December 21, 2009

IN THIS ISSUE

Editor's Column: More Than Criticism
AMA, MSMS Challenge PHPMM and BCN Merger
Two Month Extension For SGR Passed
Governor Signs Smoke-Free Air Bill
HFHS Statement on CT Scans
With Deal In Hand, Senate Democrats Proceed On Health Bill
Significant Discussions Underway On Move To ICD-10
2009 Children's Holiday Party Contributors

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Editor's Column: More Than Criticism

By JOSEPH WEISS, MD
We cannot quite congratulate ourselves for defeating the doctor’s tax-the levy passed in the Michigan State House of Representative to place a 3 percent tax on Michigan physicians’ gross receipts for the purpose of raising funds for Medicaid payments.

The issue is not dead though the state senate thoroughly trounced the bill when it came to a vote in that chamber. Another version, Senate Bill 854, is now under consideration.[1]  The new bill would establish a 3 percent tax expected to raise $321 million ($130 million to the state, $191 million for funding physicians) with $521 million in Federal matching funds leading to a net increase of $393 million to physician payments for Medicaid services.

The new version contains the same flaws as Dr Fordyce noted in his Detroit Medical News article of October 19[2]. The actual increased reimbursement rate is not mentioned, and the goal of reaching Medicare rates is not possible as the Bill make no provision for the 20 percent co-pay that is part of the Medicare rate. Nor does the bill consider the expense to physicians of additional overhead to comply with the tax rules and requirements.

As was the case in the House bill, the new Senate initiative SB 854, is inequitable as it places a society’s responsibility  for care of the needy, on a single group, the state’s physicians. Also, the new bill collects $321 million, but hardly half goes for medical services. Physicians were right to oppose the original bill and will with good reason, oppose the new bill if in its present form it comes to the state senate.

However, physicians need to do more then oppose the physician tax. If the legislature finds no new revenue for Medicaid financing by January 1, 2010, physician reimbursements will decrease by 8 percent[3], an alternative as bitter and unacceptable as the 3 percent tax.

As much as we fight against the physician tax, we must come forward with equal vigor to champion an alternative revenue source that will gain the $393 million the state seeks for Medicaid. 

Michigan physicians should lend their support to those groups calling for a freeze on the present state income tax rate of 4.35 percent. If the legislature doe not act to institute a freeze, the tax rate will drop down to 3.9 percent [4]. There is no compelling need for that reduction. The tax rate at 4.35 percent compares favorably with the nation’s other 40 states that levy an income tax[5] 

For Michigan, continuation of the 4.35 percent rate would bring in at least $6.5 billion[6] to the state treasury, an amount that would allow the state to gain the additional funding needed for the Medicaid program.

This matter of the physician tax is just one instance in which our strategy should not be only to criticize and oppose. We should provide more, we should present alternatives.

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AMA, MSMS Challenge PHPMM, BCN Merger

Alongside the Michigan State Medical Society (MSMS), the AMA is challenging a proposed merger in Michigan between Physicians Health Plan of Mid-Michigan (PHPMM) and Blue Care Network (BCN). In a letter to the Michigan Insurance Department, the AMA argues that the proposed merger between PHPMM and BCN would effectively destroy competition for health insurance in the Lansing/East Lansing Metropolitan Statistical Area (“Lansing area”). The health insurance market in the Lansing area is already highly concentrated, and the merger would give the new entity 81 percent of the market for PPO and HMO insurance products. If allowed to proceed, the merger would give the new entity the power to increase premiums for Lansing area consumers and dictate payment rates to area physicians. Given the merged insurer’s market share, it could lower payment rates to a level that would force many physicians to either leave the market or reduce the level of service they are able to provide their patients.

(Source: AMA Advocacy Update, Dec. 17)

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Two Month Extension For SGR Passed

On December 16, the House passed a Department of Defense appropriations bill that included a 2-month extension of the sustainable growth rate (SGR). The legislation would stop the 21.2% Medicare pay cut scheduled to take effect on January 1 for a period that will end March 1, 2010. The legislation does not affect any of the other payment policies included in the final 2010 fee schedule rule; those will take effect on schedule.

A cloture motion on the DoD extension bill was filed in the Senate. Votes on cloture and passage should be completed this weekend.

(Source: AMA Advocacy Update, Dec. 17)

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Governor Signs Smoke-Free Air Bill

Surrounded by celebratory smoke-free air advocates and members of the Campaign for Smokefree Air, Gov. Jennifer Granholm signed smoke-free workplace legislation, making Michigan the 38th state to take action protecting its workers from secondhand smoke exposure.

Earlier this month, both chambers of the state Legislature approved House Bill 4377 including a substitution tightening up exemptions for cigar bars and tobacco specialty shops.

"This is not only a huge win for organized medicine, but also for every resident of our state," said MSMS President Richard Smith, MD. "We are grateful that the legislature and the governor have made the health of Michigan citizens a priority."

“Workers across the state are cheering as smoke-free air is finally a law in Michigan,” said Judy Stewart, CSA campaign manager and director of state government relations at the American Cancer Society. “After more than a decade fighting for the health of Michigan workers, protection is in place from secondhand smoke.”

The new law will take effect May 1, 2010, and includes all worksites, except Detroit casino gaming floors and existing cigar bars and tobacco specialty shops. The new law is named after Dr. Ron Davis, a former East Lansing resident who lost his battle with pancreatic cancer last year. Davis was the immediate past president of the American Medical Association and director of the Center for Health Promotion and Disease Prevention at Henry Ford Health System in Detroit. He was a longtime advocate of smoke-free air in Michigan.

“We are elated that this day has finally come,” Stewart said. “None of this would have been possible without the thousands of advocates who have been dedicated to this issue for the last several years as well as the leadership of Sens. Basham, George and Jelinek and Reps. Joan Bauer and Paul Scott.”

Only 12 states have not yet made any efforts to protect their employees from the dangers of secondhand smoke.

The Campaign for Smokefree Air is a coalition with more than 270 members, including leadership from the Michigan State Medical Society, American Cancer Society, American Heart Association, American Lung Association of Michigan and Michigan Health & Hospital Association, Michigan State Medical Society, as well as other statewide groups that are committed to passing a smokefree workplace law. For more information about the Campaign for Smoke-free Air, please visit www.MakeMIAirSmokefree.org.

The law will take effect on May 1, 2010.

TAKE ACTION NOW – visit the MSMS website, www.msms.org, to thank the representatives and senators who voted "YES" on making Michigan the 38th state in the nation to enact some kind of indoor smoking ban. See how senators and representatives voted [pdf].

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HFHS Statement On CT Scans

(Editor’s Note: Henry Ford Health System released the following statement Dec. 17)

STATEMENT: CT SCAN SAFETY

Recent media reports have raised awareness and concerns about medical radiation exposure in CT scans. CT is a valuable imaging technique that provides important and potentially life-saving information.

The Department of Radiology at Henry Ford has a long history of using the most advanced imaging technologies. Our commitment to patient care, patient safety, education, research, and continuous quality improvement is demonstrated by the following:

State-of-the-art CT equipment, which ensures maximum image quality at minimum radiation dose.

A continuous Quality Improvement Program, which ensures properly functioning equipment.

All CT requests are reviewed by a radiology physician to determine the proper procedure to ensure the best results at the lowest radiation dose. Henry Ford always uses the lowest possible effective dosage for all radiology exams, including CT scans and x-rays.

Continuing education programs for Henry Ford radiologists provide the most up-to-date information on best practices in CT.The radiation dose for every CT exam is monitored and documented. 

More testing does not necessarily mean better care. Your physician will weigh the benefits versus the risks when ordering a radiology exam.

As with other medical procedures, CT scans and x-rays are safe when properly administered.

The amount of radiation used in most examinations is very small, but if you have had frequent CT scans or x-rays and change doctors, it is a good idea to keep a record of your medical history of tests you have had involving radiation. This can help your doctor make an informed decision. It is very important to tell your doctor if you are, or may be, pregnant before having a CT scan or x-rays.

CT scans and X-rays are forms of energy, like light or radio waves. But they can penetrate the body, allowing a radiologist to see internal structures. These types of examinations provide valuable information about your health and play an important role in helping your doctor make an accurate diagnosis.

All Henry Ford Radiology team members recognize that even a low radiation dose is potentially harmful, and always practice radiation safety measures. Other imaging exams such as ultrasound or magnetic resonance imaging (MRI), do not use radiation and may be useful in place of a CT scan. Your physician may contact a Henry Ford radiologist to determine whether alternative tests are appropriate.

Questions to ask when your doctor orders a CT exam at Henry Ford:

1. Why do I need this exam?

2. How will having this exam improve my health care?

3. Are there alternatives that do not use radiation which are equally as good?

4. Is my child receiving a "kid-size" radiation dose? (for pediatric exams)

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With Deal In Hand, Senate Democrats Proceed On Health Bill

(Editor’s Note: The following is a news roundup on the federal Health Care Reform Bill prior to Sunday night’s voting.)

Reuters: "The White House on Sunday sought to preserve the fragile alliance of Democratic liberals and moderates backing broad healthcare reform legislation, with tough decisions looming on abortion and a new government-run insurance program. The White House predicted that the bill, President Barack Obama's top domestic priority, will win final congressional passage, and called it a major achievement even if it does not give Obama and his fellow Democrats everything they want.

"Democratic holdout Ben Nelson announced his support for the Senate legislation on Saturday after securing language aimed at ensuring federal funds are not used to pay for abortions and winning extra healthcare funds for his home state of Nebraska" (Sullivan, 12/20).

CNN: "Obama had wanted to sign the bill by the end of year, but his senior adviser, David Axelrod, acknowledged Sunday that wouldn't happen. 'I think we're going to have some work to do when we come back' from the Christmas-New Year break, Axelrod said Sunday on NBC's 'Meet the Press.'"

"Both Axelrod and Vice President Joe Biden said Sunday the Senate bill lacks some provisions the Obama administration wanted, but that it would bring much-needed health care reforms. ... In a New York Times op-ed published Sunday, Biden said the bill was 'not perfect,' but called it 'very good' because it expands coverage to those currently unable to afford or obtain health insurance while holding down the nation's spiraling health care costs" (12/20).

The Wall Street Journal: "Republicans over the weekend criticized the deal for Nebraska. Sen. Jon Kyl (R., Ariz.), appearing on ABC News's 'This Week with George Stephanopoulos' Sunday, asked if it wasn't a good deal for Nebraskans to pay their share of an expansion of Medicaid, why should the rest of America have to foot the bill. Other Republicans have also criticized the deal, with Sen. Richard Burr (R., N.C.) saying, 'You've got to compliment Ben Nelson for playing, 'The Price Is Right.'"

Addressing such criticism, Mr. Axelrod said "every senator uses whatever leverage they have to help their states" (Scannell, 12/20).

CQ Politics: "The Democratic linchpin in a delicate Senate health care compromise said Sunday that special goodies for his constituents came at the behest of the state’s Republican governor. Speaking on CNN’s 'State of the Union,' Sen. Ben Nelson , D-Neb., said he “didn’t ask for a special favor here ... didn’t ask for a carve-out. He’s said publicly he’s having trouble with the budget and this will add to the budget woes,' Nelson said of Republican Gov. Dave Heineman. 'I said, look, we have to have this fixed.'"

"With both chambers now expected to hash out their differences after the new year, Nelson said he would not support a blended bill that includes a 'public plan' or House-proposed tax on wealthy Americans" (Murray, 12/20).

The Associated Press: "Republican Sen. John McCain, President Barack Obama's opponent in last year's election, said there was probably nothing to keep Democrats from passing the bill by Christmas Eve. Still, he said, the GOP would not relent in the battle for public opinion. 'We'll fight the good fight. We will fight until the last vote,' said McCain, R-Ariz. He said the political climate under Obama has become more partisan than ever."

"To keep the process moving under Senate rules, Democrats will need to show 60 votes — now secured, with the locked-in support of Nebraska Sen. Ben Nelson — in a series of votes. The next one is set for 1 a.m. Monday" (12/20).

The New York Times: "If the Senate bill passed, it would have to be reconciled in conference with the earlier House version. The two differ substantially; and a key senator said Sunday that it would be difficult for his chamber to pass anything that varies much from the Senate version" (Herszenhorn and Hulse, 12/20).

The Hill: Howard Dean said Sunday that the Senate healthcare reform bill was made better this past week by Democratic senators but still has not earned his support. Appearing on NBC’s 'Meet The Press,' the former Democratic National Committee chairman and ex-Vermont governor said the legislation was not the fundamental reform America’s healthcare system needed. Dean said the House version of the healthcare reform package was a better bill. 'There are some things in this bill that weren't in there a week ago that make it a better bill. But this can't be the final version of this bill,' Dean said" (Bogardus, 12/20).

Fox News: "Do not mess with this bill. That was the message Senate Democrats sent to their colleagues on the House side over the weekend ... Liberal Democrats are eager to negotiate and try to win back items that were stripped from the Senate bill like a government-run insurance plan. But the final version would again need 60 votes to overcome a Senate filibuster, and Senate moderates warn that any big changes in conference could erode that bloc. 'Anybody who's watched this process can see how challenging it has been to get 60 votes,' Sen. Kent Conrad, D-N.D., said on 'Fox News Sunday.' 'It is very clear that the bill, the final bill, to pass in the United States Senate is going to ... have to be very close to the bill that has been negotiated here'" (12/20).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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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Significant Discussions Underway On Move To ICD-10

Over the few two weeks there have been a number of meetings to discuss implementation issues surrounding the move to ICD-10. The AMA convened a meeting of industry-wide stakeholders including those representing payers, coders, vendors, labs, pharmacies, billers and others to discuss operational challenges associated with moving from ICD-9 to ICD-10, as well as opportunities to work together toward meeting the October 1, 2013, compliance date required under HIPAA. Shortly after the AMA meeting, CMS held a meeting with industry stakeholders to discuss issues ranging from educational efforts to operational challenges. The AMA also testified before the National Committee on the Vital and Health Statistics, which advises the Secretary of the Department of Health and Human Services, regarding AMA education efforts, ICD-10 implementation challenges, and ideas for further simplifying health care administration for physicians. For more information on the AMA's efforts on ICD-10, visit our website at www.ama-assn.org/go/ICD-10.

(Source: AMA Advocacy Update, Dec. 17)

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2009 Children's Holiday Party Contributors

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children that took place Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

Clarence H. Schultz, MD

Dr. Stephen Lemos

Robert G. Borchak, MD

Dr. & Mrs. William J. Cosgrove, Jr.

Dr. and Mrs. Mark A. Kelley

Steven A. & Deborah L. Portney

Hassan Amirikia, MD

Sheryl Wissman, MD

Dr. Adnan Munkarah

Paul & Debbie Natinsky

Dr. & Mrs. Mark Tuthill

Dr. Orlando S. Sison

Guat and Dionisia Sy, MD's

Giovanni A. Morreale, MD and Lisa J. Morreale

Dr. & Mrs. Theodore B. Jones

Dragos M. Galusca, MD

Julius V. Combs, MD

Dr. and Mrs. Charles Barone

Melvin L. Hollowell, MD

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