Wayne County Medical Society of Southeast Michigan

April 13, 2009

Editor's Column: Three Comments On Medical Matters
In My Opinion: The New York Times Concept Of Health Insurance
House Snuffs Smoking Ban
AMA To Cut 100 Positions
St. John Announces Plans For Near East Side Hub
Health Authority Offers Easy Internet Medicaid Enrollment
WSUSOM Researchers To Benefit From Small Animal MRI
DMC Brings Greenway Into Health IT Fold

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Editor's Column: Three Comments On Medical Matters

By JOSEPH WEISS, MD

HEALTH PLANS FOR ALL – EXCEPT US
If all Americans are to receive health insurance coverage, who will be the insurer? Will private insurers take the responsibility or will the government expand Medicare and eventually take in everyone?

For physicians, it doesn’t matter who wins. In either case, we lose.

If private insurers carry the day, they will determine our reimbursements in the manner they do now: that is, paying us roughly the Medicare rate. If government insurance becomes the way of health care coverage, we will see the prevailing Medicare reimbursement schedule carried over into the expanded government plan.

Leave it to ethicists, planners and health care economists to debate the merits of private vs. public coverage. The energy and brains of the medical community should focus on developing a suitable replacement for the Sustainable Growth Rate (SGR) formula. Whether we labor under a predominantly private or public system, that replacement, if not coming from us, will come from Congress and will govern our pay for the foreseeable future.

HEALTH PLANS OF THE FUTURE
The American College of Physicians has its document: The Future of Health Care in the United States. The American College of Rheumatologists has its document with the same title. Both organizations speak in a solemn tone, as if each were the first to conceive that health care should include coverage for all Americans, should be high quality and that cost should be low enough for the nation to afford.

Neither the internists nor the rheumatologists offer any suggestions on how the government is to devise a medical care system that provides access to all, is unwavering in its excellence and is cheap to run. The internists and rheumatologists take the stance that now that they have told the government what they want, it is the Congress’ job to figure out how to do it.

Do we dare leave it to Congress?

CONTENT TO HANG SEPARATELY
I have been to Capitol Hill and lobbied for the internists and then the next month lobbied for the rheumatologists. I can say from that experience that when the internists go to Congress they ask for more money as if no other medical group exists, has needs or deserves attention. When the rheumatologists go to Capitol Hill the same attitude prevails. Neither specialty acknowledges that any other group of physicians sees itself as needing or deserving attention.

The American College of Physicians proclaims a crisis in primary care that requires billions of dollars from Congress in higher reimbursements for Internists, subsidized residencies in internal medicine and loan forgiveness for internal medicine residents as incentives to enter the field.

The American College of Rheumatology says that a dire shortage of pediatric rheumatologists exists. The solution is government money to fund the training of a small army of these subspecialists. The rheumatology position paper then lists the needs of rheumatology research and urges Congress to pour billions of dollars into that area.

The oncologists and general surgeons follow with similar prepared talks on the crisis coming to their specialties. Claiming that Congress has not given us what we want only perpetuates the problems of receiving neither attention nor money. If we want subsidies for our residents and funds for our researchers, we must present Congress with a plan on parceling funds that comes from agreement and negotiation among ourselves.

It is as imperative that we change our present ways as it is for the auto industry to restructure or redesign its cars.

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In My Opinion: The New York Times Opinion Of Health Insurance

By SUSAN ADELMAN, MD
In an April 7 editorial, the New York Times supports a new public plan health insurance option that will compete with private plans. Arguments given include: “to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs”

Looking at the history of large-scale Medicaid fraud in California and remembering a recent attempt by the Illinois governor to shake down a children’s hospital, why does the editorialist believe a public system would be more honest than a private one? At least a private plan has an incentive to minimize abuses that reduce profitability and efficiency. Yes, there may be incentives to be less honest in order to increase profits, but studies of private hospitals fail to document this. When I was on the Council, the AMA Council on Medical Service started a report that we expected would take private hospitals to task for milking the system to pump up profits, as compared with public hospitals, but the data did not support our assumption.

“A public plan might do a better job of slowing the growth of health care costs, although Medicare has not been notably successful in that regard,” states the editorial. Well, yes. Neither Medicare nor Medicaid has been particularly successful in controlling costs. They have not lowered administrative costs by eliminating private plans either. They have subcontracted all or part of their programs to private plans and HMOs.

“And it could probably force doctors and hospitals to accept lower reimbursements than they negotiate with private insurers, allowing the public plan to charge lower premiums and attract more customers,” the editorial continues. So the NYT acknowledges that the public plan would drain away patients from the private plans. The end point for private plans will come when they become unprofitable. Then the government-run system will be the only game in town, except for wealthy patients who can pay for an expensive alternative.

A major media outlet has interviewed the staff of certain hospitals which discontinued outpatient oncology services because of a financial shortfall. This is apparently presented as an argument for a new public health care system which would presumably never do such a thing. In fact, this is exactly the sort of rationing a public system would be most likely to do when it is strapped for funds. You see this in England today, where access to dialysis and kidney transplantation is rationed by age. In the Canadian system too, a famous actress just died because the hospital lacked neurosurgical services in the locality where she fell during a ski lesson.

Yes, we need multiple health care reforms, but we must be careful what we ask for. We may get it.

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House Snuffs Smoking Ban

Health and clean air advocates will have to wait a few more months, at least, until Michigan again takes a run at joining the majority of states that don’t allow smoking in workplaces, including bars and restaurants.

Legislators of both parties have put the smoking issue on the back burner to spend more time with the state budget and issues created by dour economic conditions.

House Speaker Andy Dillon told the Detroit News he “sees(s) us getting back to the smoking issue by summer.”

The House and Senate have passed different versions of the smoking ban. The Senate approved a total ban and the House a ban that permits smoking in casinos and cigar bars.

Revenues for the next fiscal year, beginning Oct. 1, are projected to fall short by about $100 million a month.

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AMA To Cut 100 Positions

Citing the need to reduce its operating budget “to offset declining revenues,” the American Medical Association announced this afternoon that it would eliminate 100 selected open and existing staff positions from its 1,200-employee staff with layoffs occurring at both its Chicago and Washington offices. The cuts amount to 8.3 percent of its staff.

The staff reductions go in effect May 4.

“This is a tremendously difficult decision for the AMA,” said AMA Executive Vice President and Chief Executive Officer Michael Maves, MD, in a news release. “By taking these steps now, we will be in a position to continue our important work without compromising our future financial health. Appropriately aligning our revenues and expenses provides us with an opportunity to sharpen our focus and ensure we have the financial resources to get the job done.”

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St. John Announces Plans For Near East Side Hub

Primary services will remain vital at the Detroit Riverview site on East Jefferson, according to Bob Hoban, Senior Strategy Officer, St. John Health. As the health system looks to sell the hospital complex, he envisions that private primary care physician practices and the Health Centers Detroit Federally Qualified Health Center look-alike will remain in the professional building on the campus. Eventually, he would like to add diagnostic services in the hospital building to serve that site and other primary care facilities on the Near East Side.

St. John Health is supportive of the collaborative process under way through the Near East Side initiative, Hoban said. "As I look long-term, this will have to be one of the hubs for the East Side. We're going to look collaboratively where the links should be established." He noted that the Gratiot corridor and Connor Creek, a former St. John campus, offer potential sites for additional hubs. He would also like to see another FQHC site added to the East Side.

The Health Authority's Near East Side initiative calls for a "hub and spoke" model of primary care delivery in which several primary care facilities surround a hub - in this case the Riverview campus - and use its diagnostic services for their patients.

Hoban explained that the health system intends to enhance its relationship with the Oakland University nursing program, which has recently established a presence at the site. The program graduates 100 nurses annually.

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Health Authority Offers Easy Internet Medicaid Enrollment

The Detroit Wayne County Health Authority has begun using a web-based Medicaid enrollment service that will expedite the screening and enrollment of prospective Medicaid recipients. The new technology, called HelpEngen™, was developed by TriHealix, a health care technology firm based in Norwalk, CT.

HelpEngen enables health care providers to connect uninsured patients to the right assistance program by facilitating the collection of patient information, providing an immediate assessment of whether the application might be approved for benefits, and generating all the appropriate application forms for potentially eligible patients. Help Engen will be used by the Health Authority and will also be made available to health systems that it contracts with for Medicaid outreach.

"This is a major step forward in our drive to ensure that everyone who qualifies for health benefits is enrolled," according to Chris Allen, CEO of the Detroit Wayne County Health Authority. "This tool not only provides a much more expedient enrollment process, but it indicates who is likely not to qualify for benefits. We can then find alternate resources to meet their needs."

"For health systems, this tool also means greatly expanded capability to manage the growing financial burden of caring for their uninsured patients. So it represents a true win-win for both patients and providers. We believe that HelpEngen will become a national model for improving access to health care through the enrollment process."

The HelpEngen platform supports best practices in patient access and revenue cycle management, by allowing providers to:

Accurately classify uninsured patients at the point of care to distinguish those who are eligible for government-sponsored health coverage or provider charity care, from those who are truly self-pay;
Enroll eligible patients in the most appropriate program or programs, and then track the status of those patients;
Easily share information across departments or facilities;
Comply with charity care policies/regulations by capturing and reporting metrics on the delivery of charity care and community benefit.

HelpEngen, like computer-based tax software, offers an outreach worker a cleanly designed online interview that can be filled out within 30 minutes. HelpEngen then tests information collected in the interview against requirements for Medicaid and other public programs and returns a real-time detailed assessment of likely eligibility organized by program type with full program description, benefit level, and the reason why the patient is or is not eligible. At that point, the outreach worker can generate completed official application forms which can be printed for signature then saved electronically.

Initially, the forms will be mailed to the state Medicaid office. Eventually, however, the Health Authority hopes to establish an online link to the department,offering direct transmission of forms. Key information captured in the electronic interview includes demographics, insurance status, and health care use patterns, as well as all information required to determine eligibility and apply for public health coverage programs, hospital charity care programs, and uninsured patient discount programs.

While the technology has the capacity to calculate potential eligibility for any means-tested program, the Michigan Department of Human Services (DHS) will continue to make the actual eligibility determination. This tool will make the job easier. The Health Authority plans to work with DHS and the Michigan Department of Community Health to electronically submit the applications directly to local offices for determination of eligibility and enrollment. This technology will allow the Health Authority to begin to identify and assess the truly uninsured and develop the appropriate safety net measures necessary to ensure access to quality care.

"Outreach workers will find this a very helpful tool in conducting their client interviews," explains Faith Polk, Medical Program Administrator for the Health Authority. "It will give people so much more information about eligibility." There are several categories of Medicaid eligibility. It's difficult for anyone to understand and reference all of them during a client interview, she adds.

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WSUSOM Researchers To Benefit From Small Animal MRI

The 7T ClinScan MRI was installed March 31 in the Elliman Clinical Research Building on the School of Medicine campus. Bruce Berkowitz, PhD, professor and director of the Small Animal MRI Facility, estimated it would be about three months before research can be conducted on the new machine regularly.

The $2 million scanner will be one of the first of its kind with the new Siemens interface, said Mark Haacke, PhD, director of the MR Research Facility and a professor of Radiology. Both Dr. Haacke and Dr. Berkowitz are responsible for the successful shared instrumentation grant that brought this piece of equipment to Wayne State University.

“There are only four or five machines in the world like this. This machine comes with Siemens software and interface,” said Dr. Haacke. “Wayne State University has collaborated with Siemens for a long time, and we have a long history and excellent reputation for development of new technology and new uses in this field.”

The new 7T, Dr. Haacke said, should have researchers across the Wayne State University campus champing at the bit to schedule time at the MR Research Facility.

“This gives us much more capability and flexibility,” he said. “We have a lot of people using the 4.7T now, and we can switch some of them over to the 7T for higher resolution and better sequencing.”

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DMC Brings Greenway Into Health IT Fold

Greenway Medical Technologies, a leading provider of an integrated electronic health record (EHR), practice management and interoperability solution, recently announced a strategic deal with Detroit Medical Center (DMC) in which physicians and care providers within the nine-hospital network will have access to Greenway’s flagship EHR solution, PrimeSuite®, along with other solutions in Greenway’s complete integrated physician’s infrastructure, reported Greenway.

DMC is expanding its portfolio of healthcare information technology (HIT) tools that DMC physicians can use while treating patients by adding Greenway® as a preferred solution to streamline clinical, financial and administrative workflows of the center’s affiliated physicians and medical practices. DMC physicians, staff and other care providers selected Greenway as a preferred solution and as a part of this new relationship, DMC will be donating a percentage of the qualifying EHR technology to its affiliated physicians and medical practices under the recently modified Stark exceptions and anti-kickback safe harbors for donation of health information technology.

The partnership with DMC highlights Greenway’s continued growth as healthcare providers begin utilizing government HIT and EHR adoption incentives to install health IT solutions that improve care, provide increased return on investment and help establish an interoperable health care system. These incentives (include/will soon include) financial reimbursement offered through the American Recovery and Reinvestment Act (ARRA) and the Physicians Quality Reporting Initiative (PQRI).

"By offering Greenway’s solutions to care providers within our network, we add yet another tool to help eliminate medical errors and improve information exchange with our physicians," said Dr. Leland Babitch, chief medical information officer at the DMC. "Our goal is to offer a well-rounded array of tools that improve and enhance the ability of our physicians and staff to provide the highest level of patient care throughout our system and the community."

Greenway Medical Technologies provides the latest in ambulatory health care business solutions and services to more than 24,000 healthcare providers and professionals nationwide, in 30 specialties and subspecialties, by enhancing the delivery of patient care through innovative HIT software. Established in 1998, Carrollton, Ga.-based Greenway Medical Technologies is a privately held company with approximately 300 employees. For more information about Greenway, visit www.greenwaymedical.com

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