E-DMN - July 20, 2009

July 20, 2009

Editor's Column: On The Patient Registry
Blue Cross Designates 1,200 Docs As Medical Home Providers
Henry Ford Medical Group Designated As Patient Centered Medical Home
In My Opinion: Medicare Fraud Hits Metro Detroit
WSUSOM Wins Approval For Orthopaedic Surgery Residency
Researchers To Benefit From Stimulus Dollars
Dr. Ayers Appointed To National Student Medical Association
Smoke-filled Air In Detroit Casinos Deemed Unhealthy

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Editor's Column: On The Patient Registry

By JOSEPH WEISS, MD
All eyes are on Washington and the debates, decisions, and proposals on health care that will come. I would argue that whatever comes out of Washington later this year and affects our incomes is of far less importance than what is going on in our state now. I am alluding to the Patient Registry and to the Blue Cross and Blue Shield of Michigan announcement that, as of this time, 1,200 Michigan physicians are designated with Patient Centered Medical Home status. As the Patient Registry is the focal point of the Medical Home, the BCBSM announcement means these physician offices are also certified Regsitry users.

The Registry is of importance to Michigan physicians because as of this writing, BCBSM will pay a bonus of 10 percent on any E/M code submitted by a primary care doctor or primary care group certified to be using the Patient Registry.

However, it is not hard to imagine that if or when hard times come to BCBSM, that bonus will change to include only those patients in the Registry. Nor is it difficult to believe that if further hard times come to BCBSM, the bonus will change to 8 percent and then shrink to 5 percent. If even more hard times come to BCBSM, no physician would be surprised to see the bonus disappear completely.

If BCBSM faces an even a worse bottom line, then it is likely that a physician’s reimbursement will be tied to what percent of the items on the Registry the physician completes to BCBSM’s satisfaction. If, in BCBSM eyes, the physicians is completing only 90 percent of the registry requirements, then reimbursement will be only 90 percent of the E/M visit.

At the same time as BCBSM institutes this form of payment, the Blues likely will require that any primary physician becoming a BCBSM provider must have a Patient Registry in place before applying. Physicians can expect that eventually every other health insurance company will adopt a similar strategy.

Over time, likely within 5-7 years, under the banner of quality surveillance, insurance companies, whether BCBS private or Medicare public, via the Patient Registry, will institute control over our working habits and income to an extent not even conceived of today.

There is nothing we can do to stop this change. BCBSM will eventually harness the technology needed to make possible a spread sheet that holds all the data points a health care system can imagine or demand. Eventually, computer programmers will devise intricate pathways that will translate the data into payments of claims or their rejection. Finally, the pressure for cost control will become so great that any scheme that can cut medical expense or shift that expense to us, will receive an insurer’s blessing followed by immediate implementation of the scheme.

Keep this column in your tickler file for 2014. At that time, you will be able to show your colleagues who don’t read the Detroit Medical News what they missed that they should have known.

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Blue Cross Designates 1,200 Docs As Medical Home Providers

MSMS congratulates the 1,200 primary care physicians (and their respective physician organizations) across the state who were designated by Blue Cross Blue Shield of Michigan as patient-centered medical home providers. These physicians now are eligible for 10 percent add-on payments for several office visit billing codes.

The list of physicians can be found on the Blue Cross website at www.bcbsm.com under the "Find Doctor” tab.

Under the medical home care model, physicians help guide patients through the health care delivery system using a variety of services and technologies, including patient disease registries and electronic prescribing.

"This is the culmination of five years of foundational work between the Michigan Blues and its physician partners," said BCBSM CEO Daniel J. Loepp.

"This patient-centered medical home initiative underscores all that we have accomplished together and our shared aspirations for health care in Michigan. It is about strengthening primary care, improving delivery of care and ultimately creating medical outcomes that benefit all Michigan residents," he said.

Blue Cross said nearly 2 million people in Michigan may find themselves cared for by a medical home provider.

"Patients who go to patient-centered medical home practices will receive a holistic and comprehensive approach to their care," said Thomas Simmer, MD, Blue Cross's chief medical officer.

For more information about the MSMS Patient Centered Medical Home Principles, visit www.msms.org/quality or www.msms.org/pcmh. For additional information, contact Stacie Saylor at MSMS at 517-336-5722 or ssaylor@msms.org .

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Henry Ford Medical Group Designated As Patient Centered Medical Home

Physicians in 26 Henry Ford Health System medical centers have been recognized as designated patient-centered medical homes by Blue Cross Blue Shield of Michigan, which recognized Michigan physicians and outpatient clinics for implementing a model that encourages patients to take a more active role in their health with their physician.

The goal of this model is to encourage patients to take a more active role in their health care based on establishing a long-term relationship between the patient and primary care physician. It uses a team of health care professionals to coordinate and manage a patient's well being through convenient appointment scheduling, test tracking, extended office hours and an electronic patient medical record to upkeep the patient's medical history. Henry Ford physicians also use a method called e-prescribing that sends an electronic medication prescription directly to the patient's pharmacy.

"Giving patients the chance to take a more hands-on role in their health care helps them effectively manage their illnesses and maintain their health," says Richard Dryer, MD, medical director of southern region, director of chronic care initiatives. "The additional variables like extended office hours and e-prescribing, are all in place so patients can receive the care they want, when they want it."

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In My Opinion: Medical Fraud Hits Metro Detroit

By SUSAN ADELMAN, MD
“Medicare fraud case hits metro Detroit,” screamed the headline on the bottom of the front page of the June 25 Detroit Free Press. Indictments charge 53 people in an alleged Medicare scam stretching from Florida to Michigan and beyond. This brings to mind what was at the time the largest Medicare scam ever, perpetrated several years ago in California by medical equipment vendors.

Now, let me see if I have this straight. The country urgently needs health care reform in order to increase coverage, lower overhead and control costs. An essential component of this proposed change must be a public plan, which will have lower overhead than current private plans and will better control fraud, waste and abuse.

So why is it that we read about the biggest health care fraud of all, with most of the money squandered, within the public system now called Medicare? Furthermore, why do we think a new public plan will not fall prey to at least the same amount of large-scale fraud? Why would we think a public system will experience less waste and abuse than a private insurer, when it is virtually impossible to scam such large sums of money from any health care institution that watches its bottom line?

Now, moving right along, who will administer a new public plan? Medicare? Then expect more large-scale fraud. Will the job be outsourced to private insurers, as in Michigan Medicaid? Then expect the same overhead as in Medicaid, and the same bureaucracy.

Advocates of a new public plan have yet to make a convincing case.

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WSUSOM Wins Approval For Orthopaedic Surgery Residency

The Wayne State University School of Medicine’s application for an Orthopaedic Surgery residency program has been approved by the Accreditation Council for Graduate Medical Education, good news for a state in dire need of more orthopaedic surgeons to address the demands of an aging population, according to the School of Medicine.

The residency program is sponsored by the School of Medicine in a joint relationship with Oakwood Healthcare System, the primary participating institution. The program is also affiliated with St. John Hospital and Medical Center, University of Michigan Pediatric Orthopaedic Surgery and the VA Medical Center in Detroit.

A projected start date for the new program is Aug. 1, 2009, when four new residents will begin their training, said Lawrence Morawa, MD, chairman of the Department of Orthopaedics.

According to the American Academy of Orthopaedic Surgeons, Michigan ranks third on the list of the 10 states with the lowest orthopaedic surgeon density per 100,000 residents, at 4.39. Only West Virginia and Mississippi have fewer orthopedic surgeons. It is crucial that Michigan develop and train more orthopaedic surgeons who remain to practice here as the state’s population ages. As the baby boom generation -- the largest segment of the population -- continues to age, it places greater demands on orthopaedic surgeons.

“It’s a field that will continue to be in high demand,” said Dr. Morawa. “We are living longer and we want to remain active longer. That puts pressure on our aging bodies that will require treatment by skilled orthopaedic surgeons, including knee and hip replacements so that we can continue to take part in the activities we enjoy.”

Dr. Morawa was named chairman of the department in 2007 with a specific mission to rebuild the department and re-establish the residency program after the Detroit Medical Center dropped the program.

The AAOS reports that orthopaedic complaints are the most common reason Americans seek medical treatment. One in seven Americans suffers an orthopaedic impairment, and more than 7 million Americans require hospitalization for orthopaedic conditions. Back and knee injuries are the most prevalent orthopaedic complaints, with 21 million visits to physicians’ offices for back problems and 12 million visits for knee problems in 2006, the latest year for which records are available. Musculoskeletal injuries cost the nation 440 million lost days of work, and $254 billion annually for treatment.

As baby boomers continue to work and play hard – as well as live longer than their parents -- these numbers can only be expected to increase. Exercising and sports activities at ages beyond those at which their parents began to take it easy take a toll on joints, especially knees, elbows and shoulders.

Orthopaedics is an extremely competitive field, with about 650 residency slots available annually in the nation’s 170 accredited programs, according to the AAOS.

“This accreditation of our program has a dual importance,” said Valerie Parisi, MD, MPH., MBA., acting as dean for the School of Medicine. “Students who attend Wayne State University can be assured that we will continue to provide complete training opportunities in the medical specialties, and the people of Michigan can know that we will train new physicians to meet their needs, now and in the future. Wayne State University educates more physicians who remain in Michigan to practice than any of the state’s medical schools. As our state’s residents continue to age, they can remain confident that orthopaedic surgeons trained by our School of Medicine will continue to provide cutting edge care for them. I am very grateful to Dr. Morawa, his outstanding faculty and staff, and our hospital partners for their dedication and support for the creation of this new residency program.”

“For the past three years, Oakwood and Wayne State University have established and maintained a strong partnership for medical education and research while providing excellent health care for the people of southeast Michigan” said Dr. Michael Geheb, division president of Oakwood Healthcare Inc. “Under the leadership of Dr. Morawa, longstanding Oakwood orthopedic surgeon and chair of the WSU Department of Orthopedic Surgery, our relationship has now expanded to include an ACGME accredited orthopedics residency program, which was approved in June. This latest achievement builds on the clinical excellence of Oakwood in orthopedics, and continues the collaboration between Oakwood and WSU.”

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Researchers To Benefit From Stimulus Dollars

Researchers at Wayne State University and the WSU School of Medicine have collectively secured $2.36 million in grants so far under the American Recovery and Reinvestment Act, the national economic stimulus package signed into law by President Barack Obama.

More grants are expected to be announced soon. Those already announced include:

James Granneman, PhD, a professor in the Department of Psychiatry and Behavioral Neuroscience and the Center for Integrative Metabolic and Endocrine Research, will receive $316,416 from the National Institute of Diabetes and Digestive and Kidney Diseases for his study, “Analysis of Lipolytic Trafficking in Adipocytes.”

Peter Littrup, MD, a professor of the Department of Radiology at the School of Medicine and the Karmanos Cancer Institute, will receive $242,349 from the National Cancer Institute for “Functional Ultrasound Tomography: Testing a Low-Cost Breast Imaging Concept.”

Melody Neuhart Neely, PhD, an assistant professor in the Department of Immunology and Microbiology, will receive $7,468 from the National Institute of Allergy and Infectious Diseases for her study, “Analysis of the Virulence Mechanisms of a Lantibiotic Locus.”

Donal O’Leary, PhD, a professor and director of cardiovascular research in the Department of Physiology, secured three grants from the National Heart, Lung and Blood Institute: $8,853 for “Blood Pressure Control During Exercise in Heart Failure,” $8,552 for “NTS Adenosine Receptors in Cardiovascular Control” and $531,614 for “Integrative Cardiovascular Control During Exercise in Hypertension.”

Avraham Raz, PhD, a professor in the Departments of Pathology and Radiation Oncology, will receive $334,006 from the National Cancer Institute for “Characterization of Motility Factor Receptor.”

Melissa Runge-Morris, MD, an associate professor of the Institute of Environmental Health Sciences, secured $228,000 from the National Institute of Environmental Health Sciences for “PCBS: Environmental Modulators of Human Breast Cancer Progression.”

Michael Shaw, PhD, an assistant professor in the Department of Immunology and Microbiology, secured $190,000 from the National Institute of Allergy and Infectious Diseases for his study, “A Novel Splice Variant of Interleukin-13 and its Role in Promoting EAE Responses.”

Paul Stemmer, PhD, an associate professor of the Institute of Environmental Health Sciences, will receive $500,000 from the National Center for Research Resources for his study, “A Proposal to Expand Analytical Capabilities at Wayne State University With A 400.”

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Dr. Ayers Appointed To Student National Medical Association

Eric Ayers, MD, an assistant professor of Internal Medicine/Pediatrics and associate program director of Internal Medicine/Pediatrics with the Wayne State University School of Medicine, has been appointed to serve as a professional board member for the Student National Medical Association.

Dr. Ayers was initially nominated by Nakia Williams, a second-year pediatric student, who was impressed with his passion for mentorship and his students.

“For me, this is indeed an honor to serve in this capacity,” Dr. Ayers said. “For the School of Medicine and its departments, it gives us access, visibility and a vehicle to help in the recruitment of minorities in medicine.”

After he was nominated, Dr. Ayers met with the board for an interview and was asked to prepare and deliver a presentation on leadership at the Student National Medical Association’s National Leadership Institute.

Established in 1964, the Student National Medical Association consists of more than 8,000 members throughout the United States. The SNMA is the oldest and largest independent, student-run organization committed to meeting the needs of minorities and preparing them for careers in medicine.

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Smoke-filled Air In Detroit Casinos Deemed Unhealthy

Despite the claim that their air ventilation systems address the dangers of secondhand smoke, air quality testing (AQT) conducted in Detroit’s three casinos revealed indoor pollution levels that are eight times higher than outdoor air.

The testing at each of Detroit’s three casinos was sponsored by the Campaign for Smokefree Air and took place on Saturday, April 18, 2009. The tests measured the amount of tobacco smoke derived fine particle air pollution in each casino. Each location was measured over a 40-minute period using the TSI SidePak AM510 Personal Aerosol Monitor.

“Results from the air quality assessments in each casino reinforce that casinos need to be included in smokefree legislation,” said Katherine Knoll, spokesperson for CSA and senior director of advocacy for the American Heart Association. “Casino workers deserve the same protection as any other employee. These workers are unfortunately exposed to high levels of air pollution on a daily basis in order to earn a paycheck.”

The air quality was measured using Environmental Protection Agency’s (EPA) standards, established to effectively measure air quality for the protection of public health. PM2.5 is the concentration of particulate matter in the air smaller than 2.5 microns in diameter. Particles of this size are released in significant amounts from burning cigarettes and are easily inhaled deep into the lungs.

Key findings include:

The average of the fine particle indoor air pollution in these casinos was 92, which the EPA deemed unhealthy. [Note: The EPA deems healthy air quality levels at 15 and below.]
The average indoor air pollution in these casinos is eight times higher than outdoor pollution levels in Detroit.

Similar AQT, sponsored by the Pennsylvania Coalition Against Tobacco, was conducted in three Pennsylvania casinos currently exempted by the state’s smokefree law. The average of the fine particle indoor air pollution in these casinos was (at a level) the EPA deems unhealthy. The study also concluded that six out of every 10,000 Pennsylvania casino workers will die each year due to secondhand smoke exposure. The average indoor air pollution levels were six times higher than outdoor Pennsylvania air. This study reinforces the fact that exempting casinos from smokefree legislation still leaves a large amount of workers at risk.

In 2005 and 2006, air quality of 90 bars and restaurants was measured in eight Michigan cities finding similar unhealthy levels as the casino testing. AQT was conducted in both smoking and nonsmoking sections of the locations measured. The average of the eight cities in the smoking sections monitored measured at 147.75, which the EPA deems very unhealthy. Nonsmoking sections of restaurants in Detroit, Kalamazoo, and Saginaw measured at an average of 50.3 that the EPA deems as unhealthy. These results reinforced the fact that nonsmoking sections do not provide a barrier from secondhand smoke exposure.

A poll released in March, conducted by Lansing-based EPIC/MRA, stated that two-thirds of voters were in favor of including casinos in the legislation. Sixty-four (64) percent said that casinos should be included in the law, agreeing that it is only fair that casino employees should have the same protection from secondhand smoke on the job as other workers.

In May, the House passed HB 4377 sponsored by Rep. Lee Gonzales (D-Flint Township) which would create smokefree workplaces with the exception of casino floors and existing cigar bars.

The bill was sent to the Senate for consideration and assigned to State Government Operations and Reform committee chaired by Senate Majority Leader Mike Bishop. CSA is advocating for the Senate to pass comprehensive smokefree legislation as they did in the last legislative session.

For more information about the Campaign for Smokefree Air, please visit www.MakeMIAirSmokefree.org .

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