to beneficiaries and impose new marketing restrictions for Medicare Advantage plans (Young, The Hill, 6/6). The bill would reduce the copayments that beneficiaries pay for mental health services from 50 percent to 20 percent (AP/Albany Times Union, 6/6).

According to The Hill, although "Congress is under considerable pressure to prevent this reduction and preserve beneficiaries' access to medical services," the bill faces "several political and ideological barriers." For example, the Bush administration has threatened to veto any legislation that would reduce spending for MA (The Hill, 6/6).

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Kaiser Permanente, Microsoft Launch EHR Pilot Program

Officials from Kaiser Permanente and Microsoft on Monday announced that the companies are developing a patient information exchange pilot program, Reuters/Washington Post reports (Kaufman, Reuters/Washington Post, 6/9).

Under the program, patients who use Kaiser's personal electronic health record system, My Health Manager, will be able to transfer medical data -- including prescriptions, allergies, immunization information and medical conditions -- from My Health Manager to Microsoft HealthVault accounts. Users will be able to dictate what information is transferred and will have access to their profile via the Internet (Lawton, Wall Street Journal, 6/9). Initially, the program will only be available to Kaiser's 156,000 employees (Reuters/Washington Post, 6/9).

The pilot stage will last until November. If successful, the program would then be offered to Kaiser's 8.7 million members in nine states and Washington, D.C. (Lohr, New York Times, 6/10). During the pilot stage, Kaiser will be testing the program's security to ensure it meets safety standards, according to Anna-Lisa Silvestre, Kaiser's vice president of online services (Wall Street Journal, 6/9).

Other electronic health information efforts are underway, including a collaboration between Revolution Health Group and Google, which launched Google Health in February (Reuters/Washington Post, 6/9).

Silvestre said Kaiser also considered partnering with Google on its project but chose Microsoft in part because of its privacy protection and personal security technology. In addition, Microsoft and Kaiser are using the same Web-based format, called a Continuity of Care Document, while Google has focused its initial efforts on a Continuity of Care Record Web format. Google and Microsoft each are committed to supporting both formats, the Times reports.

Silvestre added, "Google will certainly be a player in this, and we look forward to working with them. We're all for consumer choice."

According to the New York Times, analysts said the Kaiser program is significant because of the company's size and "its reputation as an innovative user of information technology." Silvestre said Kaiser's internal health record system is doubling annually, adding that 2.25 million of its members currently use it (New York Times, 6/9).

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Panel Discusses Expanding Coverage Via 'Early Medicare' Program

At a panel discussion on Friday, lawmakers and health experts considered a Commonwealth Fund proposal that would provide health insurance to 44 million of the 48 million uninsured US residents, CQ HealthBeat reports (Wyckoff, CQ HealthBeat, 6/6).

Under the proposal, a government-operated connector authority would offer lower-cost health plans, including a "Medicare Extra" plan built on the existing Medicare system. All employers would be required to provide coverage for workers or contribute up to 7 percent of their payrolls into a fund to generate about $45 billion. Tax credits would be used to ensure that premiums account for no more than 5 percent of income for lower-income families and 10 percent for higher-income families. People who remained uninsured would automatically be enrolled in a plan when their taxes are filed (Kaiser Daily Health Policy Report, 5/13).

The plan also calls for the overhaul of health information technology, evidence-based medicine, public health and the health payment system.

The Commonwealth Fund estimates that Medicare Extra premiums would be 30 percent lower than employer-sponsored plan premiums. Proposal co-author Cathy Schoen of the Commonwealth Fund on Friday said that early coverage under Medicare is supported by 73 percent of older US residents and 66 percent of US residents between ages 50-64 who are currently covered by their employers.

Rep. Tom Price (R-Ga.) questioned the idea of basing a health insurance option on Medicare, saying, "It took us 40 years for us to get Medicare to see that it needed a prescription drugs program." He added, "I think we are brighter and better than the current system that we have."

Cybele Bjorklund, Democratic staff director for the House Ways and Means Committee, said that Medicare would be a good model for expanding health insurance because it is efficient and providers prefer it over private insurance (CQ HealthBeat, 6/6).

A webcast of the panel discussion, sponsored by the Alliance for Health Reform and the Commonwealth Fund, is available online at kaisernetwork.org.

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AMA Applauds Genetic Anti-Discrimination Law

President Bush's signing of the Genetic Information Nondiscrimination Act of 2007 into law last week-and Congress' approval of the bill earlier this month-drew applause from the AMA, which has long called for better patient privacy safeguards as scientific advancements make it possible to individualize health care for patients.
"Genetic testing holds great promise for improving public health, and patients must be able to trust that their genetic information will be protected from inappropriate and discriminatory uses," said AMA Trustee Edward L. Langston, MD. "This new law will allow patients to take advantage of scientific advances in genetics, such as screenings and therapies, without worrying that their personal health information could be used against them by insurers or employers."

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WSU Docs In The News

Zhe Yang, PhD, assistant professor of Biochemistry and Molecular Biology with the Wayne State University School of Medicine, has been awarded a four-year Scientist Development Grant from the National American Heart Association to further his research of an enzyme that could lead to new treatments to combat heart arrhythmia and cardiac failure.

The $308,000 award will fund research to develop a detailed structural and functional understanding of SmyD1, a histone methyltransferase specifically expressed in cardiac and skeletal muscles. Histone modifications are now widely recognized as a vital epigenetic mechanism that controls diverse cellular processes, such as gene expression, chromatin remodeling, DNA repairing and cell division. However, the molecular details of the roles of histone modifications in cardiovascular biology remain poorly understood.

His own experience with epilepsy is leading Erik Brown to a career in the field of neurology, with the possibility of playing a role in international medicine.

The first year MD/PhD student became interested in neurology while in high school because of his own experiences with epilepsy. “I decided that I definitely wanted to go to medical school one day while working as an electrical engineering co-op student with the biomedical company Cyberonics, makers of the Vagus Nerve Stimulator,” he said.

Mr. Brown, 26, is originally from Allen Park. Now living in Dearborn, he completed his undergraduate studies at the University of Michigan.

This year, Mr. Brown captured first place in MD/PhD competition and first place in the 2008 Medical Student Research Symposium with research he conducted with Dr. Eishi Asano, MD, PhD, assistant professor of pediatrics and neurology in the Electrophysiology/Neurosurgery departments of Children's Hospital of Michigan at Children's Hospital of Michigan. A manuscript associated with the research, on which Mr. Brown is first author, was accepted for publication by the journal NeuroImage.

The Medical Student Research Symposium competition requires participants to orally present their research within 15 minutes to a diverse audience. The best presentations are technical but understandable.

The goal of the research, associated with the School of Medicine’s Department of Anatomy and Cell Biology, was to determine whether gamma-oscillations induced by auditory communication localized language areas in pre-surgical evaluation of children with focal epilepsy.

Zhiwei Wang, PhD, a postdoctoral fellow in the Department of Pathology, received a $106,121 award from the US Department of Defense for his research on the genes involved in the proliferation, migration and invasion of prostate cancer cells.

Dr. Wang is investigating Jagged-1, a gene believed to be associated with Hormone Refractory Prostate Cancer (HRPC) - a state the disease sometimes reaches when hormone treatment is no longer affective - and metastatic prostate cancer, the condition in which the disease spreads from the prostate to other parts of the body.

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CBO Looks At Transparency As A Health Cost Reducer

"Increasing Transparency in the Pricing of Health Care Services and Pharmaceuticals," Congressional Budget Office: The CBO issue brief examines whether increased transparency of specific health care services and pharmaceuticals would help alleviate the rapid growth in costs. According to the brief, several factors among consumer and providers may limit the effectiveness of transparency's ability to cut costs. However, the brief notes that a greater awareness of health care costs and who bears those costs might generate increased demand for efficiency (CBO, "Increasing Transparency in the Pricing of Health Care Services and Pharmaceuticals," 6/5).

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