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January 19, 2009 |
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IN THIS ISSUE
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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Click Here To Contact Us
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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
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A perspective on the new president's health policy
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The Michigan and local Detroit-area experience of safety net
providers
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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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