E-DMN - January 26, 2009

January 26, 2009

Editor's Column: Trust
Comments On: 'Trust'
Physician Leader Optimistic About Health Care IT
Family Docs Ask President For Primary Care Education Help
Research Sheds Light On Medical Liability Insurance Market
Six Major Groups Link Health Care, Economic Reform
Beaumont To Transfer CON
Health Authority, WSU To Host Safety Net Conference In May

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Editor's Column: Trust

By JOSEPH WEISS, MD
The recent Wall Street scandals revealed more than the greed of brazen brokers and the tragedy for people who lost their savings. For many individuals the greatest shock and most intense anger came from being deceived in matters of trust.

Trust is what physicians have in common with stockbrokers. Our patients and their clients expect us to act in their best interests. Trust is the possession we should hold most dear while we give it to each patient without reservation.

We need to be alert to any attack upon our reputation for being trustworthy. Take the phrase: the Patient Centered Medical Home. When patients come to a physician’s office, they expect that the physician will act in their best interests. A patient should not feel the need to go to a “patient-centered” physician’s office to obtain a fiduciary relationship. Physicians who label themselves as “patient centered” are giving themselves airs or implying that those of us running the usual medical office operate under a lesser standard of honesty.

The scandals of the stock market show the value of trust and its possible fragility. As physicians, we should never hedge trust’s worth, debase it currency, trade off its name, or exchange it for profit. Toiling in the fields of health care should keep us aware that not even a cutting edge patient database can substitute for integrity.

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Comments On: 'Trust'

Comments from Allan Dobzyniak, MD
Pertaining to (Dr. Weiss’) excellent column on Trust, there are a couple of issues that deserve elaboration. A cause of the recent economic calamity is dishonesty at multiple levels. It cannot be laid simply at the foot of Wall Street. Those who sought housing they could not afford, those who offered inappropriate loans, government forcing home loan parity, inadequate supervision of Fannie Mae and Freddie Mac all participated. Trust was compromised by multiple culprits.

To compare physicians to stock brokers is a stretch. A profession has a code of ethics at its foundation. I would contend that medicine might be the last true profession. The medical profession must resist any erosion of its ethics because this is the basis for trust.

I worry about the “ modern internist “ not interacting with his or her medical staff peers, never leaving the office, dispensing responsibility to hospitalists all in the name of improving productivity. That which causes interference with peer-to-peer physician interaction or impairs the physician to patient relationship could be interpreted as ethically compromising.

If the medical profession, as it should, evaluates all proposed changes in health care and determines there is no violation of ethics, trust will be assured. I do agree, physicians should be sensitive to even the potential for negative perception as implied by the name “Patient Centered Medical Home.”

Indeed, it would be a tragic outcome if the demise of the last true profession is allowed.

Comments from Susan Adelman, MD
Trust in physicians has been eroded by the interposition of insurers, competition with hospitals seeking to take credit for the work of their doctors, and the political efforts of health care critics who have mounted a sustained campaign to discredit doctors in order to build a constituency for, as well as to reduce criticism of, health care reform. Doctors have contributed to this by not effectively addressing problems that the public wants corrected, and by not solving problems of integrity, access and price that constantly come up within the profession. Now the patient-centered medical home concept has been created in order to give a new name to what general physicians always practiced.

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Physician Leader Optimistic About Health Care IT

A special section about the use of health information technology (HIT) in the Dec. 19 issue of the Washington Post included a foreword written by AMA Board Chair Joseph M. Heyman, MD. In his comments, Dr. Heyman highlighted the AMA’s efforts to help physicians adopt new technology and shared the AMA’s optimism about the promise HIT holds for increasing patient safety and quality of care.

“Despite the complexity and cost of developing a secure, interoperable, nationwide HIT infrastructure, the AMA and physicians nationwide realize the transformative power that adoption of this technology promises for the future of patient care,” Dr. Heyman wrote “As advances occur, HIT can fulfill its promise to help improve the quality and safety of patient care.”

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Family Docs Ask President For Primary Care Education Help

President-elect Barack Obama can significantly improve Americans’ access to health care by making “a robust investment” in federal programs that support medical education and primary care physician training, according to Jim King, MD, chair of the American Academy of Family Physicians’ Board of Directors.

In a Dec. 24 letter to Obama, King commended Obama for “making a strong health care workforce a key component of your legislative agenda.” He urged the president-elect to invest $215 million in the Title VII, Section 747, grant program to medical schools and residency training programs and $150 million in the National Health Services Corps. Both programs should be a part of Obama’s economic stimulus package, King wrote.

“Including that level of funding for primary care training in the stimulus bill would reinvigorate medical education, residency programs, as well as academic and faculty development in primary care to prepare physicians to support the patient-centered medical home medical practice model,” King wrote.

Visit http://www.aafp.org/online/en/home/media/releases/2008/medicaleducation-lettertopresidentelectobama.html to read more about King’s letter.

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Research Sheds Light On Medical Liability Insurance Market

Two new policy research perspectives (PRP) from the AMA present information on the professional liability insurance (PLI) market.

The first PRP examines changes in PLI premiums during the past few years and presents them for select geographic areas. The PRP finds that premium increases have become less common and that increases in premiums have become smaller. In recent years, premiums in a growing number of markets either fell or did not change, with about half remaining the same in 2008. However, the increases that occurred during the recent liability crisis were large enough that the small recent decreases have not been enough to offset them. Therefore, although the PLI market appears to be softening in recent years, premiums remain at historic highs in many states.

Visit http://www.ama-assn.org/ama1/x-ama/upload/mm/363/mlm2008-summaryjguardado.pdf to view this paper.

The second PRP examines changes in indemnity and expense payments, the manner in which claims close (settled/tried and paid/unpaid) and claim policy limits. The PRP finds that average indemnity and expense payments increased from 1998 to 2007 at a rate faster than inflation. Although most claims resulted in no indemnity payment in 2007, 9 percent of paid claims involved payments of $1 million or more. The vast majority of trial verdicts were won by the defendant, while very few claims resulted in a plaintiff verdict. Finally, claims with a policy limit greater than $1 million have become more common over time.

Visit http://www.ama-assn.org/ama1/x-ama/upload/mm/363/prp2008-2indemexppymts98-07.pdf to view this paper.

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Six Major Groups Link Health Care, Economic Reform

A Multi-million dollar television ad buy unveiled earlier this month promotes health care reform as a top domestic priority for the next president and the new Congress.

Six organizations representing consumers, physicians, insurers, patients and pharmaceutical research companies are banding together to launch a new multi-million dollar national television advertising buy (Media file). Their common message: In order to fix the ailing economy, the nation needs health care reform that addresses the related problems of health care costs and people losing health coverage.

The groups are the American Cancer Society Cancer Action Network (ACS CAN), the American Medical Association (AMA), Families USA, the Pharmaceutical Research and Manufacturers of America (PhRMA), Regence BlueCross BlueShield, and the Service Employees International Union (SEIU).

The ad will air at least until Feb. 5 and focuses visually on the nation’s manufacturing sector, but the organizations all agree that every sector of the economy will benefit from health care reform. The ad opens with: “At a time when American businesses are hurting, why should we worry about fixing health care? Because quality, affordable health care can save money and make businesses more competitive.”

“Cancer patients across the country—including those with insurance—often must dig deep into their savings and risk financial ruin to pay for cancer treatment and care,” said John R. Seffrin, PhD, Chief Executive Officer of the American Cancer Society and its advocacy affiliate, ACS CAN. “Elected officials should recognize what American families already know—that fixing the economy requires that we fix the broken health care system.”

“Healing our health care system is a key component to jumpstarting our national economy. As our new ad makes clear—quality, affordable health care is good for families and it's good for businesses,” said AMA President Nancy H. Nielsen, MD.

“While businesses and families cope with unaffordable health care costs, many workers are losing their jobs and health coverage,” said Ron Pollack, Executive Director of Families USA. “As a result, it’s clear that America’s economic difficulties require meaningful health care reform. It’s this message that animates our ad campaign.”

“Expanding access to quality and affordable health insurance is good for patients and good for our economy,” Billy Tauzin, President and CEO of PhRMA, said today. “Improved access means we can do more to promote prevention and more to detect and treat conditions at an early stage, when we can do the most to avoid poor health outcomes and costly complications of chronic diseases, which account for seven out of every ten deaths in America.”

“Given the nation’s economic and health care crises, now is the time to bring meaningful, lasting change to our health care system,” said Mark Ganz, President and CEO of Regence. “We urge President-elect Obama and Congressional leaders to bring together stakeholders who are willing to discard outdated concepts and collaborate on practical solutions.”

“As the economy sputters, the need to fix healthcare is becoming more and more urgent. The clock is ticking,” said Andy Stern, President of SEIU, the nation's largest union of healthcare workers. “It will take all of us—individuals, corporate leaders, healthcare providers and the government—working together to solve America's healthcare crisis.”

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Beaumont To Transfer CON

Beaumont West Bloomfield Ambulatory Surgery Center L.L.C., a for-profit joint venture with William Beaumont Hospitals received state certificate-of-need approval to transfer the surgical services CON from the Royal Oak-based hospital, reported Crain’s Detroit Business. The center has 17 surgeons on staff.

The surgery center is at the Beaumont Medical Center at 6900 Orchard Lake Road in West Bloomfield Township.

Beaumont Hospital owns 60 percent of the partnership with the physicians owning 40 percent, according to Crain’s.

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Health Authority, WSU To Host Safety Net Conference In May

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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