E-DMN - November 10, 2008

November 10, 2008

In Memory Of Ron Davis, MD
Colleagues Remember Dr. Davis
A Note From Dr. Davis
Rapid HIV Testing Boosts Diagnoses, Screening
Urge Lawmakers To Preserve Tort Reforms, Protect Health Care
Medical Marijuana Law Resource Guide
Stark Urges Block Of Medicare Advantage Sales Commissions Rules
AMA Survey Highlights Need To Improve Medicare's PQRI

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In Memory Of Ron Davis, MD

Editor’s Note: The following item first appeared on the MSMS website.

Michigan physician and AMA Immediate Past President Ronald M. Davis, MD, died November 6 after a courageous battle with pancreatic cancer. Dr. Davis, a preventive medicine specialist from East Lansing, was a lifelong champion of tobacco cessation and wellness issues, and a leader in the national movement to provide coverage for the uninsured.He was 52.

"I found Dr. Davis to be a truly dedicated and inspirational leader," said MSMS President Michael A. Sandler, MD."He also was a genuinely wonderful person. His speeches that he had given over the last year at the AMA meetings were the best medical speeches I have ever heard," he continued."Our hearts go out to his wife Nadine, and their three sons, Jared, Evan and Connor."

Dr. Davis had a remarkable history of leadership at the national level.He was the first resident physician member on the AMA Board of Trustees, and was Chair of the Board Finance and Audit Committees, AMA representative to the Joint Commission on Accreditation of Healthcare Organization's Board of Commissioners, and AMA Liaison to the Advisory Committee for Injury Prevention & Control at the CDC, among many other key posts.

This summer, Dr. Davis told his colleagues at the AMA, "I will continue to be proud to work with all of you, in our continual effort to improve health care for patients across this nation--in a continual effort to make the AMA a testament to the love we physicians have for those under our care."

"He was showing all of us that serving a higher goal is a responsibility and a passion he cherished," said AMA President Nancy H. Nielsen, MD, PhD."Without hesitation, I can say that Doctor Davis' passion for advancing the science and art of medicine and the betterment of public health has no equal."

Dr. Davisreceived his undergraduate degree from the University of Michigan, completed medical school at the University of Chicago Pritzker School of Medicine, and earned a master's degree in public policy at the same university.

Click here to view a photo slideshow in memory of Doctor Davis.
Click here to read the press release issued by the AMA.

Condolences and messages to Doctor Davis's family may be posted at his CarePages website at www.carepages.com/carepages/rondavis.

Funeral services will be held at:
10:30 A.M.
Tuesday, November 11, 2008
Trinity Church
3355 Dunckel Rd.
Lansing, MI
Rabbi Michael Zimmerman and Pastor Royce Allen officiating

In lieu of flowers, donations in Ron's memory may be made to the following organizations:

The American Medical Association Foundation
Ronald M. Davis, M.D. Legacy Honor Fund
515 North State Street
Chicago, Illinois 60610
(312) 464-4200

The endowment fund in Dr. Davis' name will live in perpetuity, supporting the AMA Foundation's mission to advance health care through support of programs in medical education, research and public health.

The Pancreatic Cancer Action Network (PanCAN)
2141 Rosecrans Avenue
Suite 7000
El Segundo, CA 90245
www.pancan.org

PanCAN advances research, supports patients and creates hope by funding research and supporting an all volunteer network focused on community outreach programs to build awareness, as well as leading advocacy efforts on Capitol Hill to lobby for proper funding levels for pancreatic cancer research.

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Colleagues Remember Dr. Davis

Editor’s Note: The following message is from Kimberlydawn Wisdom, MD, HFHS vice president, Community Health, Wellness and Education; and Mark Kelley, MD, CEO, Henry Ford Medical Group

It is with great sadness for the nation's medical and public health communities, all of Henry Ford Health System, and those of us who called him a colleague and friend that we announce that Ronald M. Davis, MD, died Thursday at his home in East Lansing.

All the while he battled pancreatic cancer diagnosed earlier this year, Dr. Davis remained a relentless advocate for improving the health status of patients everywhere. As president of the American Medical Association from June 2007 to June 2008, Ron took an agenda begun at Henry Ford in his role as a preventive medicine physician and expanded it across the country, pushing the AMA to focus on a "healthy lifestyles" platform. His leadership on major public health issues, particularly public bans of smoking, contributed greatly to the reduction in cigarette smoking and second-hand smoke nationwide. He also served as director of the Office on Smoking and Health at the US Centers for Disease Control and Prevention, and as medical director of the Michigan Department of Public Health (now known as Michigan Department of Community Health).

As director of the Center for Health Promotion and Disease Prevention at HFHS for the past 13 years, Dr. Davis' tireless efforts on behalf of patients and populations were widely recognized. He received many honors for his leadership, including the US Surgeon General's Medallion, the American College of Preventive Medicine's Distinguished Service Award, the World Health Organization's World No-Tobacco Day medal and award, and, most recently, the American Public Health Association's 2008 Lifetime Achievement Award for his career-long fight against alcohol, tobacco and other drugs.

Dr. Davis was a highly regarded researcher, editor and writer. He was the founding editor of Tobacco Control, an international peer-reviewed journal published bimonthly by the British Medical Association, and served in that role from 1992 to 1998. Dr. Davis also was North American editor of the British Medical Journal from 1998 to 2001.

As the first Henry Ford Medical Group physician to serve as AMA president, the first preventive medicine physician ever to be elected to that role, and as a leader of our System's commitment to health promotion and disease prevention, Dr. Davis has left a legacy that will not only be remembered with awe and respect, but that will flourish as we continue his mission.

Our deepest sympathies are extended to his loving family: his wife, Nadine and three sons, Jared, Evan and Connor.

Thank you.

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A Note From Dr. Davis

Editor’s Note: The following is a note from Dr. Ron Davis to AMA Delegates prior to the board’s recent meeting.

November 4, 2008

Dear Board Colleagues, AMA President Nancy Nielsen, AMA Board Chair Joe Heyman, and Members of the House of Delegates,

Nadine and I are deeply sorry that we could not join you for this meeting in Orlando. My heart is with you as you continue the vital work in health care policy that’s ahead of us now especially with a new Presidential administration soon to take office. I will miss these discussions that will be so very rich in health policy issues critical to the well being of all Americans.

I have worked tirelessly for the American Medical Association for thirty years. I have come to know so many of you through the years and I have worked with you on the AMA committees, in my position as a member of the Board of the AMA, and as President. Some of you remember me as a young medical student just beginning my journey. That energetic medical student committed to public health is still a part of me although experience and maturity have taught me how to understand the different views of other physicians and how we must work together. I truly believe that together we are stronger. As you move forward there are challenging issues ahead especially in providing health care to the millions of Americans who are uninsured. We must also work to end health care disparities.

It has been an honor and a privilege to serve this AMA House of Delegates. You have designated me as a leader, but I tell you honestly that in many ways you have led me. Your concerns and your friendship have guided me through the years. Now I must complete my “circle of life” and go with God.

Thank you for letting me serve.

Ron

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Rapid HIV Testing Boosts Diagnoses, Screening

One in every 50 people screened for a suspected sexually transmitted infection (STI) in the Emergency Department at Henry Ford Hospital was found to be infected with HIV using a rapid blood sample screening test.

Henry Ford researchers hope their study heightens awareness and directs more focus on implementing future prevention strategies in the HIV/AIDS epidemic. They say testing in the ED could diagnose new HIV infections, expand the reach of screening, and help get patients into counseling and treatment programs.

The study comes on the heels of a report by the federal Centers for Disease Control and Prevention that showed an estimated 56,300 HIV infections occurred in the United States in 2006, up by more than 16,000 from a previous estimate earlier this year. The CDC said the difference was due to the use of a more precise method of technology for estimating HIV incidence. The report was published in the Aug. 5 edition of the Journal of the American Medical Association.

The CDC noted that while the new estimate did not represent an actual increase in new infections, it showed that the HIV epidemic is worse than previously known. An estimated 275,000 U.S. adults were living with undiagnosed HIV infection in 2006.

“This sobering news should underscore a need to look at new ways of expanding the reach of HIV testing,” says Indira Brar, MD, an Infectious Disease specialist at Henry Ford and lead author of the study.

“We know that people are more likely to modify risk behaviors and less likely to transmit or acquire infection if they know whether they are HIV positive or not. By offering more testing resources, as our study reflected, we can boost ways to diagnose infections and accelerate progress in reducing the HIV epidemic.”

The study will be presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the Infectious Diseases Society of America (IDSA) Oct 25-28 in Washington DC.

Hoping to increase efforts to better track HIV/AIDS prevalence and incidence, the CDC is working with states to implement a national system for estimating HIV incidence based on direct measurement of new HIV infections, closing a previous loophole for tracking the epidemic. The agency also says the new system, when available, will provide the “clearest picture to date” of HIV infections in the country. The new system, the CDC says, will allow better target prevention and measure progress in high-risk populations.

HIV prevalence, defined as people living with HIV/AIDS, increased from 2003-06 nationally, while HIV incidence, defined as new HIV infections, remained stable.

According to the Henry Ford study, patients who sought treatment for a STI in Henry Ford’s Emergency Department from 2004-08 were screened for HIV using a rapid antibody test. The test, administered with a finger-stick for a blood sample, provides results for HIV infection in 20 minutes.

Of the 2,575 patients tested for a STI, 56 were newly diagnosed with HIV, the virus that causes AIDS, and a majority of them also tested positive for gonorrhea, chlamydia or syphilis. Patients received counseling with their results, and were given access to follow-up care within three days.

According to national and state figures, the rate of new HIV infection among African Americans is eight times that of other ethnic groups. In the Henry Ford study, 90 percent of the new diagnoses occurred in African Americans and 75 percent were in men.

The Henry Ford study also found that 55 percent of the ER patients were infected through high-risk heterosexual sex and 35 percent were infected through male-to-male sex, in contrast to 2006 Michigan and national figures in which nearly half of all people diagnosed with HIV in the United States in 2006 were infected through male-to-male sexual contact.

The study was funded by the Michigan Department of Community Health and Detroit Department of Health and Wellness Promotion.

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Urge Lawmakers To Preserve Tort Reforms, Protect Health Care

The Michigan House Judiciary Committee held a hearing Sept. 9 about House Bill 6277, introduced by Rep. Mark Meadows (D-East Lansing), which would broadly modify-and put at risk-Michigan's nation-leading tort reforms. The bill contains numerous provisions that would change major components of the existing law, including expert witness qualification, affidavit of merit, notice of intent, statutes of limitations, etc. (Read the House Fiscal Agency analysis of the bill online at www.msms.org/advocacy.)

MSMS President and WCMSSM member Michael A. Sandler, MD, a Wayne County diagnostic radiologist, testified against the bill on behalf of MSMS.

"Health care already faces numerous strains that impede the ability to deliver care to patients. Weakening liability reforms in Michigan will lead to the same type of crisis we experienced in the past," he said. "Michigan cannot afford to turn back the clock on tort reform."

The bill comes at a particularly vulnerable time, as physicians lost a tort reform ally when Michigan Supreme Court Chief Justice Clifford Taylor lost his reelection bid last week, potentially tipping the balance of the court, which has upheld challenges to tort reform laws in place since 1994.

Doctor Sandler further testified about the current medical liability climate in Michigan and its effect on access to care. He specifically cited Pennsylvania, which has been slow to address its liability crisis and is struggling to recruit young physicians to practice there, as well as access problems in Nevada and West Virginia.

"Access to specialty care is generally available in Michigan, unlike recently in Nevada and West Virginia, where severe trauma cases required traveling to neighboring states to receive care," he said.

Daniel J. Schulte, JD, of MSMS Legal Counsel Kerr, Russell & Weber, PLC, also testified and articulated MSMS's legal concerns with the bill, including the provision that would eliminate the requirement of an expert witness to be board certified in the same specialty as the defendant physician.

"Being judged by one's peers is a fundamental tenet of US jurisprudence," he said. "Medical malpractice cases shouldn't be any different."

Thanks to the hard work of MSMS, the Committee decided not to take a vote on the issue during the hearing. However, the bill could move soon.

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

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Medical Marijuana Law Resource Guide

In light of passage of Proposal 1 allowing use of smoked marijuana for medical purposes, MSMS is investigating the details that physicians need to know with regard to definitions, procedures, and legal parameters for recommending marijuana as a pain and symptom relief solution for patients, starting in April 2009, if they so choose. MSMS will provide input to the Michigan Department of Community Health (MDCH) as rules are developed.

Following are resources that outline and explain the next steps in this process:
--Crain's - Administrative rules are next step for new medical marijuana law

--MDCH Q&A [pdf]

As background, in May the MSMS House of Delegates resolved (Resolution 59-08A) that the ballot proposal on smoked marijuana could not be supported. MSMS communicated that through a coalition including MHA, MOA, law enforcement and other agencies.

Watch the MSMS website, email and Medigram for further developments on definitions, rules and parameters as this new law takes form.

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

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Stark Urges Block Of Medicare Advantage Sales Commissions Rules

Rep. Stark Urges CMS To Block New Medicare Advantage Sales Commissions Rules, Saying They Will Promote 'Churning'
[Oct 24, 2008]

House Ways and Means Subcommittee on Health Chair Pete Stark (D-Calif.) on Thursday in a letter to CMS acting administrator Kerry Weems called for a limit on new sales commissions in an attempt to dissuade sales agents from pressuring Medicare beneficiaries to frequently switch Medicare Advantage plans, CQ HealthBeat reports (Reichard, CQ HealthBeat, 10/23).

CMS on Sept. 15 issued new rules governing insurance companies, agents and brokers regarding the marketing of Medicare prescription drug plans and MA plans. The new rules -- some of which were mandated by Medicare legislation passed earlier this year -- took effect Oct. 1, the first day marketing efforts for the Medicare open enrollment period that begins Nov. 15 are allowed. The rules stipulate, among other things, that commission for sales agents will be required to conform to a structure used in other parts of the insurance industry. First-year commission for a new customer cannot exceed 200% of the commission for the next five years, in order to remove the incentive for agents to "churn" beneficiaries between different plans each year (Kaiser Daily Health Policy Report, 9/16).

However, because the regulations are just taking effect, some plans now are increasing commissions in order to lock them in for the next five years. In the letter, Stark wrote that insurers are "gaming" the new regulations by raising commissions to levels "that far exceed any previous year's commissions" (CQ HealthBeat, 10/23).

Stark added, "I am gravely concerned that without immediate action ... these elevated commissions will lead to an unprecedented amount of churning of beneficiary enrollment this year, in a way that is disruptive to their care and detrimental to their coverage." Stark recommended a cap on sales commissions at a "reasonable rate, perhaps as a percentage of what was offered in years past." CMS spokesperson Jeff Nelligan said, "We are aware, have been aware and will address this issue." According to Robert Zirkelbach, a spokesperson for America's Health Insurance Plans, members are dedicated to reducing unnecessary plan turnover and support CMS' efforts to oversee MA marketing activities. Zirkelbach agreed that there is a need to rework the commission structure to ensure the new rules achieve their aim (CQ HealthBeat, 10/23).

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Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/healthpolicy . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved."

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AMA Survey Highlights Need To Improve Medicare's PQRI

Key elements of Medicare's Physician Quality Reporting Initiative (PQRI) must be improved so that physicians can successfully participate and use the information to increase the quality of patient care. This is the main take-away from the American Medical Association's (AMA) new survey of physicians who participated in the PQRI during its first year of implementation.

More than six out of 10 physicians surveyed rated the program difficult, and only 22 percent were able to download the PQRI feedback report for their practice. To maximize physicians' experience with the program and to encourage more to participate, the Centers for Medicare and Medicaid Services (CMS) should place a greater emphasis on early education and feedback. In addition, Congress should allow CMS to develop a process that allows physicians to appeal CMS judgments on inaccurate reporting.

"Physicians are committed to improving the quality of patient care, and the AMA is committed to working with policymakers to make this program a viable quality improvement tool for physicians," said AMA Board Member Ardis Hoven, MD. "The AMA survey shows a clear need for the program to be improved so that physicians can more easily participate and so that they and Medicare get greater value from the program."

Of those who were able to access their feedback reports, less than half found the information instructive. Of the physicians who asked for assistance from CMS, 59 percent rated their satisfaction with CMS responsiveness as none to low. Physicians who began reporting in July 2007 did not receive a feedback report until 12 months later, halfway through the program's second year, making it impossible to fix any reporting problems. This may have contributed to the fact that nearly half of all PQRI participants did not receive any bonus payment. If reforms are not made to the program, physicians who participate in 2008 will not receive feedback reports until 18 months after initial reporting.

"It is our hope that CMS works with the AMA and uses this information to improve the PQRI so that more physicians can successfully participate in the program," said Dr. Hoven. "Physicians need to be confident that the effort they put into participating in the PQRI is worthwhile for both their patients and their practice."

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