E-DMN - September 15, 2008

September 15, 2008

Editor's Column: Education And Self Reliance
Hurricane Relief Efforts
Protect Tort Reform: Support Justice Cliff Taylor
Tort Reform Faces Legislative Challenge
Capitol Check-Up
AMA Urges Medicare Payment System Shakeup
St. John Surgeon Performs Unique Procedure
Michigan Hospitals Deliver $2.6 Billion In Community Benefits

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Editor's Column: Education And Self Reliance

By JOSEPH WEISS, MD
Annals broke the link. The Aug. 19 article in Annals of Internal Medicine titled “The Advantage Seeding Trial”, can be considered the final blow that will end the connection between the pharmaceutical houses and postgraduate medical education.

The Annals article detailed how the pharmaceutical house, Merck, undertook a clinical trial of Vioxx to convince primary care physicians to use the drug. Merck manipulated the study design to corral a large number of practitioners to believe the drug possessed effectiveness beyond what evidence to date could sustain.

Even before the Annals article, Congress had urged the Federal Drug Administration to better police the relationships between drug information, drug promotion, physician incentives and the selling of new drugs. Even before publication of the Annals article, voices in the Accreditation Council for Continuing Medical Education (ACCME), were calling for an end to all pharmaceutical sponsored CME. The Annals article will further push Congress to no longer urge, but demand increased surveillance. The Annals article will change the voices in ACCME to a chorus mandating a written rule forbidding the use of pharmaceutical funds for CME.

Hospital CME departments will now need to turn to medical staff dues and grants from hospital administration for money to support postgraduate medical education.

However, this change may be a fortunate one for medical education. Control of topics and content will rest with the hospital staff paying for and receiving the benefit of CME.

Making physicians pay for their education returns the profession to self-reliance. In a time when we see our professional lives directed by health insurance companies and Medicare and subtly shaped by pharmaceutical houses, the return of CME to our control reminds us that we are capable of working on our own behalf. With the challenges and hazards to come, we help ourselves more by developing self reliance rather than indulging in anger or despair.

Comments from George Shade Jr., MD
Unfortunately; I happen to be one of the dissenting votes on this issue. With dollars becoming less available for medical education and research from the federal government, the private sector has been a tremendous resource. It’s one thing to regulate how those dollars are received and utilized; it is irresponsible to cut off a tremendous source of funding with no alternative of substance.

Surgical equipment manufacturers and pharmaceutical companies do have the right to talk to the various parties that they consider their customers. It is up to each of us individually and collectively to exercise professional integrity in how we balance the good of the public versus personal gain and profit. If we can’t exercise that some amount of self control and self determination, then what else are we willing to give up with respect to our free will and freedom of choice?

Comments from Susan Adelman, MD
I actually never allowed pharmaceutical reps in my office. I always felt that their information would be biased and untrustworthy, and I never wanted to feel beholden to any of them. As it turns out, even research that they sponsor has been misleading fairly often. I think that is a bad way for a doctor to keep abreast of new medical advances.

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Hurricane Relief Efforts

Hurricane Ike

AMA CPHPDR response

On Sept. 10, the Texas Department of Public Health contacted the AMA's Center for Public Health Preparedness and Disaster Response (CPHPDR) and requested assistance. Italo Subbarao, DO, Director of the AMA’s Public Health Readiness Office, was dispatched to Austin, Texas to provide assistance and to assess the situation on behalf of the AMA. Doctor Subbarao is currently in the Texas governor’s office working in the state emergency operations center helping with medical needs assessments and responding to questions. He will continue to provide updates as time and conditions permit.

Federal coordination activities

Texas Medical Special Operations Team liaised with the Department of Health and Human Service’s National Disaster Medical System (NDMS) Coordinator, to ensure appropriate forward deployment of Disaster Medical Assist Teams (DMAT’s) and Public Health Services Rapid Deployment Forces (RDF’s) throughout Texas. The American Red Cross and Medical Reserve Corp. National Headquarters were contacted to assist with coordination in Texas.

State and local coordination activities

Texas Medical Special Operations Team units are forward deploying to staging areas throughout Texas. They have contacted the Texas Medical Association (TMA), who have established a Web site for TMA members to volunteer and assist with disaster response at the local level. TMA is also posting information on their Web site regarding the AMA’s In Case of Emergency Prescription (ICERx) Program.

Current medical and public health concerns

· Medical evacuation transportation risks

· Persistent rain, flooding, and loss of essential services in East Texas coastline (hospital and shelter damage)

· Potential risk of injury (downed trees, down power wires, etc.)

· Psychological illness and concerns (anxiety, depression, PTSD

· Water contamination and diarrheal outbreak concerns as a result of contamination from flooding

· Evolving health threats may include carbon monoxide poisoning as the result of portable generator use, as well as vector-born illness from mosquitoes and rats.

AMA Foundation grants for physicians

The AMA Foundation is currently accepting donations for its Health Care Recovery Fund, which is offering grants of up to $2,500 to help physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in that declared disaster area. This ongoing fund will also be available to physicians affected by future natural or man-made disasters.

Last updated: Sep 14, 2008
Content provided by: CPHPDR

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Protect Tort Reform: Support Justice Cliff Taylor

After a near miss with a broad ballot proposal that would have been damaging to the courts and a current bill (HB 6277) that would severely weaken tort reforms, it is more important than ever to elect judicial candidates who will uphold existing laws instead of legislating from the bench. Michigan Supreme Court Chief Justice Cliff Taylor, a strict construction jurist who is up for re-election this fall, is being targeted by the Michigan trial bar.

If Justice Taylor were to lose his seat on the bench, Michigan's nation-leading tort reforms could be at risk of being diminished. Michigan Doctors' Political Action Committee (MDPAC) has endorsed Justice Taylor, and encourages you to support his candidacy. Meet Justice Taylor at two upcoming events:

--Ingham County Medical Society general membership meeting: Tuesday, September 16, 5:30pm, at the University Club in East Lansing (RSVP at 517-336-9019 or icms@voyager.net )

--MDPAC Fundraiser: Tuesday, October 28, 6:00 - 8:00pm, at the Skyline Club in Detroit (RSVP at 517-336-5788 or jrichmond@msms.org )

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Tort Reform Faces Legislative Challenge

The Michigan House Judiciary Committee held a hearing on September 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 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."

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.

House Judiciary Committee members are as follows: Rep. Paul Condino (D-Southfield), Chair; Rep. Andy Colouris (D-Saginaw), Vice Chair; Rep. Tonya Schuitmaker (R-Lawton), Minority Vice Chair; Rep. Steve Bieda (D-Warren); Rep. Marc Corriveau (D-Northville); Rep. Kevin Elsenheimer (R-Bellaire); Rep. Rick Jones (R-Grand Ledge); Rep. David Law (R-West Bloomfield); Rep. Meadows, who drafted the bill; Rep. Andy Meisner (D-Oak Park); Rep. Tory Rocca (R-Sterling Heights); Rep. Bettie Cook Scott (D-Detroit); Rep. Virgil Smith (D-Detroit); Rep. John Stakoe (R-Highland); and Rep. Rebekah Warren (D-Ann Arbor).

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

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Capitol Check-Up

Thursday, September 25, 2008

Radisson Hotel • Lansing, MI

With state and national elections just around the corner, this year’s Capitol Check-Up will provide you with up-to-minute information about the current state of affairs in Lansing, the latest legislation being considered and what impact current and future legislation could have on the medical profession.

MSMS will be scheduling visits with legislators prior to the formal program. This is your chance to let your legislator know how current issues are affecting you personally in your day-to-day practice. Take this opportunity to meet with your local legislator and share your thoughts on pending legislation. MSMS will provide briefing materials to assist you in your meetings.

Who Should Attend: Physicians, practice administrators, health care professionals, and government officials

Time:12:00 p.m. – 4:00 p.m.

Fees:$10

Click Here To Register Now!

Join legislators and public health officials to explore topics on:

Future of Medicaid

Michigan Department of Community Health (MDCH) Update

2008 Elections

Emerging Health Care Issues

Pending Legislation

Confirmed Speakers, to date:

Senator Tom George, MD (R-District 20)

Senator Roger Kahn, MD (R-District 32)

Senator Michael Switalski (D- District 10)

Senator Deborah Cherry (D- District 26)

Representative Marc Corriveau (D-District 20)

Representative Brian Calley (R-District 87)

Representative John Proos (R- District 79)

Mr. John Truscott, President, The JohnTruscott Group

Janet Olszewski, Director of the Michigan Department of Community Health (MDCH)

Greg Holzman, MD, State Chief Medical Executive

Anne Corgan, Director of the Legal and Regulatory Services Administration, Michigan Department of State

To Register:

Mail registration form to MSMS Foundation, PO Box 950, East Lansing, MI 48826

Fax registration form to 517-336-5797

Phone MSMS registrar at 517-336-5784

For More Information:

Please contact Elizabeth Hammel at (517) 336-7575 or ehammel@msms.org

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AMA Urges Medicare Payment System Shakeup

Congress has created a window of time to fix the fatally flawed Medicare physician payment system, and American Medical Association (AMA) President Nancy Nielsen, MD urged them to use it to enact permanent reform in testimony Sept. 11 before a congressional committee. In testimony before the House Ways and Means Health Subcommittee, Dr. Nielsen highlighted that reform is necessary to achieve the vision of a health care system that provides quality, cost-effective care.

"By stopping Medicare physician payment cuts until January 2010, Congress has provided us with an opportunity to roll up our sleeves and work together on payment reforms that will benefit patients," said Dr. Nielsen. "The AMA is committed to legislative action that will result in Medicare payments that accurately reflect increasing medical practice costs so that physicians can continue to improve the care they provide to Medicare patients."

"Millions of baby boomers will begin aging into Medicare in three years, making it imperative that we solve this problem once and for all while we have the chance," said Dr. Nielsen. "By 2020, the government predicts a shortage of 85,000 physicians in many medical specialties including primary care, geriatrics and general surgery."

"As we work to improve the quality of health care, we must be able to implement health information technology systems and recruit new physicians," said Dr. Nielsen. "We want to achieve these goals, and reforming the Medicare physician payment system is crucial to success."

The AMA is actively engaged with the federation of medicine (state and specialty medical societies) to analyze specific reform proposals such as rewards for care coordination, the medical home model, quality incentives, bundling payments for medical services and demonstration projects that test new payment models such as accountable care organizations. The country must also invest in comparative effectiveness research to ensure the promise of high quality, cost-effective health care.

"It is critical to gain widespread physician input and consensus for these reforms in order to make the Medicare program strong and sustainable," said Dr. Nielsen.

"We need to collaborate to create a flexible, multi-pronged approach to reform so that our nation can fulfill the promise of Medicare for America's seniors and the physicians who care for them," said Dr. Nielsen.

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St. John Surgeon Performs Unique Procedure

St. John Hospital and Medical Center surgeon, Abdelkader Hawasli, MD, director of Laparoscopic Surgery & Minimally Invasive and Robotic Surgery, is the first in the Tri-County area to remove a gallbladder through a unique minimally invasive operation requiring only a single incision, reported St. John Health System.

The procedure involves removing the gallbladder through a tiny ½-inch cut in the belly button rather than the traditional laparoscopic surgery that requires four incisions in the abdomen.

“This is a great advancement for our patients,” says Dr. Hawasli. “It means less scarring, providing the best cosmetic results because the incision is hidden and is hardly seen. It has the potential for potentially faster recovery times, less risk for infection, less risk for bleeding and less pain.”

Dr. Hawasli used specialized tools that included a flexible camera and an instrument to cut and suture that were developed for single-incision surgery. He says while the surgery is more challenging and can take longer time than the regular operation because of the skill needed to use the instrumentation, he says the technique can be standardized, and has the potential to transform the field of minimally invasive surgery.

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Michigan Hospitals Deliver $2.6 Billion In Community Benefits

Michigan's nonprofit community hospitals provided a value of nearly $2.6 billion in direct patient care services and targeted outreach to those who could not afford it in fiscal year (FY) 2007, according to a report recently released by the Michigan Health and Hospital Association.

In its MHA 2008 Hospital Community Benefits Report representing the voluntary efforts of 132 of Michigan's 146 nonprofit community hospitals that responded to the most recent community benefit survey, the following were provided:

● More than $2.1 billion in unreimbursed medical care to

Michigan residents. This includes more than $209 million in charity care, more than $605 million in bad debt and more than $1.2 billion in unreimbursed cost of health care services provided to individuals covered by Medicaid, Medicare and other

government-sponsored programs.

● Nonprofit hospitals provided more than 224,000 visits to free hospital- and community-based clinics. contribution of nearly $35 million by these hospitals in the communities they serve.

● Nonprofit hospitals provided nearly 5,900 free community health-screening opportunities, serving more than 222,000 individuals at a hospital investment of more than $3 million.

● Nonprofit hospitals provided nearly 44,000 free immunizations to their communities, representing a contribution of more than $305,000.

● More than 3.1 million Michigan residents participated in more than 31,900 health education and outreach programs and activities

provided by nonprofit hospitals, investing nearly $22 million in their communities.

● In 2007, more than 140,000 individuals benefited from free or discounted prescriptions and medical supplies provided by nonprofit hospitals at a hospital investment of more than $3.8 million.

● In-home services, respite care, meals on wheels and food donations served nearly 179,000 individuals at an investment of nearly $3.6 million in community contributions by nonprofit hospitals.

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