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October 13, 2008 |
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IN THIS ISSUE
Editor's Column: The Playing Field Unlevels More
Detroit Receiving Wins Award For Surgery Program
WSUSOM News
Mental Health Parity Bill Becomes Law
How The Candidates View Health Policy
AMA Releases Health And Wellness Book
E-Summit: Six Degrees Of Electronification
Michigan Healthcare Provider
Recovery Program |
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The Playing Field Unlevels More
By JOSEPH WEISS, MD
The proposal is now policy. In its October issue of The Record, Blue
Cross Blue Shield announced that as of Oct. 1, its non-reimbursement
for specified adverse events is in effect.
BCBS borrowed the idea of no payment from rules already
adopted by Medicare, stating that the government would not reimburse
hospitals for adverse events such as objects left in a patient after
surgery, surgery on the wrong body part, injuries to patients from
falls in the hospital, orthopedic and bariatric surgical site
infections etc. BCBS went further, adding that not only will the
hospital not receive payment, but the physicians providing care
should submit their claims with a charge of 1 cent( The Record,
October 2008, p16).
The BCBS policy of punitive action is wrong. No argument
exists that what Medicare and BCBS have labeled as “serious adverse
events” is a proper designation. What needs to be done is to
compensate the patient, a concept fully developed in the Michigan
State Patient Compensation Act, a proposal from MSMS. What also
needs doing is an investigation whenever a serious adverse event
occurs. If the Joint Commission on the Accreditation of Healthcare
Organizations made each serious adverse occurrence “a sentinel
event,” then an inquiry as to cause and recommendations for
prevention would be a required hospital response.
An appropriate approach to serious error should focus on
assisting the patient and changing the environment that brought on
the mistake. The BCBS policy on adverse events does not foster
reform, but instead perpetuates punishment.
Dr. Adelman’s Comments
It appears to
me that nonpayment for supposedly preventable adverse events will
have several effects: It will cause some payments to be put off on
patients, a patently unfair result.
It also will result in a reluctance to truthfully report adverse
events or to correctly analyze their cause. This probably will also
generate an additional expensive institutional bureaucracy dedicated
to trying to prevent the types of events that trigger nonpayment.
One might hope that this will result in better patient care, but
experience has not borne out this result consistently. This probably
will result in increasingly demoralized doctors, which will further
skew the choices of a career that we will see among graduating
residents. It also will narrow margins for hospitals, thus adversely
affecting their ability to hire additional staff.
We should really ask for precise definitions of preventable adverse
events, and the profession, led by our medical societies, needs to
go over with the insurers the circumstances under which such events
might not be preventable or might be due to elements in the system
not under the control of the doctor. That last point is actually
quite important. Penalizing the doctor because a member of the
hospital staff did not count sponges correctly or change a dressing
on a catheter properly seems quite wrong.
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Detroit Receiving Wins
Award For Surgery Program
Detroit Receiving
Hospital has been awarded a five-star rating for superior clinical
performance in gastrointestinal surgery for 2009, by Health Grades,
a national medical rankings organization. These rankings are based
on Medicare inpatient data from the MedPAR database, collected over
a rolling three-year period, and Health Grades’ risk-adjustment
methodology.
Receiving
Hospital’s five-star rating indicated that actual performance was
better than predicted and the difference was statistically
significant, reported the hospital. The rating was based on data and
risk-adjustment methodology concerning 21 clinical procedures
associated with gastrointestinal surgery, including gastric ulcer
sutures, partial resection of the small bowel and total removal of
the small intestine, among others. To learn more about Health
Grades’ ratings and awards, visit their web site
www.healthgrades.com/ratings .
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WSUSOM News
Dermatology Chair Endowment
Research in the Department of Dermatology at the Wayne State
University School of Medicine has a promising future, thanks to Dr.
Ken Hashimoto and his wife, Noriko.
The Hashimotos recently made a significant bequest to establish the
Dr. Ken Hashimoto and Noriko Hashimoto Endowed Chair in the
Department of Dermatology and Syphilology. Dr. Hashimoto chaired the
Department of Dermatology from 1980 to 2000, when he retired as
professor emeritus.
“Research was the most important element of my job,” said Dr.
Hashimoto, who wrote 384 professional papers, 39 book chapters and
eight books during his distinguished career. Earning respect as an
excellent educator and widely regarded as a top clinician
internationally, in addition to managing classroom and laboratory
teaching responsibilities, Dr. Hashimoto trained 100 resident
physicians and 40 research fellows, assuring the continuance and
growth of his academic and clinical expertise in new generations of
dermatologists.
Dr. Hashimoto was born and raised in Niigata City, Japan. A strong
legacy of achievement in academic medicine exists in his family. His
father held the position of professor and chairman of dermatology,
dean of the Niigata University School of Medicine and president of
the university, where Dr. Hashimoto received his M.D. degree. Dr.
Hashimoto’s brother also is a dermatologist and Noriko's father was
the professor and chairman of the Department of Surgery at Niigata
University.
Dr. Hashimoto held faculty positions at the University of Tennessee
and Tufts University, and was chairman of Dermatology at Wright
State University in Dayton, Ohio, before coming to Wayne State
University in 1980.
Kresge Grant To Help Fund Education Commons
The Wayne State University School of Medicine Development and Alumni
Affairs Department has secured a $3 million grant from The Kresge
Foundation to be used in the construction of the Richard J. Mazurek,
MD, Medical Education Commons.
The
Kresge Foundation committed the grant with the condition that the
School of Medicine first raise $30 million for the building,
destined to become the new face of the school. The School of
Medicine’s development team met that goal with a recent gift from an
anonymous donor, triggering the Kresge challenge grant.
“With the awarding of this grant, we are saluting your efforts to
improve conditions and advance opportunities in your community,"
said Rip Rapson, president of The Kresge Foundation. "We must
partner with nonprofit organizations such as the School of Medicine
if we are to pursue our grant-making vision. You enable our work as
much as we try to enable yours.”
The
Kresge Foundation is a private foundation that supports communities
by building the capacity of nonprofit organizations in health, the
environment, arts and culture, education, human services and
community development.
SOM
Team Lands $1.67 Million Grant For Breast Cancer Blood Test
A Wayne State University research team has secured a $1.67 million
National Institutes of Health grant to investigate the possibility
of a simple blood test to diagnose breast cancer.
Felix Fernandez-Madrid, MD, PhD, professor of Internal Medicine,
will serve as principal investigator of the research, which is a
collaboration of School of Medicine faculty, including Judith
Abrams, PhD; Wei Chen, PhD; and Naimei Tang, PhD; as well as members
of the Henry Ford Health System Departments of Pathology (Azadeh
Stark, PhD; Richard Zarbo, MD; and Arun Dhananjay, MD), Radiology
(Matthew Burke, MD); and Surgery (David Nathanson MD).
The
research will attempt to develop a diagnostic test based on proteins
called autoantibodies that could detect accurately the earliest
forms -- as well as the invasive forms -- of breast cancer.
The
outcome of the project, Dr. Fernandez-Madrid explained, may be a new
antibody-based diagnostic instrument that could prove to be an
accurate, relatively inexpensive, accessible, rapid and
easy-to-administer blood test for the early diagnosis of breast
cancer.
“If
successful, this test -- used in conjunction with mammography -- has
the potential to complement and increase the accuracy of the
screening process,” Dr. Fernandez-Madrid said. “By reducing the
false negative results of mammography, the increased accuracy of the
screening process would lead to earlier recognition of breast cancer
and better responses to therapy, while the decrease of false
positive mammography results would alleviate women’s anxiety, and
would diminish the cost incurred in unnecessary additional
diagnostic procedures and surgery.”
The
spark for the research occurred, Dr. Fernandez-Madrid explained,
when he was treating a rheumatoid patient, who later developed
breast cancer. He drew a blood sample after her cancer treatment and
found the autoantibodies. He compared the post-treatment sample with
a sample drawn before treatment and found the autoantibodies in her
blood. That catalyst led to the proposition that the autoantibodies
could be a primary indicator for breast cancer.
Dr.
Fernandez-Madrid, who is also a member of the School of Medicine’s
Center for Molecular Medicine and Genetics, and the Karmanos Cancer
Institute, said the NIH grant runs for three years.
The
research secured a previous three-year NIH grant for $223,500 in
2001.
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Mental Health
Parity Bill Becomes Law
The AMA applauded
a new law enacted earlier in the month that expands access to mental
health care for the 57 million Americans who struggle daily with
mental illness.
The law is part
of the economic bailout package that Congress approved and President
Bush signed last week. It prohibits health insurance plans from
setting higher copays or deductibles for mental health or substance
abuse treatment than for medical care, and it requires that
insurance coverage for mental health and substance-use disorders is
on par with physician health care coverage.
“Health insurers
routinely impose more benefit restrictions on mental health services
than on physical health services, despite the similarities in cost,”
AMA Trustee Jeremy Lazarus, MD, said. “Nearly half of all patients
with a mental health disorder do not receive needed treatment.
Thanks to congressional action, we can bring an end to insurance
discrimination against patients with mental health needs.”
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How The Candidates View Health Policy
Editor’s note:
The following is a thumbnail analysis provided by the Greater
Detroit Area Health Council, with a link to a more complete
analysis. Two trillion dollars a year are spent in the U.S. on
health care that is often not accessible, affordable or highest
quality. The 2008 Presidential candidates have outlined their views
on how to provide insurance coverage for the roughly 50 million
people who do not have it and at the same time reduce the cost of
health care for everyone. Health care policy views mirror their
economic views generally. The McCain plan expands the individual
insurance market. The Obama plan subsidizes and regulates the
current public-private health insurance market. Sen. McCain seeks to
treat employer based insurance payments as taxable wages. In
exchange he would give families a $5,000 tax credit that can be used
to buy insurance either through their employer or on the individual
market. Sen. Obama's plan would regulate, but not change tax policy
in the current the employer-based system. It would set up a
government run plan that would be open to everyone. The cost of
insurance for low income workers would be subsidized. For more
details on how the candidates differ in their views on health
care, go to
www.healthaccess1.org
look
for "Backgrounders" on the home page.
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AMA Releases Health
And Wellness Book
Everyone hopes
for a long, healthy life, and preventive medicine can hold the key
to living for many years. On Oct. 7 the American Medical Association
(AMA) released a new book, the American Medical Association Complete
Guide to Prevention and Wellness that provides guidance on achieving
optimal health at every stage of life. Filled with the latest
medical information on illness, prevention, and self-care, this
500-page book is the first AMA publication to offer comprehensive
preventive health information and tools for staying healthy
throughout life.
More than 24
million Americans have been diagnosed with heart disease; nearly 21
million have diabetes and an additional 54 million people have
pre-diabetes; and more than one-third of the American population is
obese. Making simple lifestyle changes and using preventive medicine
practices can significantly reduced a person’s disease risk factors.
The American
Medical Association Guide to Prevention and Wellness is separated
into three parts to help readers build a foundation for good health,
implement lifestyle changes to avoid illnesses, and take positive
health measures throughout life. Readers will learn the basic steps
to take to reduce health risks and prevent major illnesses that may
affect every part of the body. The book describes recommended
screening tests and key measures for healthy living, such as proper
nutrition, physical activity, and stress reduction – all of which
may help increase longevity.
The American
Medical Association Complete Guide to Prevention and Wellness
(Wiley, September 2008, $35.00/ Cloth; ISBN: 978-0-470-25130-0) is
comprehensive, easy to navigate, and filled with clear, helpful
information and illustrations. This book can be purchased at retail
and online bookstores and also directly from the AMA Bookstore.
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E-Summit: Six
Degrees Of Electronification
The MSMS Foundation invites physicians and other health care
professionals to attend E-Summit: Six Degrees of Electronification
on Thursday, November 6, 8:00 a.m. to 4:00 p.m., in Troy. The event,
which brings together a broad range of guest speakers, will
include these great presentations: “Getting Your Practice Ready for
the Digital Age,” “Data Dashboards in Clinic Practice,” and “Is
There a RHIO in Your Future?” Cost is
$25 for MSMS &
MMGMA members; $75 for non-members. For more information or to register,
visit
www.msms.org/eo or contact the MSMS Registrar at 517-336-5784 or
abatten@msms.org.
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Michigan Healthcare
Provider Recovery Program
HOW OFTEN ARE YOU
REMINDED OF THIS?
St. John
Health-Brighton Hospital
TREATMENT CENTER
FOR THE
MICHIGAN
HEALTHCARE PROVIDERS RECOVERY PROGRAM (HPRP)
INVITES YOU TO
JOIN US!
FREE DINNER AND
CONTINUING EDUCATION PROGRAM
(*approved 1CME
AMA PRA Category 1 Credit(s)™)
“Pharmaceuticals
Used in the Treatment of Chemical Dependency”
THE DISEASE OF
ADDICTION & THE HEALTHCARE ENVIRONMENT
MICHAEL BROOKS,
D.O., CHAIR OF PSYCHIATRY
THURSDAY, OCTOBER
16, 2008
6:00 p.m. – 9:00
p.m.
MEADOWBROOK
COUNTRY CLUB
40941 W. EIGHT
MILE ROAD
NORTHVILLE,
MICHIGAN 48167
248.349.3600 for
directions
Forward
reservation requests to:
Brighton Hospital
Attn: Maya
McElroy
Phone:
810.225.2531
Fax:
810.220.5518
Email:
mmcelroy@brightonhospital.org
GET ANSWERS TO
HOW ADDICTION AFFECTS YOUR PATIENTS,
CO-WORKERS,
FAMILY, FRIENDS, COMMUNITY, YOURSELF AND OTHER F.A.Q.s.
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