Wayne County Medical Society of Southeast Michigan

February 9, 2009

Editor's Column: Where Convention Cracks
Karmanos CEO To Quit, Take Job In Las Vegas
Kansas Governor On Shortlist For HHS Job After Daschle Fiasco
Michigan Hospitals Crisis Gains National Notice
Medicare Payment Disputes Outsourced
Medical Marijuana Law Resource Guide
Health Authority Safety Net Report Highlights
States Employ Variety Of Responses To Health Professionals Shortage

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Editor's Column: Where Convention Cracks

By JOSEPH WEISS, MD
The conventional consensus is wrong. The greatest threat to an equitable health care system in this country is not from the flaws in the present system but from the needs of our aging citizens.

Readers of the Detroit Medical News do not need graphs and statistics to grasp the enormous health care cost the nation incurs because of the success of technology and innovative therapies which allow Americans the opportunity for longevity.

None of us will get out of here alive. However, the effort to hold on by taking another drug, inserting a more sophisticated pacemaker, or undergoing a robot-related repair, has created a new life cycle. This process of hanging on takes up a huge amount of physician time and health care dollars. The flow of technology and the ingenuity of the medical community means the potential exists to nearly create a world without end for the elderly.

However, no reasonable way exists for American Society to make rules for who should get medical care and for how long. That decision now, and for the foreseeable future, will remain, an individual choice.

What the public needs is not yet another article about costs, quality and access, but editorials and commentary on the importance of the elderly to decide how far they want health care to go on their behalf. The courts and legislatures need to work further to end areas of confusion on end-of-life directives, and better restrain emotional relatives and acknowledge other culture customs and beliefs. The public needs more information on the place of palliative care and end-of-life assistance.

A call for reason is what should shape our health care goals, not the voices of righteous health care critics calling for one more roundup of the usual suspects.

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Karmanos CEO To Quit, Take Job In Las Vegas

Dr. John Ruckdeschel will leave the Barbara Ann Karmanos Cancer Institute where he has been since 2002 for a new post as CEO at the Nevada Cancer Institute in Las Vegas, a nonprofit organization that began treating cancer patients in 2005, according to published reports

Dr. Ruckdeschel, who oversaw Karmanos split from the Detroit Medical Center three years ago. He will remain in his current position for the next several months to assist in the transition to a new CEO. .

Karmanos plans to name an interim CEO and director within the next several weeks and will eventually launch a nationwide search for a permanent leader, Alan Schwartz, chairman of the Karmanos Board of Directors told the Detroit News.

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Kansas Governor On Shortlist For HHS Job After Daschle Fiasco

Kansas Gov. Sebelius Among Top Choices for HHS Secretary, Obama Administration Officials Say
[Feb 09, 2009]

Kansas Gov. Kathleen Sebelius (D) has emerged as "the leading contender" for HHS secretary, with Tennessee Gov. Phil Bredesen (D) also under consideration, according to Obama administration officials, The Politico reports (Allen, The Politico, 2/8). According to the AP/Baltimore Sun, Sebelius has had a "long and close working relationship" with Obama, and she "worked tirelessly for Obama's bid and was a top surrogate to women's groups" (AP/Baltimore Sun, 2/9). In addition, advocacy groups believe that her former role as Kansas insurance commissioner benefits her candidacy for the position.

Bredesen also remains under consideration for the position, although some advocacy groups have raised concerns about his former role as an executive with a managed care company, as well as his continued financial ties to the health insurance industry. In addition, advocacy groups "haven't forgotten" his decision to eliminate about 170,000 adults from the Tennessee Medicaid program, The Politico reports (The Politico, 2/8). A senior official said that while Bredesen is still under consideration, his nomination is not as likely as Sebelius'.

According to the Sun, "[o]ther candidates, including former Clinton White House chief of staff John Podesta, remain in the mix." White House spokesperson Reid Cherlin on Saturday said that President Obama has not made a final decision (AP/Baltimore Sun, 2/9).

Lawmakers Endorse Dean
In related news, Sen. Bernie Sanders (I-Vt.) on Sunday became the latest of several lawmakers to endorse former Democratic National Committee Chair and former Vermont Gov. Howard Dean (D) as the nominee for HHS secretary. In a letter sent to Obama, Sanders wrote that Dean, a physician, is "eminently qualified" for the position. He wrote, "Gov. Dean understands, as you do, that all Americans are entitled to health care as a right of citizenship, and that we must pay far more attention to the needs of our children if we are to have a healthy and prosperous society."

In addition, Sanders wrote, "As you well know, reforming our health care system will not be easy," adding, "It will take somebody with determination and focus to lead that effort," and "I think that Howard Dean is that person" (Brush, The Hill, 2/8).

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Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/healthpolicy . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved."

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Michigan Hospitals Crisis Gains National Notice

Michigan Hospitals Face 'Fiscal Crisis' Because of Recession, Uncompensated Care Costs, Report Finds
[Feb 09, 2009]

The nationwide economic recession is pushing Michigan hospitals "to the brink of a fiscal crisis," according to a report released on Thursday by the Michigan Health and Hospital Association, the Detroit News reports. According to the report, state hospitals in the third-quarter of 2008 posted low and negative profit margins, in part because of losses from uncompensated care and the fall of the credit market (Rogers, Detroit News, 2/6). Hospitals incurred bad debt of a record $2 billion, the report found, while uncompensated care for the third quarter increased by 8% compared with the same period in 2007 (Anstett, Detroit Free Press, 2/6).

The report found that between 1999 and 2007, the number of state residents with private health coverage declined by 727,000, while the number of Medicaid beneficiaries grew to a record-high 1.6 million. Meanwhile, funding for hospitals that treat Medicaid beneficiaries declined by more than $850 million between 1996 and September 2008, the report found (Detroit News, 2/6).

For the third quarter, the average total earnings for hospitals dropped to negative 2.9%, or a loss compared with positive 2.2% for the same period a year earlier, according to the report (Detroit Free Press, 2/6). To help offset losses, hospitals are reducing staff and delaying construction on new buildings "at a time when Michigan hospitals are treating more patients than ever," according to the News.

Lori Latham, spokesperson for MHA, said that the report aims to draw the state Legislature's attention to the funding needs of hospitals. "The health care safety net is in dire straits unless there's a new infusion of money," Latham said (Detroit Free Press, 2/6). MHA President Spencer Johnson added that the developments of recent years are "forcing Michigan hospitals perilously near the edge of a financial cliff" (Detroit News, 2/6).

The report is available online (.pdf).

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Medicare Payment Disputes Outsourced

As of January 1, 2009, the Centers for Medicare and Medicaid Services (CMS) has a new process for handling payment disputes raised by providers who serve Medicare patients enrolled in Medicare Advantage PFFS plans. CMS has hired a third party, First Coast Service Options (FCSO), to handle all of these disputes. Providers should submit dispute decision requests directly to FCSO.

For more information, go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0902.pdf.

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Medical Marijuana Law Resource Guide

Although the new law allowing use of smoked marihuana for medical purposes took effect on December 4, 2008, the rules about the law’s application won’t take effect until April 4, 2009. The Michigan Department of Community Health (MDCH), Bureau of Health Professions currently is processing administrative rules for the Medical Marihuana Program (MMP), developing program forms, and recently held a public hearing for input. MDCH also created a website for more information about the MMP. MSMS will continue to provide input to the Michigan Department of Community Health (MDCH) as appropriate.

Meanwhile, following are resources that outline and explain the next steps in this process:
--NEW! MSMS Legal Alert: Michigan's 'Medical Marihuana Act' [pdf]
--MIRS - Proposed Marijuana Rules Questioned
--Gongwer - PROPOSED MEDICAL MARIJUANA RULES DRAW OPPOSITION
--News release - MDCH Launches New Michigan Medical Marihuana Program Web site

Watch the MSMS website, email and Medigram for further developments.

Background:
In May, the MSMS House of Delegates resolved (Resolution 59-08A) that the ballot proposal on smoked marihuana could not be supported. MSMS communicated that through a coalition including MHA, MOA, law enforcement and other agencies.

For more information, contact Colin Ford at MSMS at 517-336-5737 or cford@msms.org.

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Health Authority Safety Net Report Highlights

The Safety Net Resource Center has completed work on the first annual report that documents the status of the health care safety net in Wayne County. "Detroit and Wayne county are at ground zero for America's health care crisis," according to the report. "America's health care system is expensive, not always high quality, and not accessible to those without health insurance."

Some key points raised in the report include:

Wayne County has a higher death rate than Michigan.
The cities of Detroit, Ecorse, Highland Park, Taylor, and the City of Wayne have substantially higher than average health disease death rates and generally higher than state average cancer and diabetes mellitus rates indicating need for great access to comprehensive quality primary care services.
The infant mortality rate for Detroit is more than three times the rate for the top five states.
The Detroit metropolitan area lacks the resources to respond to the health care needs of the underinsured. Wayne County receives $11.10 per low income resident compared with Ramsey County (St. Paul, Minnesota) which receives $46.41 and Marion County (Indianapolis, Indiana) $37.32.
Emergency department use for primary and chronic care needs continues to be a problem. According to "Taking Care of the Uninsured: A Path to Reform," a book published locally, an average emergency department visit costs $412, while the cost of a primary care visit is $78.30. If ambulatory conditions were treated in a primary care setting rather than and emergency department, the savings would be about $333.
Safety net performance can be improved: Uninsured ED access is high compared to the insured population. ED visits for Ambulatory Sensitive Conditions are 34 percent higher for uninsured than for all Wayne County residents. Hospital use by the uninsured in Detroit is lower than national rates. Even with the low rate, 34 percent of uninsured hospitalizations are for Ambulatory Sensitive Conditions.Eliminating Ambulatory Sensitive ED visits and hospitalizations could save nearly $5 million. Healthy lives indicators are below top performing states and should be targeted for improvement.

The complete report will be published in the Health Authority's annual report and placed on its website, www.healthaccess1.org. For more information, contact Dr. Jim Chesney at 313-871-3751.

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States Employ Variety Of Responses To Health Professionals Shortage

As the United States faces a looming shortage of 6 million health care workers by 2014, many states have initiated programs to get ahead of the game, according to an analysis from the National Conference of State Legislatures.

States are creating and participating in marketing campaigns that feature websites and cooperative ventures with universities and employers to help entry- and mid-level professionals find jobs.

K-12 outreach programs have been set up in 45 states. Called “health education centers,” they extend health care services into underserved areas using government money and collaborating with academic health centers. This is not new; the program was established by the federal government in 1971.

States are also offering “health career enhancement” for students in grades K-12, which includes job shadowing programs.

At least 35 states are offering scholarship or loan repayment programs for physicians who practice in federally qualified underserved areas. Massachusetts has considered legislation to reduce tuition for physicians who agree to specialize in primary care and practice for four years in underserved areas. New Mexico has considered providing tax incentives to doctors who practice in underserved areas.

Some states have worked with professional boards to discuss multi-state licensing and other regulatory reforms that would allow health professionals flexibility and ease of transition in where they choose to work.

At least five states are offering career ladders to some health professionals, allowing nurses and some allied health professionals to advance their careers and academic qualifications while on the job.

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