Wayne County Medical Society of Southeast Michigan

April 20, 2009

Editor's Column: What P4P And The Stock Market Have In Common...
Longtime WCMSSM Employee Faces Illness
5th Annual James C. Hazlett, Jr. Memorial Golf Outing
DMC Brings Greenway Into IT Fold
Is There Really A Primary Care Physician Shortage?
Oakwood Physicians Earn Fellowship Designation
Kresge Eye Institute Names Interim Scientific Director
Dr. Puklin To Chair Key Research Committee At WSU

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Editor's Column: What P4P And The Stock Market Have In Common:
Both Are Losing Value Before Our Eyes

By JOSEPH WEISS, MD
The medical community is heading into its fourth year of pay-for-performance (P4P) measures. From that experience, we have learned that P4P uses time and resources. Personnel in the office or the physician must record the indicator, keyboard the claim, and track payments received. Efforts to make the process of entry and reimbursement computer driven have proved complicated, resulting in additional cost and questionable efficiencies. Furthermore, in most cases, the amounts physicians receive are less than expected and do not pay for the effort involved.

We have learned that P4P is demeaning to physicians and irritating to the public. It appears that we need a bribe do undertake the level of care we should provide as professionals. Public feeling is to pay physicians less if they don’t come up to the expected standard of care. US Rep. Henry Waxman, Chair of the House Ways and Means Committee, shares this view.

As a way of minimizing the rolls of patients whose care will not result in bonus payments, the logic of P4P would lead physicians to drop non-compliant patients and refer treatment of complex cases to other physicians.

Over the last three years no evidence has come to light that indicates any savings to the insurers putting out dollars for P4P. No study as yet indicates that under P4P the patient improves or that physicians change behavior. Any reported improvements in care can be attributed solely to better capture of data.

Insurers want to increase the measures under surveillance, while physicians want increased reimbursements for the P4P items they now report.

The strategy to correct present deficiencies in P4P is to drop the idea; this suggestion is not a far-fetched dream. As already noted, Waxman opposes it. His position gives him leverage to exert unusually strong pressure to limit or end this form of physician payment. The medical community should offer strong support for his position.

If P4P is a failure at rewarding quality work, what can we offer in its place? Michigan physician organizations (POs) already have in place a plan that works. It is bonus payments of $5,000 or more to physicians whose patient-per-thousand-members needing emergency room visits are fewer than the physician group average. The thinking is that a physician who can keep his numbers lower then than others in the group is doing singular work and deserves credit for the effort.

A PO is large enough to garner statistics that are both local and meaningful, and thereby applicable to individual physicians in the group. Furthermore, in contrast to P4P that imposes an immediate national standard on all physicians, the PO approach introduces one quality standard at a time, and follows its effect on the group.

Opposing P4P, supporting Henry Waxman, and putting forward the role of POs is the best way, as of now, to encourage quality and keep the monitoring of physician activity within the profession.

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Longtime WCMSSM Employee Faces Illness

Linda Masters has been diagnosed with pancreatic cancer, family members announced last week.

Linda has served at WCMSSM for many years in various roles, including administrative assistant, specialty society coordinator and membership director. Most recently served as executive secretary for local surgical societies managed by WCMSSM.

She is in Beaumont Hospital – Royal Oak receiving chemotherapy. There is no definite date set for her release from the hospital.

Linda’s friends and colleagues at WCMSSM wish her the best during this difficult time.

The family has set up a website for Linda’s family and friends to view the latest updates on her condition. Messages may also be sent to Linda via the site: http://www.carepages.com/carepages/Nonni

The family has provided the following contact information for those who wish to contact them regarding Linda’s condition. Please call before visiting Linda.

Leslie Backus
248.219.7721 – mobile
810.360.0532 – home
leslie@netastic.net

Lisa Masters
248.212.4231 – mobile
248.792.8593 – home
lkrmasters@comcast.net

Mark Masters
248.890.9258 – mobile
248.593.9341 – home
masterm@secrestwardle.com

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5th Annual James C. Hazlett, Jr. Memorial Golf Outing

Spots are filling up! Register online @

http://www.golfdigestplanner.com/11468-HazlettMemorialGolfOuting

Payment and registration can also be dropped off at Student Affairs

The 5th Annual James C. Hazlett, Jr.

Memorial Golf Outing

Bringing together students, faculty, alumni, and friends

of Wayne State University School of Medicine

Saturday, May 2, 2009

Twin Lakes Golf and Swim Club

455 Twin Lakes Drive

Oakland Township, MI 48363

Come out for the awesome golf, tasty dinner buffet,

and prizes - including Winning Team, Longest Drive,

Closest to the Pin, and tons of raffle giveaways!!!

Proceeds help to support the James C. Hazlett Jr. Medical Student Scholarship fund, graduation expenses for senior classmen, and the philanthropic student organizations of Wayne State University School of Medicine who actively volunteer in the Metropolitan Detroit community.

An associate professor of anatomy and cell biology, Dr. James Hazlett, Jr. joined the WSU faculty in 1980, and was instrumental in the design and implementation of the medical school curriculum. He served as course director for medical neuroscience and gross anatomy - two critically important comprehensive areas that are required of all medical students. In addition, he taught human body dissection, anatomy, neuropharmacology and neuroanatomy in the School of Medicine. In 2001, he was named assistant dean after serving many years on the Admission and Curriculum Committees, which then allowed him to play a critical role in the development of the Year I and II medical doctorate programs.

The James C. Hazlett Jr. Memorial Scholarship Fund and Annual Golf Outing were established in honor of Dr. Hazlett's deep commitment to medical education and student success after his death on February 22, 2005. For more information or to donate to the fund, please contact Terri Larrew at 313-577-8311.

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DMC Brings Greenway Into 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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Is There Really A Primary Care Physician Shortage?

Editor's Note: The following comments are in response to a Scripps Howard News Service item urging solutions to the what many perceive as a primary care physician shortage. The editorial characterizes primary care as the cornerstone of health care reform.

M. Salhaney, MD, submitted comments referencing the last line in the editorial, which reads: If our health care system is broken, primary care is the place to start fixing it.

The last sentence in the article is highly significant. "If" leaves me with a question about the premise of a current or future shortage of family physicians. What and where is the supporting evidence? What societal factors confound the issue of “doctor shortage?” How is the term "family physician" defined? Is a physician that administers primary care also a family physician?

I wonder if the critical shortage of family physicians that is supposed to be upon us, may be, in some measure, ameliorated by rationing of health care that is sure to arrive, as in other locations where the government is the single payer ?

The full Detroit News/Scripps Howard editorial can be found at:

http://www.detnews.com/article/20090416/OPINION01/904160325

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Oakwood Physicians Earn Fellowship Designation

Oakwood Healthcare System recently announced that Bobby G. Lee, MD, of Oakwood Hospital and Medical Center, has earned the Fellow in Hospital Medicine (FHM) designation. Becoming a Fellow is an avenue for special recognition by the Society of Hospital Medicine (SHM) members who have distinguished themselves among their colleagues and the hospital medicine specialty.

To be designated as a Fellow in Hospital Medicine, an applicant must be a hospitalist for five years, a member of SHM for three years, demonstrate their dedication to quality and process improvement, commitment to organizational teamwork and leadership, as well as lifelong learning and education.

Approximately 500 Hospitalists will be inducted in the inaugural class of Fellows this May at Hospital Medicine 1009 in Chicago.

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Kresge Eye Institute Names Interim Scientific Director

Paul Finlayson, PhD, assistant professor of Otolaryngology and Ophthalmology for the Wayne State University School of Medicine, was named interim scientific director of the Ligon Research Center of Vision at Kresge Eye Institute.

Dr. Finlayson’s role will be to guide and work directly with researchers in the Ligon Center, including Nicolas Cottaris, PhD, and Sylvia Elfar, PhD, (Ophthalmology), and further collaborations with Yong Xu, Ph.D., (Electrical Engineering), R.M. Kannan, PhD, (Chemical Engineering) and former Ligon scientific director Raymond Iezzi, MD, now at the Mayo Clinic in Rochester, Minn.

“We will be continuing the effort to develop prosthetics to restore sight in visually impaired individuals,” Dr. Finlayson said. “I will be supervising the fabrication, development and testing of new devices for electrical and neurotransmitter stimulation of the retina.”

In collaboration with members of the center, Dr. Finlayson will strive to add new grant funding, and will also work with the director of development at Kresge Eye Institute to solicit additional funding for the Ligon Center.

The Ligon Research Center of Vision is a multidisciplinary center and one of only a few centers in the world that is exploring the possibility of artificial vision for the blind. The center is dedicated to restoring vision in patients who are losing their sight or have become blind from retinal degenerations.

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Dr. Puklin To Chair Key Research Committee At WSU

James E. Puklin, MD, professor of Ophthalmology at the Wayne State University School of Medicine and a retina expert at Kresge Eye Institute, knows his way around medical research. His more than 260 presentations, dozens of grants, 58 published scientific articles and six book chapters have put him in good stead to become a reviewer himself.

Dr. Puklin recently received two prestigious appointments that put him in a position to review research by many types of scientists and medical researchers. At Wayne State University, he has been named chairman of the Human Investigation Committee, reporting directly to the university president. The committee’s six Institutional Review Boards review, approve and supervise 2,500 protocols for local studies and national clinical trials in the biomedical and social sciences.

“IRBs were established by the federal government to protect the safety of human subjects who participate in all types of research,” Dr. Puklin said. “We work to ensure patients are not coerced into participating; that risk levels are reasonable; and that patients are treated with dignity, respect and openness.”

Before being named chair, Dr. Puklin served on the IRB since 2000.

In 2008, he was reappointed to the Medicare Evidence Development Coverage Advisory Committee of the Centers for Medicare and Medicaid Services. As the only ophthalmologist among 100 experts on the national committee, Dr. Puklin advises CMS on which medical procedures provide effective and appropriate patient outcomes and should receive Medicare reimbursement. He had previously served on MedCAC from 2005 to 2007.

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