E-DMN - August 10, 2009

August 10, 2009

In My Opinion: A Solution: Stop Caring For The Sick
Dr. Smitherman On Short List For Kanter Prize
Dr. Juzych Takes National ACGME Post
Thomson Reuters Names HFHS As Top In US
Pertussis Levels High In Michigan
White House Uses Web To Battle Reform Rumors
MMGMA Fall Conference
Reader Survey 2009

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In My Opinion: A Solution: Stop Caring For The Sick

By ALLAN DOBZYNIAK, MD
That caring for sick patients is costly has led some to conclude that this is not what doctors should do. In fact the statement, “physicians only take care of sick patients,” has been cast as a negative for the medical profession and in need of bureaucratically sponsored enlightenment for the greater social good.

Regardless of there not being solid data to support the alleged cost savings of preventive care, it seems politically intuitive to many of our national legislators that the public should be convinced it is so. Facts suggesting preventive care may be more expensive to implement and support with little outcome benefit are certainly to be ignored. After all, such facts are not relevant to the indoctrination necessary for creating the “right” public perception.

It is apparent that caring for chronically ill patients, often elderly, with multiple health problems is inefficient, time consuming and may necessitate repeated hospitalizations. Numerous phone calls from the patient and family members, lengthy explanations, and even trips to the emergency room are inevitable. When the compromise to productivity, impossibility of coding for appropriate reimbursement, difficulty with a fit into standard quality criteria, and the certainty of negative outcomes measures are considered, I must admit the bureaucratic health care “experts” are correct.

I should have realized that caring for healthy clients was the way to go. Counseling on proper diet, appropriate weight, smoking cessation, alcohol moderation, exercise, stress reduction, seat belt use, and advising on Botox, massage therapy, cosmetic surgery and magical potions clearly is more rational. Just think, the facilitated productivity might allow 50 patients a day, even more if numerous physician extenders could be employed. Eight-hour work days with lunch, coffee breaks and exercise time allotments would be possible. Client phone calls would be eliminated by novel and educational Internet sites. I would have extra time to be sure my EMR was humming, producing loads of educational advice and the perfect documentation to support coding and billing. A clear, concise, utilitarian, informative progress note would never need to thought out. God forbid somebody might really get sick. But to be sure my appointments were always on time and my outcomes were perfect, a referral to a doctor still foolishly interested in caring for sick patients would be facilitated. Liability concerns, mortality, ER visits, hospitalizations, pharmacy utilization and non-severity adjusted cost of care comparisons would soon become only distant memories. Despite the waste of a medical education, life would be great?

The manifest clarity of irresponsible fiscal behavior on display in the currently proposed health care legislation is akin to the absurdity presented in the non-logic above. If it is accepted that people only believe what best fits their perception of reality, then there is no need for truth. The arguments can then be constructed to create public perception without any regard for truth. It is then not what an individual thinks based on truth, understanding and accuracy but what should be thought based exclusively on perception. This requires a strategy to create a perception (talking points) and rapidity of action lest understanding become complete and truths exposed.

There is an ugliness to opportunism. Opportunists feed off the misery or perceived misfortune of others, which more often than not, they themselves have manufactured. The crisis then created can be used to galvanize power. This power must be centralized, concentrated in a few hands and not democratized, to be used effectively. Worse yet, extremism can catch hold if a sufficient amount of animosity can be created. The proposed revision of health care based on opportunism is of course not logical. Improvement in the system then will be unlikely or impossible. What is amazing is there seems to be no deterrent capable of stopping it or even giving it pause.

In general physicians have always done willingly what has been asked of them. This has now evolved to leave them as pawns to the real powers of the secular world, business and politics (private insurers and government entitlements). In the separate struggle, politics is emerging as the mightier victor over business. Medical professionals functioning upon an ethical foundation and a true desire for clinical improvement are an anathema in the current political environment motivated by lobbyists, power, populism, reelection, economic irresponsibility, innuendo, non-truths, and broken promises. Cost is ostensibly a main driver of health care change (power of course the true motivation), and it is through economic means that the fall of medical professionalism can take place. It is this conclusion that the preposterous initial comments on caring for ill patients versus caring for healthy clients attempts to demonstrate.

It is difficult not to be cynical based on the current manipulation of public perception motivating health care change and the potential for a disastrous outcome, but I guess cynicism is better than lassitude.

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Dr. Smitherman On Short List For Kanter Prize

Dr. Herbert C. Smitherman Jr., assistant dean of Community and Urban Health and assistant professor of the Department of Medicine for the Wayne State University School of Medicine, is among ten finalists for the J.H. Kanter Prize.

The inaugural award recognizes physicians who have dedicated their medical careers to enhancing health care delivery. Organizers said the prize stands as national recognition for “landmark work, their tireless efforts and creativity in developing new systems to eliminate disparities and to optimize health care for more people in the United States.”

Dr. Smitherman, who also serves as president and chief executive officer of Health Centers Detroit Foundation Inc., was nominated by the Michigan State Medical Society and the Wayne County Medical Society of Southeast Michigan.

The MSMS and the WCMSSM nominated Dr. Smitherman for running three community-based health centers in urban Detroit, working with culturally diverse communities to improve urban-based primary care delivery systems and his dedication to organizing, expanding and improving access to cost-effective, high-quality health care for the uninsured, as well as volunteering his time without pay to see that patients get the care they need, regardless of income.

"We are extremely proud that our colleague, Dr. Herb Smitherman, is among the finalists for the Kanter Prize,” said George Shade Jr., MD, associate professor of the Gynecology Division in the Department of Obstetrics and Gynecology for the Wayne State University School of Medicine and president of the WCMSSM. “His work in addressing disparities in health care and improving access should be recognized nationally."

The prize, named for Joseph H. Kanter, a pioneering health care reform advocate for a personal electronic medical database, is sponsored by the Health Legacy Partnership, a public private partnership with the federal Agency for Healthcare Research and Quality.

“Dr. Smitherman is certainly worthy of consideration,” said Valerie Parisi, MD, MPH, MBA, interim dean of the School of Medicine. “He has done so much to ease the health care disparities and to battle the obstacle of access to primary care in the Detroit region. He is a marvel as a physician who cares about his community, and an outstanding example of what we can do to confront our challenges.”

The winning Kanter Prize laureate will receive a $100,000 prize. Four runners-up will receive $25,000 each. The finalists were selected from nominations from state medical associations. The society that nominated the winner will receive $10,000.

The winners will be announced Aug. 11 in Washington, D.C.

Nominees must be practicing physicians who developed innovative programs that enhanced health care delivery by helping to diminish health care disparity while demonstrating implementation and duplication potential on a national level.

Dr. Smitherman has spent the past 22 years working with diverse communities in Detroit to develop urban-based primary care delivery systems that integrate the health and social goals and concerns of the community. He has been successful in establishing and working with best-practice models that have community participation and collaboration as the key element in creating sustainable primary care programs. Those efforts led to the publication of a book, “Taking Care of the Uninsured: A Path to Reform,” which details the 10-year path of the Voices of Detroit Initiative. That project, launched in 1998 with a $5 million grant from the Kellog Foundation, sought to ease the strain on emergency rooms used by the uninsured as primary care facilities by providing access to true primary care.

Originally tasked with addressing the primary care needs of 27,500 patients, the initiative far surpassed that goal by assisting 33,093 uninsured Detroit residents. The program established 11 new primary care access sites in addition to providing primary care for the uninsured and easing the strain on emergency rooms.

"Dr. Smitherman has committed his medical career to improving access to health care for the most vulnerable people in Detroit," said MSMS President Richard E. Smith, MD, an obstetrician/gynecologist at Henry Ford Hospital. "The rest of the nation should look at what he has been able to accomplish. He deserves this honor and recognition."

“The Kanter Prize honors and highlights practicing physicians who have selflessly and creatively helped to minimize disparities in health care delivery,” said Joseph H. Kanter. “It encourages other medical professionals to build upon these revolutionary ideas to create a system of high-quality care accessibility for all Americans.”

Kanter has long supported efforts to improve public health. He established the Joseph H. Kanter Foundation in 1964, which has funded health care research, educational institutes and charitable endeavors. In 1998 Kanter helped establish the Health Legacy Partnership, a private-public partnership between the Joseph H. Kanter Family Foundation and the AHRQ to develop a national database of medical outcomes research treatment information.

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Dr. Juzych Takes National ACGME Post

Mark S. Juzych, MD, MHSA, professor and associate chair of Ophthalmology for the Wayne State University School of Medicine and Kresge Eye Institute and associate dean for Graduate Medical Education for the School of Medicine, was appointed chairman of the Ophthalmology Residency Review Committee for the Accreditation Council for Graduate Medical Education for a four-year term.

The ACGME is a private, non-profit organization that accredits approximately 8,500 residency programs in 127 specialties and subspecialties that educate 108,000 residents. Its mission is to improve the quality of health care in the United States by assessing and advancing the quality of resident physicians’ education.

“In this position I will be overseeing accreditation of all ophthalmology residency programs in the United States involving standards and guidelines.” Dr. Juzych said. “Being nominated and elected for this position is not only a personal achievement, but also recognition of Kresge’s excellence and outstanding residency program.”

ACGME is responsible for the accreditation of post-MD medical training programs within the United States.

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Thomson Reuters Names HFHS As Top In US

Henry Ford Health System has been named one of the top 10 health systems in the United States by Thomson Reuters, reports HFHS.

The designation was based on clinical performance of 252 health systems. Researchers from the Thomson Reuters analyzed the quality and efficiency of these health systems and found that Henry Ford had 25 percent lower mortality, 19 percent fewer medical complications, and 13 percent fewer patient safety incidents - even with sicker patients and significantly shorter hospital stays on average.

Researchers looked at the following five core measures published by the Centers for Medicare and Medicaid Services that gauge clinical quality and efficiency:

Mortality

Medical complications

Patient safety

Average length of stay

Adherence to clinical standards of care.

All U.S. health systems with two or more short-term, general, non-federal hospitals were assessed.

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Pertussis Levels High In Michigan

Reported pertussis levels in Michigan, and several other states, remain high in 2009. Please share the following information with clinicians and other appropriate health care providers. Medical and public health providers should help to assure proper diagnosis, treatment, prevention and control. Clinicians should consider pertussis in prolonged cough illnesses (2+ weeks). Recommended diagnostic tests are culture or PCR of nasopharyngeal (NP) aspirate or swab (Dacron). Serology and DFA tests are NOT recommended. Cases should be reported to local public health departments, investigated, and classified according to the national surveillance case definition. Recommended treatment is a course of a macrolide antibiotic (5 days azithromycin, or 7 days clarithromycin, or 14 days erythromycin; an alternative is 14 days TMP-SMZ). Household and other close contacts of cases should receive antibiotic prophylaxis within 3 weeks of exposure using same antibiotics and doses in treatment recommendations. Infants are at highest risk of severe disease and death; older siblings and adults often are the source. Infants and children should receive pertussis vaccine series (DTaP) as per the U.S. recommended childhood immunization schedule. All doses should be given as close to the recommended ages as possible. A routine pertussis vaccine booster dose (Tdap) is recommended for adolescents and adults, and is especially important for those in contact with infants.

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White House Uses Web To Battle Reform Rumors

White House Web Site Launched To Battle Health Reform Rumors

Aug 10, 2009

USA Today reports in The Oval blog that "the White House has rolled out its newest weapon in the cyberwars over health care: A website called Reality Check." The site seeks to debunk "some common myths" about reform proposals and also provides readers with online tools and content to share within their social networks. But a spokesman for Senate Republican leader Mitch McConnell of Kentucky is skeptical "the new website will turn around public opinion on Obama's vision for health care. 'Do people really want to watch videos of people they don't know telling them how great a program is that they already disagree with?'" he said (Jackson, 8/10).

The Associated Press: "The White House has turned to its favorite tool — the Internet" to "directly counter what it calls myths" about reform proposals backed by President Obama. The site includes video clips of top administration aides responding to criticisms.

Fox News Politics: "The Web site... uses the same set-up as the 'Fight the Smears' page the Obama campaign maintained last year to battle rumors seen as potentially damaging to his candidacy." Among the specific claims White House aides dispute are assertions that "health care reform will lead to 'rationing'" and "the idea that reform would lead to euthanasia for seniors." Fox notes that it is not clear if these claims are the result of last week's effort "to gather 'fishy' e-mails," which triggered "charges that the administration was gathering information on health care reform critics, something the White House denies." The new site includes a 'We Want to Hear From You' section which urges readers to send in "myths" (8/10).

Additionally, The Wall Street Journal reports in its Washington Wire that "seeking to combat the negative message on health care coming out of town hall meetings across the nation this August, President Barack Obama's political arm sent an e-mail to supporters over the weekend urging supporters to visit local congressional offices over the break in favor of the health care overhaul" (Davis, 8/10).

This information was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

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MMGMA Fall Conference

MMGMA’s fall conference at

the Grand Traverse Resort & Spa

September 16 through 18.
Steering the Ship through Turbulent Waters.
Access conference registration online now at www.michmgma.org
Session highlights include:

Louis C. Rabaut
Changes in employment law under
the Obama administration

Jill Callahan Dennis
New challenges and risks in digital
information management

Bonnie St. John
Strategies for managing your
practice through turbulent times

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Reader Survey 2009

Detroit Medical News/WCMSSM Reader Survey August 2009

**Please feel free to cut and paste into an e-mail and send to

arj@msms.org or fax to (313) 874-1366**

What is your specialty:________________________________

What is your age:____________________________________

How often do you read the DMN magazine? (please circle one):

Every issue Sometimes Infrequently Never

How often do you read the DMN weekly e-edition? (please circle one):

Every week Sometimes Infrequently Never

For what do you read the magazine for most? (please circle one):

News Features Opinion pieces
Other (please describe):_________________________________

For what do you read the e-edition for most? (please circle one):

News Features Opinion pieces
Other (please describe):_________________________________

The magazine is published six times yearly. Is this (please circle one):

Too often Not often enough Just right

The e-edition is published weekly. Is this (please circle one):

Too often Not often enough Just right

Are you a member of social or business networking site?

Yes No

If so, which one(s)?:

Facebook Twitter Linked In Sermo.com
Other:________________________

Are we covering the right issues in the magazine and e-edition?

Yes No Usually Sometimes Not often Never

What are the issues that most affect you:

1:__________________________________________

2:__________________________________________

3.__________________________________________

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