E-DMN - September 22, 2008

September 22, 2008

Editor's Column: Waiting For Change Or Change While Waiting
WSUSOM-DMC Payment Dispute Dissipates
Henry Ford CEO Dubbed As One Of 'Most Powerful' In Health Care
Dr. Sandler Testifies To Preserve Tort Reform
Dingell, Congress Ramp Up Health Care Reform Efforts
Anonymous Gift Helps Fund Mazurek Education Commons
WSU Researchers Develop Cancer Vaccine
HFHS Study: Reduce Unnecessary Tests For Cardiac Imaging

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Editor's Column: Waiting For Change Or Change While Waiting

By JOSEPH WEISS, MD
The presidential race is on. The word race brings to mind rallies, events, activities and crowds. For the medical community, now is the time we are forced to wait. No one wants to hear about our issues let alone respond to them. The Medicare payment freeze will last at least 18 months, but will certainly face extension as Congress has little incentive and great fear of changing the current Medicare reimbursement formula.

But we are waiting for even more. The presidential candidates speak freely of their health care philosophies and plans, but we can consider their phrases as etched in ice, easily melted by the hot air of contrary political rhetoric. Congress is not a group to readily agree on health care and the capacity of health lobbyists to turn a bill to a particular group’s advantage is accepted American political policy.

We have little choice but to wait for scenarios to unfold, and then try to keep those changes we see as helping our profession and to fight vigorously as we did with the Medicare cut, against new legislation that we see as threatening to our livelihood or independence.

However, we need not just wait. The medical profession should use the next two years to come together in areas that disrupt us with internecine conflicts.

For example, the oncologists, rheumatologists and infectious disease specialists should agree on a reimbursement for infusion policy. In my field, rheumatology, our national society is lobbying for action on osteoporosis, while the orthopedists are preparing their own congressional initiative on osteoporosis. The Endocrine Society has its plans for going to Congress for funding on osteoporosis education and research. Radiologists and cardiologists have separate initiatives for funding for cardiovascular imaging. The Back surgeons, whether neurosurgeons or orthopedists, should develop common ground on the introduction of instrumentation and hardware before CMS imposes its ground rules.

Now is not really the time to wait and watch. Instead, we should work to remove our internal divides. If we achieve that end, we will be prepared for the difficult political battles to come.

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WSUSOM-DMC Payment Dispute Dissipates

The $12 million payment dispute between the Detroit Medical Center and the Wayne State University School of Medicine is being resolved quietly, with money beginning to flow to the university’s physician group, according to a report appearing in Crain’s Detroit Business.

This latest dispute began in February when DMC alleged that WSUSOM was receiving double-payments for some services it was providing – payment from DMC and money from the state.

DMC notified WSU in February that it would begin withholding payments of about $1 million per month. The payments were part of a term-sheet agreement between the parties signed in 2006 and expiring in 2010.

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Henry Ford CEO Dubbed As One Of 'Most Powerful' In Health Care

Nancy Schlichting, president and chief executive officer of Henry Ford Health System, has been named one of the “100 Most Powerful People in Healthcare” by Modern Healthcare magazine.

This is the fourth straight year in which Schlichting has been listed in the magazine’s annual ranking. She is ranked No. 52.

Voting was done by readers of Modern Healthcare.

Steve Case, CEO of Revolution Health Group ranked No. 1, followed by Eric Schmidt, CEO of Google with Bill Gates of Microsoft in the 3rd position. The other top ten are elected officials or government leaders.

Schlichting joined Henry Ford in 1998 as senior vice president and chief administrative officer. She was promoted to executive vice president and chief operating officer the following year and assumed the additional responsibility of president and chief executive officer of Henry Ford Hospital in 2001. She assumed the position of president and CEO of the health care system in June 2003.

Henry Ford Health System, one of the country's largest health care systems, integrates primary and specialty care with research and education. It includes the 1,000-member Henry Ford Medical Group, seven hospitals, the 540,000-member Health Alliance Plan, 26 primary care centers and many other health-related entities located throughout southeastern Michigan.

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Dr. Sandler Testifies To Support Tort Reform

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. 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."

Dr. 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.

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Dingell, Congress Ramp Up Health Care Reform Efforts

Congress has found new urgency in solving the nation’s health care crisis amid economic chaos caused by recent developments including the continuing housing crisis and its ripple effect on the investment industry and stock market.

According to published reports, the House Energy and Commerce Committee, chaired by Rep. John Dingell (D-MI), heard testimony last week that included allowing the purchase of health insurance across state lines, expanded use of medical savings accounts and expansions of government programs such as Medicare and Medicaid.

Reportedly, the testimony was short on new ideas and served more as a review of well-known proposals.

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Anonymous Gift Helps Fund Mazurek Education Commons

A monetary gift by an anonymous donor has completed the Wayne State University School of Medicine’s efforts to capture a $3 million Kresge Foundation grant to assist in the construction of the Richard J. Mazurek, MD, Education Commons, the new face of medical education in Michigan.

The donor's commitment represents a significant investment in medical education and metropolitan Detroit, said School of Medicine Dean Robert M. Mentzer Jr., MD.

The donor, who wished to remain anonymous, helped finalize the campaign goal of $30 million for the new state-of-the-science facility.

The donor asked that the pledge be used to honor Raymond Margherio, MD, who graduated from the School of Medicine in 1965.

“This gift means so much to the School of Medicine, and to the future of medical education and healthcare,” said Dean Mentzer. “The donor’s foresight and commitment to the School, the residents of the community and to medicine will help establish the foundation for the next generation of medical education in Michigan.”

The Margherio Family Conference Center will serve as an education center for the future leaders and innovators in medicine, and as a focal meeting place for community groups.

The center will seat up to 120, and will contain eight alcoves along its perimeter to accommodate break-out study sessions. Each alcove will boast a plasma screen and computer, providing students access to online diagnostic resources to research topics ranging from diabetes to women’s health issues. Grand Rounds can also take place there, allowing physicians to present unusual cases. The two projection screens are so technologically advanced that physicians will be able to display large images, such as X-rays or pathology specimens, with microscopic precision from almost any angle. The hub’s user-friendly technology will easily display material with great accuracy so students can witness, for example, close-up footage of surgery.

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WSU Researchers Develop Cancer Vaccine

Researchers at the Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute have developed an HER2 DNA cancer vaccine that has shown to be effective on drug-resistant tumors in mice. The study was reported in the Sept. 15 issue of Cancer Research, a journal of the American Association for Cancer Research.

The vaccine, researchers said, completely eliminated HER2-positive tumors – including cancers resistant to current anti-HER2 therapy – in mice, without any toxicity.

The study suggests the vaccine could treat women with HER2-positive, treatment-resistant cancer or help prevent cancer recurrence. The researchers also said it might potentially be used in cancer-free women to prevent initial development of these tumors.

Wei-Zen Wei, PhD, professor at the Barbara Ann Karmanos Cancer Institute and Department of Immunology and Microbiology at the School of Medicine, together with a team of researchers, has been working on a series of cancer-fighting vaccines since 1996 to help prevent HER2-positive breast cancer.

Approximately 20 percent to 30 percent of breast cancers make too much of the protein HER2, which is made at low levels by normal breast cells. Tumors that overexpress HER2 (called HER2-positive) tend to grow faster and are more likely to return than tumors that don’t overexpress the protein.

Dr. Wei said this vaccine was tested in the laboratory on tumor cells that no longer responded to other therapies for HER2-positive breast cancer. The results in mice showed that the vaccine prevented cancer growth and was not toxic.

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HFHS Study: Reduce Unnecessary Tests For Cardiac Imaging

Hospitals that perform cardiac nuclear stress testing under published national practice guidelines could reduce unnecessary testing and, potentially costs, according to a Henry Ford Hospital study.

The study looked at 375 patients who underwent nuclear stress testing at Henry Ford and showed that in the majority of cases, 90 percent, physicians ordered the diagnostic imaging test appropriately using the updated 2007 Appropriateness Criteria of the American Society of Nuclear Cardiology (ACNC) and American College of Cardiology.

However, researchers also found that 21 patients should not have received the test because their patient profile and assessment didn’t meet the test criteria under the guidelines. While these patients were considered low risk for nuclear testing, none required additional testing such as a cardiac catheterization and 95 percent of the scans in the group turned up normal.

Karthik Ananth, MD, a Henry Ford cardiologist and the study’s senior author, and cardiology fellow Natesh Lingam, MD, will present the findings Friday, Sept. 12 at the American Society of Nuclear Cardiology Conference in Boston.

While the Henry Ford study did not look at cost, researchers theorize there is potential for savings based on their findings. Further study will be required to determine the cost analysis, researchers say.

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