E-DMN - September 8, 2008

September 8, 2008

Editor's Column: Rhetoric And Reality
State Announces $1.2 Million In Technology Planning Grants
Doctors Who E-Prescribe Get Bonus Medicare Payment
WSUSOM Study: Older Stroke Patients Helped Equally By Drug Therapy
St. John Opens Hospital In Novi
Karmanos/WSU Physician Earns Cancer Grant
ASM: 'Ensuring Access & Improving Care In Difficult Times'
Medicaid Will Allow Paper Prescriptions Only With Security Features

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Editor's Column: Rhetoric And Reality

By JOSEPH WEISS, MD
“We are engaged in a war with those controlling medicine,” according to a recent blog I viewed. Our foes include the insurance companies, the government, the pharmacy benefit managers, hospital administrators. “We must draw a line in the sand.” So speaks the rhetoric of medical militancy.

Few physicians would argue those insurers’ practices of bundling services, down coding, mandating prior authorization, presenting us with schemes like pay-for-performance and no-pay-for-error, creates tension between physicians and payers. However, the medical community should stop short of blazing rage or unmitigated despair.

We need to keep in mind that we work in a marketplace economy. Whether contracting with Blue Cross, Aetna, Humana, United Health or Medicare, our aims as doctors are to protect our livelihoods and maintain our independence. On the other hand, whether we contend with private organizations like United Health or public ones like Medicare, the intent of health insurers is to contain costs. The purpose of the marketplace economy from Adam Smith to the present has been to create tension between competing interests that will force a compromise between them. What we need to bring to this marketplace environment is not a combative state of mind, but a willingness to negotiate.

We witnessed the power of negotiation in the repeal of the Medicare reimbursement cut. We can work from that momentum. Through MSMS and our state specialty societies, we should press our issues with preparation, patience, persistence and reason. We best forward our cause not by rage, but with reason.

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State Announces $1.2 Million In Technology Planning Grants

The Michigan Departments of Community Health (MDCH) and Information Technology (MDIT) announced $1.2 million in planning grants to promote an electronic statewide infrastructure that will streamline the secure and confidential exchange of clinical information throughout Michigan.

“These grants will help Michigan move toward becoming the nation’s leader in the health IT field,” said MDCH Director Janet Olszewski.

“The goal is to provide patient data to physicians in faster, safer and more efficient manner to improve the quality of care.”

Utilizing the power of Health Information Exchange (HIE) to lower costs and improve health care quality is one of Gov. Granholm’s top health care reform initiatives. Michigan’s HIE strategy is designed to ensure that all of the information a physician needs about a patient is available at the point of care. The purpose of HIE is to give Michigan physicians and other health care professionals the right information at the right time to make the most informed decision possible. As physicians and other health care professionals receive increasing access to timely and accurate patient data through HIE, Michigan citizens will benefit from improvements in efficiency, safety and quality of health care.

“Sharing health information so that the quality of health care continues to improve is what this is all about,” said Ken Theis, director of the Michigan Department of Information Technology and CIO for the State of Michigan. “The citizens of Michigan deserve to be relieved of the burden of completing the same health information every time they make contact with the health care industry, and these grants get us a step closer to that goal.”

Funding for the program was introduced by Granholm in her FY08 Executive Budget and was appropriated by the Legislature for FY08. Regional partners awarded grant funding include the following:
- ChangeScape, Inc. for $580,000 (Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph and Van Buren counties)
-Altarum Institute for $674,474 (Hillsdale, Jackson, Lenawee, Livingston and Washtenaw counties)

The focus of these grants is to develop the technical specifications, business plan and community support to implement HIE efforts throughout a specific multi-county region. The grants have a start date of September 1, 2008.

Statewide HIE development is being led by the public-private partnership known as the Michigan Health Information Network (MiHIN).

This is the second year for MiHIN HIE planning and implementation grants. In 2007, eight grants were distributed with work currently underway in over 70 counties in Michigan. With these two new awards, all the counties in the state are part of either planning or implementation efforts for regional health information exchange.

MiHIN grew out of a statewide, multi-stakeholder planning process in

2006 that resulted in a report titled Conduit to Care. These current grants advance the report's recommendations to increase connectivity and make patient information available at the point of care. The state has also funded a MiHIN Resource Center to coordinate and support the regional initiatives as well as develop solutions to critical statewide HIE issues including privacy, security and confidentiality.

The report and more information can be found at www.michigan.gov/mihin.

For more information on the MiHIN Resource Center and the regional HIE efforts, please visit www.mihin.org.

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Doctors Who E-prescribe Get Bonus Medicare

Under a new Medicare payment law, physicians who prescribe electronically for Medicare Part D patients in 2009 will get an incentive payment equal to 2 percent of all the Medicare services they provide for the year. Starting in 2012, physicians who are still paper-only will see a cut in their total Medicare payment for the year. The Consortium of Independent Physician Associations, an MSMS subsidiary, has partnered with DrFirst to offer physician members the opportunity to incorporate e-prescribing into their practices, virtually free, by subsidizing first-year costs and paying for a personal digital assistant or comparable hardware. For more information, visit www.thecipa.com or contact Lynda McMillin at 517-336-1400 or lmcmillin@medadvgrp.com.

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WSUSOM Study: Older Stroke Patients Helped Equally By Drug Therapy

Elderly people who take a cholesterol-lowering drug after a stroke or mini-stroke lower their risk of having another stroke just as much as younger people in the same situation, according to research by a Wayne State University School of Medicine physician published in the Sept. 3 online issue of Neurology, the medical journal of the American Academy of Neurology.

“Even though the majority of strokes and heart attacks occur in people who are 65 and older, studies have found that cholesterol-lowering drugs are not prescribed as often for older people as they are for younger people,” said study author Seemant Chaturvedi, MD, professor of Neurology at the School of Medicine and director of the WSU-DMC Stroke Program.

“These results show that using these drugs is just as beneficial for people who are over 65 as they are for younger people,” added Dr. Chaturvedi, who is a Fellow of the American Academy of Neurology.

The study involved 4,731 people 18 and older who had a recent stroke or transient ischemic attack, or mini-stroke. The 2,249 people 65 and older were in one group, with an average age of 72, and the 2,482 people younger than 65 made up the other group, with an average age of 54. Within each group, about half of the people received the cholesterol-lowering drug atorvastatin and about half received a placebo. The participants were then followed for an average of four and a half years.

Overall, LDL, or low-density lipoprotein “bad” cholesterol, was lowered by an average of 61 points during the study for the elderly group, and by 59 points for the younger group. Those in the younger group reduced their risk for another stroke by 26 percent; the risk was reduced by 10 percent in the elderly group.

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St. John Opens Hospital In Novi

St. John Health today opened the doors to the new Providence Park Hospital in Novi, Mich., the first and most clinically advanced hospital to open in southeast Michigan in more than 20 years. The leading-edge medical center will bring with it more than 1,200 new jobs and an economic impact of approximately $80 million annually, according to hospital officials.

The 200-bed, $229 million hospital is designed to allow patients to remain in one room throughout their stay. Typically, reports St. John, patients would be transferred to various units for each stage of their care, but a flexible design approach and advanced ICU-like technologies in every room at Providence Park Hospital enable clinicians to deliver a safer model of care that minimizes patient transfers and reduces health care costs.

“Residents in the growing communities of western Oakland County now have greater access to high quality health care and can enjoy proximity to one of the nation’s premier medical facilities,” says Patricia A. Maryland, Dr. P.H., president and CEO of St. John Health and Ascension Health Michigan ministry market leader. “Yet the impact of this facility will be felt far beyond Oakland County, as the technology and best practices employed at Providence Park Hospital will be leveraged across St. John Health to fulfill our mission of improving the health of individuals in every community we serve.”

Specialty programs at Providence Park Hospital include Neurosciences, Orthopedics, Women’s Services, Cardiology, Oncology and minimally invasive Surgical Services. The new hospital also features a 24-Hour Emergency Department with 49 individual treatment rooms and capacity to treat more than 60,000 patients a year. The entire third floor of Providence Park Hospital is dedicated to comprehensive Women’s and Infant Health services and includes 27 Labor/Delivery/Recovery/Post-Partum (LDRP) rooms with sleeping areas for spouses and families, a 15 bed special care nursery, dedicated operating rooms, and a Gynecology unit. Additional services will include state-of-the-art imaging technologies, an advanced robotic x-ray controlled catheterization lab imaging system; pediatric care and dedicated pediatric emergency services.

Approximately 1/3 of the wooded 200-acre campus has been left in its natural state and will support walking trails and nature areas for the community. Other portions of the campus have been developed through private investments of approximately $80 million. This includes a physician-owned medical office building that also houses a Neurosciences Institute and Surgical and Procedural Skills Lab; a physician-owned orthopedic center that includes an ambulatory surgery center; as well as a 108-bed Staybridge Suites extended stay hotel.

St. John Health provides comprehensive prevention, primary care and advanced treatment programs with more than 125 medical centers and seven hospitals spanning five counties. For more information on St. John Health, please visit www.stjohn.org.

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Karmanos/WSU Physician Earns Cancer Grant

Masood Shammas, PhD, director of Surgical Oncology and the Developmental Therapeutics Laboratory of the Karmanos Cancer Institute and Department of Surgery at the Wayne State University School of Medicine, received a National Cancer Institute R01 award for his project, “Telomerase and Homologous Recombination as Targets in Barrett’s Adenocarcinoma.” Dr. Shammas will receive $1.8 million in funding over the next five years.

Working on the project with Dr. Shammas are Ramesh Batchu, PhD, associate director of the Surgical Oncology and Developmental Therapeutics laboratory at the Karmanos Cancer Institute and assistant professor of surgery at the School of Medicine; and Madhu Prasad, MD, co-chief of Surgical Oncology at Karmanos and associate professor of surgery at the School of Medicine.

The funding from this award will allow Dr. Shammas’ lab to study telomeres, telomerase, and homologous recombination in the development and progression of Barrett’s esophageal adenocarcinoma (BEAC), a cancer associated with heartburn. Telomeres are the ends of chromosomes, the structures carrying genetic material or DNA. Normal human cells lose a portion of telomeric DNA each time a cell divides. As soon as the average length of telomeres in a cell dips below a critical limit, the cell dies. Cancer cells acquire the ability to maintain their telomeres at a specific length and therefore can continue to grow. The maintenance of telomeres in cancer cells is either achieved by activation of a protein called telomerase or by a process of genetic rearrangement, called homologous recombination. The lab will also test the inhibitors of telomerase and recombination, separately and together, for prevention and treatment of BEAC in mice.

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ASM: 'Ensuring Access & Improving Care In Difficult Times'

The best way for Michigan physicians to learn the latest in clinical sciences and implement this knowledge into their practices, while earning up to 21 AMA PRA Category I Credit(s)™, is to attend the 143rd MSMS Annual Scientific Meeting (ASM), which will take place Wednesday-Friday, October 22-24, at the Somerset Inn in Troy.

“The Annual Scientific Meeting hosted more members than in the last few years, and it was pleasing to see so many younger colleagues take time off from their busy practices to attend,” said Michael Kleerekoper, MD, a Wayne County endocrinologist and 2008 ASM Planning Committee Chair, commenting on the success of last year’s conference.

This year, top experts will speak during courses such as “BCBSM PGIP:

Catalyzing Practice Transformation with a Focus on the Patient Centered Medical Home”; “An Integrative Medicine Approach to the Prevention & Treatment of Major Diseases”; “Peripheral Arterial Disease, Screening, Diagnosis & Management: Parts I & II”; and more. In addition to these topics, participants also will be able to explore areas such as cardiology, asthma, ophthalmology, pulmonary medicine, and many others.

As usual, the ASM also will be surrounded by a variety of special events, including the popular Masters Series, which will take place Thursday, October 23, noon-4:30p.m., also at the Somerset Inn. The program, titled “Health Care: Defining the Next Decade,” will feature experts panelists who will address issues such as “Defining the Challenges of Health Care,” “Responding with Solutions for Reform,” and more.

Confirmed speakers include John M. MacKeigan, MD, a Kent County colorectal surgeon, and Chair of the Board/Chief Medical Officer, Michigan Medical, PC; and Marianne Udow, Director, Center for Health Care Research & Transformation. View complete conference details in the July 31 special edition of Medigram.

To register, contact the MSMS Registrar at 517-336-5784 or abatten@msms.org. For more information, contact Elizabeth Hammel at MSMS at 517-336-7580 or ehammel@msms.org.

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Medicaid Will Allow Paper Prescriptions Only With Security Features

Written Medicaid prescriptions will be required by Oct. 1 to have three at least three anti-fraud features intended to reduce unauthorized copying, erasure or counterfeiting under a recent federal law, reported the American Medical News.

Acceptable features include using “microtext” in the prescription – a line of tiny text that blurs when photocopied and printing asterisks after the number of pills prescribed so that, for example, 50 can’t be changed to 500.

The change was implemented in recognition of the high cost to physician offices of altering an electronic medical record system to meet tamperproof measures and the high cost of copy-resistant paper, reported the AMA.

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