Wayne County Medical Society of Southeast Michigan

January 19, 2009

Editor's Column: Quality Assurance: Now and Forever?
Comments On 'Quality Assurance: Now And Forever?'
Health Disparities Continue To Plague People Of Color
Blue Cross To Trim 1,000 Jobs This Year
CMS Issues Policies On Three 'Never Events'
AMA Calls For Insurers To Reject Database
MSMS Foundation Establishes The Kevin A. Kelly Leadership Fund
Health Authority, WSUSOM To Host Safety Net Conference

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Quality Assurance: Now and Forever?

By JOSEPH WEISS, MD
American physicians should receive comfort that the same objections and foot dragging responses that we give to Physician Quality Reporting Initiatives (PQRI) are paralleled by our French medical colleagues. Drs. A Giraoud-Roufast, and J.M. Chabot report on the problems of government efforts in France to institute quality assurance in French medical care. In an article in the Dec. 10 issue of the JAMA, (Journal of the American Medical Association) the French authors note that the reporting measures that the French medical system is using to judge physician competency has created resentment among French physicians. In the French tradition, medical quality comes out of the activities between patient and physicians and French physicians believe the character of those activities can be judged only by fellow medical professionals.

According to Drs, Giraoud-Roufast and Chabot, French physicians see the implementation of practice guidelines as a means to make physicians conform to a government-mandated way of practice; the physicians feel they are being forced to exchange their independence for a government-derived conformity.

French physicians find further fault with their government PQRI because most quality-of-care measures they must meet come from outside the profession and inside the government. The quality regulations are disconnected from clinical activity and give the physician little leeway to adjust care to the real life problems their patients face.

In short, French physicians see government requirements of quality assurance as an intrusion and as a burdensome addition to their paperwork.

American physicians can take some solace that our anger and opposition has counterparts in a different society. In both France and America, measures to improve physician performance revolve around insurance companies, business–health coalitions (our local example would be the Greater Detroit Area Health Council), consumer advocates and government officials. The physician’s voice is a minor one.

Physicians understand that the people paying the bill want quality. But imposing and policing required care guidelines gains only resentment from the physicians judged in that way.

The better approach is having payers must meet with the physicians who provide that care. That connection should come through medical societies, with the medical societies deciding guidelines and mandates that can achieve payers’ aims. Working through the medical and specialty societies rather than ignoring them is the way to gain physician compliance, both in America and France.

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Comments On 'Quality Assurance: Now And Forever?'

By Allan Dobzyniak, MD
I support (Dr. Weiss’) interpretive insights into business, academic, governmental and health insurance companies’ alleged motivation toward improved health care “quality.” However, (does Dr. Weiss) truly believe that their use of the word “quality” not have cost savings, economic manipulation and control at its core?

The tragedy is that organized medicine, as well as the general public, accepts the quality initiatives as focused without insight into the underlying agendas. Organized medicine, as usual, will commit energy to this populist initiative. In the end, and again, will be an attempt to influence or even design the new set of rules aimed at real quality improvement. Unfortunately, the outcome as usual will be the further subjugation of individual physicians to the control of an ever-increasing number of public and private bureaucrats.

I would only support organized medicine if its quality initiatives include an appreciation of the full scope of implications, has a priority goal of improving professional satisfaction and includes innovative new economic and productivity models. Seeing more patients for briefer and briefer times will never allow quality improvements. Schemes that remove the physician from the patient, interfere with this basic interaction and do not appreciate appropriately its economic value are shams at best.

The profession needs to educate the present and especially the new physicians to economic and business realities. They need to acquire an appreciation of the importance of and contribute to the independent organized medical staff as well as understand and engage local state and national meaningful, pertinent and inclusive professional issues. Overlying business and political perspective with the ethics implicit to the medical profession and standing firmly behind such principle will rescue the profession and our patients. We must be first realistic then idealistic.

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Health Disparities Continue To Plague People Of Color

          "Of all forms of inequality, injustice in health care
          is the most shocking and inhumane."
                                                -- Dr. Martin Luther King, Jr.

It has been more than 40 years since Dr. King observed the impact of injustice on people of color and other disadvantaged people in American society. Despite advances in science and expansion in access to health care, many people - increasing numbers recent years - fail to receive equal quality of health care, if they have access to health care at all.

Economic inequities complicate the ability for people of color to gain access and benefit from the American health care system. In December, 2008, two studies were released correlates a lack of health insurance and blacks with inferior quality of care for colon cancer and diverticulitis. Research presented at the National Institutes of Health First Summit on Racial Health Disparities, also in December, evaluated why black dialysis patients are les likely than whites to be evaluated and listed for kidney transplants and barriers to colonoscopy screenings for blacks.

"Advances in science, medicine, and technology have the potential to improve health, but large segments of populations in the United States and globally continue to suffer a disproportionate burden of premature death, disability, and disease," according to the national Center on Minority Health and Health Disparities. "There is a growing body of evidence that points to a complex interaction of factors that may contribute to health disparities." Those factors include biology, socioeconomics, discrimination, politics, environment, culture, and lack of access to health care.

The Center is investing in research to understand health disparities, including how they relate to poor health outcomes. Populations that experience health disparities and are more likely to suffer from diseases and conditions such as diabetes, stroke, heart disease, HIV/AIDS, and obesity include African Americans, American Indians, Alaska Natives, Asian Americans, Hispanics, Pacific Islanders (including Native Hawaiians) and individuals of all races/ethnicities living in poor and medically underserved communities. (Source: Detroit Wayne County Health Authority)

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Blue Cross To Trim 1,000 Jobs This Year

As it continues to face losses in the individual insurance market, the state’s largest insurer plans to cut 1,000 jobs in 2009 and implement other cost-cutting measures, according to published reports.

The Blues reportedly expect losses of more than $1 billion over the next three years, the company announced late last week.

The measures come in the midst of an aggressive lobbying and advertising effort to pass so-called “individual insurance market reform” that the company says would help it offset losses in the individual market by pricing its products differently, but still provide fairly priced health insurance. Opponents of the legislation contend it would allow the Blues to operate more like a private insurer, yet retain their tax break. In exchange for agreeing to insure all comers and subject its rates to state approval, the Blues receive significant tax breaks.

Other changes announced by the Blues include cutting senior executive pay, freezing wages and reducing spending on advertising and lobbying by 25 percent.

The cuts also affect Blue Care Network, its HMO subsidiary.

The company said it will seek average rate increases of 55 percent for individual plans, 42 percent for group conversion plans and 32 percent for Medicare supplemental plans, or Medigap.

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CMS Issues Policies On Three 'Never Events'

On January 15, 2009, the Centers for Medicare and Medicaid Services (CMS) issued three national coverage determinations (NCDs) establishing uniform national policies regarding non-payment by Medicare for certain serious, preventable surgical errors, also known as "never events." CMS has determined that Medicare will not cover a surgical or other invasive procedure on a Medicare beneficiary under any of the following situations because it is not a reasonable and necessary treatment for the Medicare beneficiary's particular medical condition:

· The practitioner erroneously performs the procedure on the wrong body part

· The practitioner erroneously performs the wrong procedure on the patient

· The practitioner erroneously performs the procedure on the wrong patient

For more information, including previous reports and the national coverage determinations, visit www.msms.org/yourpractice or contact Stacey Hettiger at MSMS at 517-336-5766 or shettiger@msms.org.

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AMA Calls For Insurers To Reject Database

The following statement from the American Medical Association is from President Nancy Nielsen, MD.

"In the wake of groundbreaking agreements arranged by New York Attorney General Andrew Cuomo, the AMA calls upon all health insurers to immediately reject the fatally flawed Ingenix database.

"The Ingenix database has corrupted the system for paying out-of-network medical bills, resulting in patients and physicians being cheated by health insurers. A lack of transparency, accuracy and integrity in the payment system has allowed insurers to place profits ahead of their promises to patients.

"Health insurers who truly recognize the importance of restoring their damaged relationships with patients and physicians should commit to the solution proposed by New York Attorney General Cuomo without delay.

"His proposal would remove the grossly flawed Ingenix database from the control of health insurers and trust its repair and operation to a not-for-profit institution. An independent and transparent database will keep private interests from corrupting the data used to set reimbursement rates for out-of-network care.

"Health insurers should act immediately to create an industry-wide commitment to end their use of the rigged Ingenix database and work to restore fair reimbursements to patients and physicians."

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MSMS Foundation Establishes Kevin A. Kelly Leadership Fund

The fund honors and memorializes former MSMS Executive Director Kevin A. Kelly's lifelong leadership and mentorship of countless individuals.

It is the goal of the Kevin A. Kelly Leadership Fund to inspire future leaders to follow Kevin Kelly's extraordinary example. The Fund will support scholarships on an ongoing basis for promising medical students, residents and young physicians to attend MSMS and AMA leadership training and conferences.

The Foundation, with initial gifts from the Michigan State Medical Society and generous physician donors, expresses the physician community's admiration and gratitude for Kevin Kelly's extraordinary example of leadership throughout his career, and within the community, the state and the nation.

MSMS will match contributions to the Kevin A. Kelly Leadership Fund up to a total match of $10,000. The Michigan State Medical Society Foundation is a 501(c)3 public charity, and donations to the Foundation are tax-deductible.

We Remember Kevin A. Kelly, Former MSMS Executive Director, click here
To post a comment or a memory about Kevin A. Kelly, click here.

Please send contributions payable to MSMS Foundation, Attn: Kevin A. Kelly Leadership Fund, 120 W. Saginaw, East Lansing, MI 48823 or donate online by clicking here.

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Health Authority, WSUSOM To Host Safety Net Conference

Together with the Wayne State University School of Medicine, the Health Authority plans to bring together leaders of health authorities and safety net organizations throughout the country at a conference planned for May 14-15, 2009, called "Weaving a Seamless Fabric of Services for the Uninsured"

The conference will include the follow topical areas:

Application of the medical home concept nationwide
A perspective on the new president's health policy
The Michigan and local Detroit-area experience of safety net providers
Clinical issues in chronic disease management, the role of clinical protocols.
The use of technological innovation such as electronic medical records, e-prescribing, and telemedicine to enhance the delivery of care

For more information on this conference, call 871-3751, ext. 110.

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