Wayne County Medical Society of Southeast Michigan

October 6, 2008

East Side Initiative Fills Void From Riverview Hospital Closure
Mulling Medical Marijuana
MSMS Reiterates That Smoked Marijuana Is Not The Answer
In My Opinion: Victory? I Wonder
Domestic Violence: What Every HC Provider Needs To Know
You Can 'Make A Difference' Oct. 25
Oct. 23 'Masters Series' Looks At Health Care Reform
New Disease Registry Improves Quality, Eases Burden

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East Side Initiative Fills Void From Riverview Hospital Closure

The Near East Side Planning Team, coordinated by the Detroit Wayne County Health Authority, has released a policy report, “Ensuring Essential Health Services on Detroit’s Near East Side.” Central to the group’s recommendations is establishing a method for ensuring that all 70,000 people living in the area have access to a medical home – a comprehensive approach to providing community-based, patient-centered primary health care. An estimated 15,000 residents in the area – defined by zip codes 48207, 48213, 48214, and 48215 – do not have a personal physician. Many use hospital emergency facilities for primary and chronic care.

The East Side Planning Team which worked for a little more than a year, involves 22 hospital, health center, public health, and community representatives either based on the Near East Side, or having a significant interest in community health. It began Oct. 1.

“This initiative is indicative of what we can achieve when the health care community comes together to solve a problem. The synergy of these efforts doesn’t just solve a problem, it creates a model of health care delivery that is replicable elsewhere,” said Chris Allen, Executive Director and CEO of the Health Authority. “We are pleased with the leadership of St. John Health and the many community organizations that have made this initiative possible.”

“The collaborative effort undertaken on Detroit’s East Side can be a model for development of the medical home for families in the area,” explained Adam Jablonowski, Executive Director of the Wayne County Medical Society of Southeast Michigan. Jablonowski also serves as Chair of the Health Authority’s Provider Advisory Committee. “Now, we must move forward with the training of more primary care physicians to meet the challenge of delivering the care.”

Other recommendations issued by the East Side Planning Team include:

• Strengthen existing health care safety net providers. Representatives of the Michigan Primary Care Association and Health Authority staff will provide technical and financial assistance for community health centers.

• Expand primary care capacity. Add at least 20 new primary care providers at existing health centers and new sites, preferably as affiliates of existing Federally Qualified Health Centers. Oral/dental health services, as well as mental health and substance abuse services, will also be available to health centers on a centralized basis.

• Organize the system of care. Develop a “hub and spoke” model of service delivery that will ensure comprehensive primary and urgent care services are available in the “hub” location while primary medical care in the medical home is accessible in spoke locations. The St. John Riverview campus will become the “hub” for the integrated system of care. At a minimum, services in the “hub” will include primary medical care, urgent care, behavioral health, oral health, pharmacy, and social services. A transportation network will enable people to easily access the full continuum of services.

• Implement an emergency facility diversion strategy. In collaboration with the Voices of Detroit Initiative, the Health Authority will engage all Detroit health systems to redirect non-emergent patients to primary care sites. A community and patient education program focused on changing behavior regarding how people access care will discourage use of hospital emergency services for non-emergent care. People will be encouraged to call United Way 2-1-1 to secure a primary care provider.

• Create connectivity within the “hub and spoke” system through technology. Funding will be secured to ensure that all safety net providers have electronic health records and other records to track, manage, and support patient care, including e-prescribing.

The Health Authority has provided a $400,000 grant to launch this initiative, including the addition of a program director. Additional funding will come from local, state, and federal resources.

For a full copy of the report, or further information on the Health Authority, contact Dennis Archambault at 313-871-3751, ext. 110.

The Detroit Wayne County Health Authority is a public body corporate, established in 2004 by the State of Michigan, City of Detroit and Wayne County. Its mission is to coordinate efforts to meet the health needs of the uninsured and underinsured residents in the City of Detroit and Wayne County by assuring access and improving the health status of all people. For more information, visit www.dwcha.org.

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Mulling Medical Marijuana

By PAUL NATINSKY
Whether or not marijuana use provides medically beneficial results weighty enough to legalize the drug still hangs in the air like a smoky fog. Likely the issue will remain in a bit of a haze regardless of the results of a ballot proposal that would legalize the drug up for consideration in the Nov. 4 election.

Proposal 1, as it will appear on the ballot, states:
A LEGISLATIVE INITIATIVE TO PERMIT THE USE AND CULTIVATION OF MARIJUANA FOR SPECIFIED MEDICAL CONDITIONS

The proposed law would:

• Permit physician approved use of marijuana by registered patients with debilitating medical conditions including cancer, glaucoma, HIV, AIDS, hepatitis C, MS and other conditions as may be approved by the Department of Community Health.

• Permit registered individuals to grow limited amounts of marijuana for qualifying patients in an enclosed, locked facility.

• Require Department of Community Health to establish an identification card system for patients qualified to use marijuana and individuals qualified to grow marijuana.

• Permit registered and unregistered patients and primary caregivers to assert medical reasons for using marijuana as a defense to any prosecution involving marijuana.

WCMSSM Board Chair H. Michael Marsh, MBBS, gave a talk on the issue at the Sept. 25 Medical Legal Committee meeting that covered the drug's effects and purported benefits, its current legal status and pros and cons to consider when evaluating the ballot proposal.

Dr. Marsh, who chairs the Department of Anesthesiology at the Wayne State University School of Medicine, said marijuana creates a sense of mild euphoria and relaxation in users along with decreased attention and memory. He said the drug's medical uses include treatment of glaucoma (reduces intraocular pressure), nausea, wasting diseases (increases appetite), uncontrollable movement disorders and, in some cases, addictions (blocks receptors that create drug-seeking behavior). Marijuana is not addictive and its active ingredient can be incorporated into a pill. In rare cases, Dr. Marsh reported, marijuana can lead to schizophrenia, which has been a barrier to federal approval from the FDA.

Marijuana, according to Dr. Marsh, is legal for medical use by federal law, but under a very narrow set of conditions, with “draconian” penalties for use outside of that narrow band. However, the federal law is rarely enforced and California and “about a dozen other states” have laws on the books similar to the Michigan ballot proposal.

Discussion among Medical Legal Committee members focused on the complications created by the status of marijuana as a recreational drug that has purported medical benefits and the political stigma created by the drug’s dual status.

The committee also discussed, irrespective of legal issues, marijuana’s place in the spectrum of dangerous drugs. Debate leaned toward grouping it with alcohol, nicotine and caffeine, as opposed to heroine, cocaine and other more potent and addictive illegal drugs.

“My preferred solution is that if you are going to legalize (marijuana), legalize it as a drug,” said Dr. Marsh, citing the benefits of regulation and controls that would help regulate dosage, quality and other factors, as well as allowing for enforcement of intoxicant laws as a hedge against abuse. Dr. Marsh also said he thinks the delivery mechanism of choice should be a pill.

Regardless of the outcome of the Nov. 4 election, medical marijuana’s status will remain decidedly murky until and unless there is movement on the federal level regarding the drug’s legal status.

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MSMS Reiterates That Smoked Marijuana Is Not The Answer

The MSMS House of Delegates in May voted not to support any measures that advocate for smoking marijuana, on these and other grounds: smoking as a delivery system; no uniform dosage; no authorized route for obtaining marijuana or seeds; negative side effects; and more scientific research is needed. To reiterate that message, MSMS has joined a coalition of organizations representing health care (including the Michigan Osteopathic Association and the Michigan Health & Hospital Association), business, law enforcement, and others to oppose Proposal 1, which aims to make smoked marijuana use legal for citizens with certain chronic health conditions.

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In My Opinion: Victory? I Wonder

By Allan Dobzyniak, MD
The position of organized medicine and many, if not most, physicians related to the proposed 10.6 percent decrease in Medicare reimbursement is humiliating. That the profession should annually beg that their fees not be cut should be tragic to self-esteem. It is pathetic that physicians should fall for such an obvious political ploy of pitting physicians against insurance companies. It is embarrassing to watch competing specialty groups clash for their share of a shrinking pie.

The Medicare Trustees now note that the program has an unfunded liability of $36 trillion over the next 75 years. As a percentage of GDP, Medicare expenditures are projected to increase from 3.2 percent in 2007 to 10.8 percent by 2082. The reality here for physicians is that they will continue to beg, but the situation will become impossible.

Medicare is a monopoly. It controls prices. In fact, as an open-ended entitlement, there is really no other way to control spending other than with price fixing. Information technology, pay-for-performance, paying for quality or outcomes are simply busy work which will have no significant impact on the cost of care or physician reimbursement given the magnitude of the financial shortfall.

Physicians need to confront this reality and aggressively defend their value. They and their patients cannot prosper within the present system. Expanding or simply just retaining this entitlement as it now exists will absolutely result in an inevitably negative outcome.

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Domestic Violence: What Every HC Provider Needs To Know

Thursday, October 16, 2008,

7:30AM - 12:30PM at Kresge Eye Institute.

Free parking at Bethel Church and free shuttle from Bethel to Kresge. Continental Breakfast Provided. Registration Fee: Free

Click below to register:
http://www.wcmssm.org/DV_Conference.pdf

Free parking in the Bethel Church parking lot,

located on the northwest corner of Warren Avenue and I-75 expressway

Free shuttle service provided from Bethel to Kresge Eye Institute

Continental breakfast provided

See full course outline on the reverse.

For more information, please contact Sandie Garling, at (313) 745-3030,

or Peggy Mitchell, (313) 874-1360, ext 10. You can also visit www.WCMSSM.org .

Sponsored By:

Wayne State University School of Medicine, Department of Emergency Medicine, Grand Rounds

Supported By:

Wayne County Medical Society of Southeast MichiganTask Force Against Violence

Detroit Receiving Hospital

The Wayne State University School of Medicine is accredited by the Accreditation Council for Continuing Medical

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You Can 'Make A Difference' Oct. 25

The annual “Doctors and Their Families Make a Difference” initiative is an annual effort organized by MSMS physicians, MSMS Alliance members, and their families that helps provide basic comforts to victims housed in family crisis shelters around Michigan. Conducted under the auspices of the MSMS Foundation, the effort consists of two parts: the Foundation recognizes physicians and their families who volunteer their time, and it organizes a drive to collect personal care items for crisis shelters. National Make a Difference Day will take place on Saturday, October 25, but collection efforts begin now. For more information or to participate, visit www.msms.org/foundation or contact Brenda Denbow at 517-336-5745 or bdenbow@msms.org.

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Oct. 23 'Masters Series' Looks At Health Care Reform

The MSMS Foundation’s Annual Scientific Meeting will be surrounded by a variety of special events, including the popular Masters Series, which will take place on Thursday, October 23, 12:00-4:30 p.m., at the Somerset Inn in Troy. The program, titled “Defining the Next Decade in Health Care,” will feature expert panelists who will address issues such as “Defining the Challenges of Health Care,” “Responding with Solutions for Reform,” and more. To register, visit www.msms.org/asm, or contact the MSMS Registrar at 517-336-5784 or abatten@msms.org. For more information, contact Elizabeth Hammel at 517-336-7575 or ehammel@msms.org.

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New Disease Registry Improves Quality, Eases Burden

As chronic diseases place more of a burden on the health care system, computerized patient registries are becoming valuable tools in managing groups of patients with these conditions. Medical Advantage Group, an MSMS subsidiary, has developed Ariphrôn, a web-based, point-of-care patient registry that will assist physicians in managing their patient populations. Ariphrôn will be available to physicians in the Consortium of Independent Physician Associations (CIPA) this fall and will focus initially on diabetic patients. For more information about Ariphrôn, contact Judy Oake, RN, at joake@medadvgrp.com or 517-336-1400. For more information about CIPA, visit www.thecipa.com or contact Lynda McMillin at 517-336-1400 or lmcmillin@medadvgrp.com.

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