E-DMN - July 13, 2009

July 13, 2009

Editor's Column: He Should Mind His Own Business
In My Opinion: Improved Quality, Lowered Cost Could Mean Economic Boon
In My Opinion: Economics And Professionalism
Key Issues On The Table For WCMSSM Leadership Committee
Dr. Shade Featured On WSUSOM Website
Walk For the Uninsured To Rally Supporters Aug. 15
Obama Chooses Surgeon General, According To News Report
Detroit Medical News Wins Fourth Consecutive Award For Excellence

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Editor's Column: He Should Mind His Own Business

By JOSEPH WEISS, MD
Sandeep Jauhar writing in the Tuesday July 7 New York Times condemns doctors for “constantly thinking about money” He ends his article with the statement: “something fundamental is lost when doctors start thinking about medicine as a business.”

Jauhar is wrong.

Everyone in the medical community must consider income and cost. Academic medical centers must bring revenue to their institutions; faculty from professors to instructors must fight for grants and from income-expense statements prove that they are profiting the faculty-physician medical group.

Doctors must look hard on their reimbursement if they are to pay their office rent, staff, heat, electric and water bills, raise their families, keep their home, and repay their medical school debts.

In today’s environment of recession, physicians are keeping close watch not only on their costs but the expenses of their patients. Can there be a physician practicing in Wayne County who has not heard from more than one patient a story of financial desperation?

The New York Times’ characterization of physicians as fiscal monsters comes just at a time when we most need the public’s support. Will the public and its politicians consider our request for payment reform if we seem to them to be Wall Street brokers carrying a stethoscope.

The truth is physicians think as much about the cost of care as they do about their profit from it. To further the public welfare, Jauhar should not condemn us for thinking about the business of medicine, but encourage us to focus more on it.

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In My Opinion: Improved Quality, Lowered Cost Could Mean Economic Boon

By SUSAN ADELMAN, MD
Suppose that U.S. health care resources actually were limited by immutable practical considerations. Who would be the right people to allot them? Patients, each of whom would be motivated to fight for what he or she wanted? Doctors, each of whom would fight for his or her patients? Or a third party? Who would that be? These decisions could be litigated or mediated, but too much of that would break down the whole health care system.

What would be the way out? One solution would be to do everything necessary to make sure that health care resources are not that limited. The problem is that in a zero-sum economy growing health care resources means shrinking resources available for other services. So, to get out of the zero-sum situation, we would need to figure out how to make health care services increase our nation's wealth and resources.

Right now medical tourism is increasing all over the world. Patients who used to travel to the Mayo Clinic now go to high-quality low-cost institutions in third world countries. Should we not increase the number of institutions in the United States that will attract medical tourists from abroad and stop the loss of American patients to facilities overseas? That means helping them keep costs down and supporting the quality of their care.

Should we not more effectively incentivize research and development in the United States so that our health care not only remains cutting edge, but becomes even more innovative? That means finding out and correcting what is wrong with our NIH grant system, among other things. What we should not do is stifle innovation.

In fairness however, the issue of rationing under the present circumstances cannot be lightly dismissed. There is a rational argument against doing joint replacement, aggressive cancer treatment or open-heart surgery on people in a nursing home, for instance.

Everybody understands the slippery slope problem, but in some cases the slippery slope can run in the opposite direction. Greedy practitioners can convince themselves of the need to do fancy eye surgery that will restore sight to patients with dementia, and that kind of enthusiasm may need to be curbed by some outside force.

These issues cannot be reduced to slogans. They require serious discussion. Unfortunately, they will not be solved properly if proposed solutions are embodied in a bill that is 1,000 pages long and arrives on the desks of Congress on the day it is expected to vote.

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In My Opinion: Economics And Professionalism

By ALLAN DOBZYNIAK, MD
Why would anybody expect a government program to be efficient and above politics? Remember it was the introduction of Medicare, cost-plus reimbursement, the disconnecting of consumer from payer, tax deductibility of health care benefits for employers, liability driving immediate adoption of new technology, no-fault auto insurance diverting trial lawyers to med-mal, and lack of consequential tort reform that were all government decisions creating the perfect storm for rampant health care inflation.

The changes proposed for health care are cost driven.(I believe the true motivation is the power implicit in controlling the largest segment of the U.S. economy and the most personal of freedoms.) There is nowhere near enough savings from the implied improved efficiencies, digitizing medical data, or preventative care to even come close to resolving the presently estimated $55 trillion Medicare and Medicaid underfunding. Professionalism, concern for patients, altruism, egalitarianism are admirable, heartfelt attributes but of negligible consequence in economic, cost-based negotiations. Physicians generally share these emotional attributes, but it is useless and nonsensical to rely on them in purely economic discussions. Worse yet is to use these as a ploy to manipulate physician behavior and attitudes in the presently uncertain health care milieu. Making an economic decision from the heart is perhaps laudable philosophically but will not lead to the long-term economic strategy needed to support an ideal physician-patient relationship.

Before drawing a conclusion about whether a public-private insurance competition is possible, please consider the following. Entitlements such as a government health plan are monopolies. Prices can be set non-competitively. There is no need for profitability since bureaucrats use our tax money as they see fit. Entitlements do not need to satisfy customers but create an isolated dependent segment of society to perpetuate them. They govern by regulation, and rationing of your health care is done for you. Innovation and progress are not even part of the equation. Tell me, what business could continue to exist and be in debt trillions of dollars like Medicare? For a business to be successful, it must positively differentiate based on exceptional value (cost, quality and service) in a competitive market. Profitability then leads to growth based on innovation and exceptional value. Innovation is customer driven and supported by appropriate investment. Market-based health care reform and a government entitlement cannot coexist equally in a competitive market. The government program will preempt, but will patients be winners or losers?

Rationing of health care services is immoral and clearly in violation of medical professionalism. It is not possible to defend professionalism and acknowledge the appropriateness of rationing. This is a contradiction. Only patients should make life and death, and quality of life decisions. Physicians can help intelligently to guide these decisions by providing information and expressing a personally identified position. They cannot decide. Worse yet would be a group of bureaucrats making such decisions simply based on population data and cost considerations.

President Obama’s recent lecture to the AMA was certainly off the mark.

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Key Issues On The Table For WCMSSM Leadership Committee

The following is a piece penned by WCMSSM President George Shade Jr., MD. WCMSSM members are invited to share their opinions and suggestions regarding these issues at the Aug. 12 at 7 a.m. at the Skyline Club in Southfield. For more information, contact Adam Jablonowski at (313) 874-1360, ext. 12 or arj@msms.org

By GEORGE SHADE JR., MD
What has been made crystal clear by our pursuit of tort reform with the local and national legislators against what to us is the incessant greed of the Trial Lawyers Bar Association, has been reiterated once again by the President of the United States and the Congress as it pertains to health care reform in America. We, as physicians, have to present a stronger, more convincing argument to the people of this state and this country as to why they should care about our plight. In fact, that has been most of our problem. Our argument has been based entirely too much on our plight as physicians. Now, I would be more than naïve if I were to assert that we should have no concern for the stability of our great profession. With the practice of medicine being both our vocation as well as our avocation, there unquestionably is a strong economic driver that motivates us to do the work that we do. However, if that is the only message that we can deliver individually and collectively than let us heed the sagacious words of Charles Dickens in his classic novel A Christmas Carol, “…know these two children, Ignorance and Want, and fear them for they spell you doom…” If we remain ignorant to the needs of society and focus on our wants, then we shall surely fulfill this prophecy.

Over the next year as I serve as your President of the Wayne County Medical Society of Southeast Michigan, the focus of my term in office will be to make it clear by word and deed that the physicians of this great state and society are committed to two noble causes: To remove the barriers to access to health care and to confront and end the disparities in the quality and delivery of health care so prevalent in the lives of so many.

When we talk about access, what message do we want the world to hear? Webster tells us we should say that access is “…freedom or ability to obtain and make use of…” The mere availability of health care does not make it accessible. We need to address the following bullet points:

Doctors with practices in the neighborhoods where people live. It does no good to have doctors on the moon if we are living here on earth. We continue to lose too many physicians from our inner cities and rural communities. We have seen too many hospitals and clinics close their doors, leaving an unfilled void.
We need to talk about why doors to practices and hospitals are closing. We need to talk about why young physicians are making a conscientious decision not to choose primary care.
We need to talk about the “poverty tax” placed on physicians who try to serve the community. A tax comprised of crippling debt from student loans long before a doctor ever sees his or her first patient. A tax of high overhead expenses: Professional liability insurance, high property owner’s insurance premium, being a target for crime, the cost of office staff, equipment and supplies.
We need to talk about why attempting to treat the uninsured and the underinsured is drowning physicians in a sea of red ink. There is no discount on overhead expenses, no line item in EMTALA that assures that health care facilities can stay solvent and certainly no “safety net” for doctors.
We need to talk about overly burdensome regulatory requirements, perennial Medicaid and Medicare cuts. The fallacy of “pay-for-performance” and “Save Lives, Save Dollars.”
If access to health care is truly a goal, a mission in this culture, then we have to treat it like any other crown jewel of our nation. The public must treasure it. The public has to insure its preservation by wise legislation and public funding. The onus is on each one of us to preserve and make it better for all generations.
Our second message must address in clear and no uncertain language the commitment of all physicians to end disparities in health care based on ethnicity, socioeconomic status and where one lives geographically. It is important to understand that even someone who is not socially or economically disadvantaged may still find that he or she is the victim of disparate treatment. Just like access to care, disparity in care is a beast with many tentacles.

One of the myths that we must eradicate is the sentiment that certain ethnic groups cannot appreciate the difference between caviar and ordinary fish eggs. The definition of a gold standard is that it represents the very best in its given category. We should not change the gold standard of how we provide medical care.

Like access, disparity in care is closely annexed to economics. Lack of first class medical facilities, appropriate technology, technological expertise, a full complement of highly trained primary care and specialty care physicians and doctors who respect and communicate effectively with their patients all affect the quality of care.

Once again, if we want the public to care about the plight of the medical profession, then we must be just as committed to its concerns for high-quality medical care delivered with concern, compassion and professionalism.

If we can begin to understand and address the intricacies of access to health care and disparities in health care, then we will have finally found the correct way to have the winning argument that is needed to sway the opinion of the public, government and industry. The bonus for this effort is the fact that in many ways, we will have changed our own opinion of who we are and what we stand for as a profession.

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Dr. Shade Featured On WSUSOM Website

WCMSSM President George Shade Jr., MD, was highlighted on the Wayne State University School of Medicine website. The item read, in part: Dr. Shade said his goal is to have the organization focus on access to health care in the Detroit metropolitan area and disparities in health care in the region. “By addressing these two issues alone, we will be required to look at several very important issues that create the problems we have in these two areas,” he said.

“I feel extremely honored to have been selected to step into this role,” Dr. Shade said. “I am a native Detroiter and have always felt a strong commitment to the city of Detroit. The women in the Detroit metropolitan area have myriad significant health care issues unique in many respects to this region. I believe that as a collective force of dedicated and talented physicians we can make a tremendous difference in the quality of life in southeastern Michigan."

Dr. Shade, who is chief of Obstetrics and Gynecology for Sinai-Grace Hospital, was appointed specialist-in-chief for Obstetrics and Gynecology for the Detroit Medical Center in March. The system-wide position includes overview of services at Hutzel Women's Hospital, Huron Valley-Sinai Hospital and Sinai-Grace Hospital. The chief of each hospital’s department of obstetrics and gynecology reports to Dr. Shade. He said he views his primary role as overseeing quality, physician credentialing and patient safety as it pertains to women's health care.

The position, Dr. Shade explained, includes adherence to best practices to ensure “that every woman coming to the DMC gets the very best health care available in the United States of America.

“Over the past three decades, health care in this nation has become more and more regionalized,” Dr. Shade said. “I see it as incumbent upon me to work closely with the physicians in comparable roles as mine in other health care systems to make sure that we put an end to lack of access to health care as well as the problems of disparities in health care encountered on a daily basis across southeastern Michigan. I believe I can best influence my colleagues by demonstrating that the DMC is truly a campus of breakthroughs and innovation strengthened by its long-term relationship with the Wayne State University School of Medicine and its time-tested commitment to the city of Detroit.”

In addition, Dr. Shade is serving his second term as vice chairman of the Michigan State Board of Medicine. Re-elected in January, he will hold the position through January 2010.

Selection to the board is by gubernatorial appointment. The governor receives recommendations from the Michigan State Medical Society, elected officials, industry, and civic and community organizations.

The board is charged with protecting the public safety as it pertains to the practice of medicine. Members oversee physician licensing, investigate complaints against physicians and are responsible for enacting disciplinary measures up to and including license revocation for infractions and unprofessional conduct.

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Walk For The Uninsured To Rally Supporters Aug. 15

On Saturday, August 15, 2009, the Detroit Wayne County Health Authority will host its second-annual Walk for the Uninsured. Metro Solutions is the premier sponsor of the event, while CBS will be the Health Authority’s media partner. The Walk will begin at Belle Isle Casino at 10 a.m. with on-site registration at 9 a.m. Participants can opt for a 3- or 1-mile track that will take them around the small island in the Detroit River. The actual walk will begin at 10 a.m.

The primary goal of Walk for the Uninsured is to raise awareness of and garner support for an estimated 280,000 residents of Wayne County who do not have health insurance, and a growing number of others with inadequate health coverage. More than 500 individuals from many different walks of life are expected to rally around this critical issue.

The Co-chairs of the 2009 Walk are Rose Khalifa, Executive Director, Metro Solutions, and Wayne Bradley, President and CEO, Detroit Community Health Connection.

“Walk for the Uninsured is a way for the Health Authority to unite a community of concern for this growing issue which has been compounded by the downsizing of the automotive industry in this region,” said Chris Allen, President and CEO of the Health Authority. “We support all efforts to bring universal health coverage, whether that be a state solution or federal solution. However, for the immediate future, we need to strengthen our health care safety net and provide a medical home for all uninsured people.”

The Walk also commemorates National Community Health Center Week, Aug. 9-15. Community health centers are critical components in the health care safety net. As part of the event, “The Best of the Safety Net” awards will be given to health center employees who have made significant contributions to improving the strength of the health care safety net in Detroit and Wayne County.

The Walk will also feature a tent with exhibits promoting and educating walkers on the notion of the medical home. The Health Authority’s purpose is not only to strengthen the safety net, but also to provide a consistent point of access to health care resources, regardless of insurance status. As part of this effort, a “Medical Home” pavilion will be established at the Walk, offering health and human service information and an opportunity for those lacking insurance to apply for coverage through HelpEngen, a tool offered by the Health Authority that allows individuals to learn more about their

eligibility for Medicaid and other funding, and apply with relative ease. The tent will also house exhibits regarding nutrition and wellness. On top of this, children’s attractions will help ensure that this event is one that the whole family can enjoy.

Although there is no registration fee, donations are encouraged. Proceeds will support the newly developed Uncompensated Care Fund, which will help underwrite the cost of primary care for the uninsured at Wayne County health centers. Those interested in sponsoring a walking team or exhibit should contact the Health Authority for additional information. Walkers of all ages are welcome. For more information on participating in the Walk, contact Megan Kolodgy at 313-871-3751.

The Detroit Wayne County Health Authority is a public body corporate, established in 2004 by the State of Michigan, City of Detroit and Wayne County. Its mission is to coordinate efforts to meet the health needs of the uninsured and underinsured residents in the City of Detroit and Wayne County by assuring access and improving the health status of all people. For more information, visit www.dwcha.org. Or contact Adam Jablonowski at (313) 874-1360, or arj@msms.org

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Obama Chooses Surgeon General, According To News Report

The Associated Press reported that President Barack Obama has chosen a well-known Alabama family physician, Dr. Regina Benjamin, to be the next surgeon general.

An administration official told the AP Obama will announce the nomination later on July 13. The official spoke on condition of anonymity so as not to upstage the official announcement.

Benjamin was the first black woman to head a state medical society, received the Nelson Mandela Award for Health and Human Rights and just last fall received a MacArthur Foundation ''genius grant.'' But she made headlines in the wake of Hurricane Katrina, with her determination to rebuild her rural health clinic Bayou La Batre, Ala., which serves 4,400 patients who would be hard-pressed to find care elsewhere.

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Detroit Medical News Wins Fourth Consecutive Award For Excellence

The Detroit Medical News this month received a 2009 award from the writing group Apex for excellence in magazine and journal writing. Apex reviewed the May 2008 edition of the magazine and placed it among about 30 other publications nationally that were also recognized. MSMS’ Michigan Medicine magazine was also awarded.

The 2009 award is DMN’s fourth consecutive Apex award, to go along with two recognitions from the Michigan Society of Association Executives.

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