October 27, 2008

IN THIS ISSUE

Editor's Column: What Is The Real Patient Centered Medical Home?
In My Opinion: Is Health Care A Right?
Henry Ford Team Performs First Incisionless GERD Surgery
WSUSOM Student Saves Heart Attack Victim On Street
Mazurek Commons Well Underway
WSU, Local Hospitals Take Big Role In $57-Million Children's Health Study
Kennedy Concocts Health Plan
Stark Looks To Block Medicare Advantage Sales Commissions Rules

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Editor's Column: What Is The Real Patient Centered Medical Home?

By JOSEPH WEISS, MD
The American Association of Family Practice is the organization that fostered the concept of a medical home for adults. The Association’s definition of The Patient Centered Medical Home is a medical office that: “provides care that is accessible, continuous, comprehensive, coordinated and delivered in the context of family and community.”

According to Blue Cross and Blue Shield of Michigan, if a medical office is to achieve the designation of a medical home that office is required to have in place seven “domains of function” with each domain requiring anywhere from seven to 15 “capabilities.” The Domains and number of capabilities are:

According to the Geisinger Clinic, upkeep of their Patient Centered Medical Home model requires a special $1,800/month payment to the participating physician, and a $5,000/month additional stipend to the office per 1,000 covered patients. Michigan BCBS expects to pay $35/patient/month as total reimbursement for both physician incentive and Medical-Home-incurred office expense.

Likely, if someone asked the public what came to mind with the phrase “Medical Home,” the probable answer would not be a place with disease registries, reminder systems and graphs tracking performance measures. The more likely reply would be a medical office that is a familiar place, with familiar people who consistently provide care that is good, prompt and available when needed.

Insurers, policy makers, the heads of medical societies, and politicians are in pursuit of the Medical Home without consideration of the real needs of patients, and the human limitations of physicians. The effect of a policy following this fad will be to further discourage physicians from entering primary care as they see themselves saddled with responsibility beyond reason, and forced to manage an office with reimbursements below necessity.

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In My Opinion: Is Health Care A Right?

By ALLAN DOBZYNIAK, MD
Examination of the concept of health care as a right to be guaranteed by the government produces some interesting conclusions. Government does not and cannot create health care. Health care is the creation of people through their abilities, work and unique talents. This includes nurses, physicians, physical therapists, scientists, teachers, businessmen and others I do not wish to diminish if inadvertently omitted. The point being that government must usurp their work, wealth, and private property (personal talents) and distribute these to others simply because they need it, not because it has been earned. This is most clearly an immoral, unethical act. Because of this immorality government controlled health care can neither produce excellence nor can it be sustainable.

Health care solutions need to be practical solutions. Practical solutions insure moral solutions and therefore will be sustainable.

In fact the belief in guaranteed, government-controlled health care as a right has already led the system into its present mess. Arbitrary reimbursement schemes, progressive regulation, nonsensical tax policy, frivolous litigation, limiting of competition, and open-ended entitlements have all contributed to inappropriate and poor decision making by patients, payers and providers. Remarkably and despite this dismal record, physician leadership continues to look to government for mandates and regulations as a solution.

Patients must be put in charge and free markets allowed to provide competition. Free markets provide practical solutions. These are moral since they honor the concept of personal private property. In a free market health care would be viewed as a commodity and not perceived as a right. Then as a commodity in a capitalist system the resulting competition would lead to greater access, lower cost and increased innovation.

With health care as a right in a socialized system, the outcome would mimic other such failed systems with poor quality, inefficiency, increasing costs, higher taxes and the ugliness of rationing. And because of its basic immorality, it would not be sustainable.

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Henry Ford Team Performs First Incisionless GERD Surgery

Henry Ford Hospital has performed Michigan’s first incisionless surgical procedure for treating gastroesophageal reflux disease (GERD), a common, exasperating condition that affects men, women and children worldwide.

The new procedure could become the treatment of choice for the millions of patients with GERD, which is often accompanied by chronic heartburn and regurgitation of acid.

“I feel terrific. It’s an easy procedure,” says Betty Jones, 65, of Rochester Hills who underwent the procedure Sept. 16. Her symptoms went undiagnosed for 20 years until she saw a Henry Ford specialist five years ago.

Many patients rely on over-the-counter medicine or prescribed medications like Pepcid or Prilosec OTC for daily relief. Open or laparoscopy surgery provides effective, long-term solutions if medication does not bring relief.

Jones had been taking seven different medications for the past 20 years, including Prilosec for seven. She has been since weaned off the medication.

Vic Velanovich, MD, division head of General Surgery at Henry Ford who performed the procedure, says the incisionless technique is a viable option for improving the quality of life for patients.

“Patients who undergo this procedure recover faster and experience less post-operative pain compared to the open or laparoscopy techniques,” Dr. Velanovich says. “Patients also can resume consuming many of the foods they previously avoided without the fear of stomach acid and juices refluxing from the stomach back into the esophagus.”

The procedure, which takes about 45 to 60 minutes, is performed under general anesthesia and requires an over-night hospital stay. During surgery, an endoscope is inserted through the mouth and esophagus to access the stomach. Using an EsophyX device attached to the endoscope, the surgeon pulls tissue from the top of the stomach to create a new valve between the stomach and esophagus, preventing acid from backing up into the esophagus.

The manufacturer of the EsophyX device says 80 percent of its patients in recent studies reported improved quality of life and saw their heartburn symptoms either reduced or eliminated. All of its patients stopped their daily medication and 80 percent were still medication-free one year after surgery.

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WSUSOM Student Saves Heart Attack Victim On Street

A Wayne State University School of Medicine medical student used lessons and equipment from one of his classes to save the life of a man who suffered a heart attack outside a Dearborn furniture store.

Andre Porchia, 25, a third-year medical student, and his friend, Bethany Rowe, a nurse at University of Michigan Hospital, had just parked outside the store on a recent Sunday when a frantic woman approached them. The woman said her husband was having a heart attack and she was seeking directions so that she could advise an emergency phone operator of her location.

Mr. Porchia and Ms. Rowe ran to the woman’s car and found the man, in his 50s, slumped in the car seat, unresponsive and with no pulse. The pair pulled the man from the car, laid him on the ground and began CPR.

“I had my breathing mask in the glove compartment of my car, so I ran and got it,” Mr. Porchia said. “Bethany performed chest compressions and I did the breathing for about 5 minutes until the ambulance arrived.”

Mr. Porchia said he had completed his required Advanced Cardiac Life Support class just two days earlier. The techniques he learned in the class prepared him for the emergency.

The wife of the victim, Mr. Porchia said, told them her husband had recently been treated and released for a heart attack.

Mr. Porchia, who has an interest in general medicine and emergency medicine, said he discovered from the victim’s family later that the man underwent emergency heart surgery and initially was not expected to live through that evening. He survived, however, and after eight days in the hospital, was released and is recuperating well.

The family tracked Mr. Porchia to thank him for his efforts through an advertisement placed on Craigslist.

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Mazurek Commons Well Underway

Anyone who has had the opportunity to stroll along Canfield Avenue between St. Antoine and Brush will certainly observe that the landscape of the Wayne State University School of Medicine campus has changed.

Construction continues to move rapidly on the Richard J. Mazurek, MD, Medical Education Commons. The structure will be completely closed in during the month of November. Windows are being installed, and, in "sealed" areas, drywall installation and painting are under way. In fact, the construction team office is now situated in the southwest corner of the first floor of the building, which indicates that all mechanical systems are operational.

The construction of this facility cost $30 million, all of which was raised through philanthropy. Generosity of alumni and alumnae, community leaders, faculty members and grateful patients makes possible this new building and the state-of-the-science educational experience that it will offer. At the same time, an additional $5 million is needed to fully equip the education commons.

Many prominent recognition and naming opportunities are available to those who join this effort. Please contact the development office at (313) 577-1495 to discuss philanthropy at the medical school.

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WSU, Local Hospitals Take Big Role In $57-Million Children's Health Study

A large consortium of major universities and health care providers are taking part in a multimillion-dollar study of children's health, and Wayne State University is right in the mix of it all.

Wayne State is working with Children's Hospital of Michigan, Henry Ford Health System, University of Michigan, Michigan State University, Michigan Department of Community Health and Wayne County and City of Detroit Health Departments. The study is focusing on the health of children from birth to adulthood.

Michigan's role in the National Children's Study is to monitor more than 1,000 children from across the state. By studying these children, researchers will be able to determine cures for childhood diseases such as autism and cerebral palsy or come up with ways to prevent them.

Wayne State will oversee the assessment and care of pregnant women in the study and take in part of the $57 million grant to fund the study. That money does not include $18.5 million announced last fall for additional work in Wayne County. The study is set to kick off next year.

Source: Wayne State University/DMC website
Writer: Jon Zemke
Article Source: Model D

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Kennedy Concocts Health Plan

Sen. Edward Kennedy Works To Craft Bipartisan Legislation That Would Provide All U.S. Residents With Affordable Health Coverage
[Oct 24, 2008]

      Sen. Edward Kennedy (D-Mass.) has "secretly been orchestrating" and overseeing meetings with members of both parties to draft health care legislation to present to the new president and Congress next year that would extend health insurance to all U.S. residents, the Washington Times reports. The "wide-ranging talks," which Kennedy has monitored through telephone updates from his staff, have included 14 roundtable meetings attended by Kennedy aides and staffers for both Democrats and Republicans in the Senate Budget Committee, Senate Finance Committee and Senate Health, Education, Labor and Pensions Committee, chaired by Kennedy. The talks also were attended by representatives from a "panoply of interests groups with stakes in the cost and availability of health coverage," including the AFL-CIO, Business Roundtable, National Federation of Independent Business, the National Retail Federation, Federation of American Hospitals, the American Medical Association, America's Health Insurance Plans, Families USA, AARP and Consumers Union, according to the Times. In addition, Kennedy aides have started meeting regularly with consumers and small groups of people representing each area of the health care industry.

The Times reports that the conversations, which started in June, are "extraordinary" because they are bipartisan and have "managed to put in the same room interests that rarely meet -- let alone agree with one another." Ron Pollack, executive director of Families USA, said, "There is a serious process moving forward and that augurs well," adding, "There really is a sea change that should not be underestimated in terms of attitude." A spokesperson for Sen. Michael Enzi (R-Wyo.), ranking member of the Senate HELP Committee and a participant in the meetings, said the discussions "are a testament to how people feel about [Kennedy]." Kennedy is "really seizing the moment," Adrienne Hahn of Consumers Union said, "He's a real bridge-builder. He can bring strange bedfellows together." The Times reports that participants believe Kennedy's active role in the talks has "increased the likelihood of a break through."

Prospects
Kennedy hopes to introduce a bill as early as possible in the next congressional session. Kennedy aides have said they have not yet drafted legislation but likely will do so soon. Aides say Kennedy's close ties to Democratic presidential nominee Sen. Barack Obama (Ill.) "could prove a boon to those prospects," the Times reports. The aides said that they are not working with the Obama campaign on the proposal, but that the ideas are not ones to which Obama would object. According to the Times, an Obama aide attended many of the early meetings arranged by Kennedy, but no aides to Republican presidential nominee Sen. John McCain (Ariz.) did.

The Times reports that Senate Finance Committee Chair Max Baucus (D-Mont.) also may propose health care reform legislation, although a Baucus aide said he plans to work closely with Kennedy (Birnbaum, Washington Times, 10/24).

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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Stark Looks To Block 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).

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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