July 27, 2009

IN THIS ISSUE

Editor's Column: What Washington Is Doing And Our Response
In My Opinion: Physician Organization Support For HR 3200
In My Opinion: Support For What?
Docs Give Mixed Review To House Health Care Reform Bill
Henry Ford Hospital Ranked Among America's Best
Study Finds Pervasive Use Of Flawed Databases
We Need Your Input
Reader Survey 2009

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Editor's Column: What Washington Is Doing And Our Response

By JOSEPH WEISS, MD
Can any group be more vigorous in supporting health care reform than Michigan physicians?

Has any physician reading this column not faced patients this year who said: “I can’t afford it?” The “it” being a medication, MRI, laboratory test, hospitalization, operation or referral to physical therapy, a specialist, a pain or psychiatric center. The patient’s reason for rejecting the recommendation is insurance, rather, the lack of it. Either the patient has lost his or her job and cannot afford to pick up the cost independently, or the employer has negotiated a new company health insurance contract and the copay that was $25 is now 25 percent.

Does any physician reading this column not understand the real meaning of the phrase: “At 15.5 percent, Michigan has the highest unemployment rate in the country?” No doubt each of us can give one or more examples of what this unemployment rate means in seeing children or grandchildren leaving the state, or giving money to help relatives through a financial crisis, or calming the anxieties of friends fearful of being laid off.

We must disregard the columnists and essayists, most of whom live outside of Michigan, who say that government intervention in health care or the auto industry is loathsome and, if accomplished, will mean the end of the American way of life. Experience in our offices and homes tells us otherwise; a crisis is not coming, but is with us now.

We should support and encourage Michigan congressional representatives to support health care reform. House Bill 3200 is complex and windy. It is not reasonable to be in favor of every “and,” “but” and “or,” in this 1,000 page bill. But the bill’s intent is sound. We should let our national organization such as the American College of Surgeons, the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the AMA, hear of the adversity we face and the need to support the legislation coming from Washington.

We need to stand up to the opponents of change. We should not let people who do not understand our present pain determine our future distress.

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In My Opinion: Physician Organization Support For HR 3200

By SUSAN ADELMAN, MD
The AMA has released a statement of support for House Bill HR 3200, the pending majority health care reform bill. After listing the reasons why this bill will be good for patients, the AMA gets down to business.

According to the AMA, “HR 3200 provides substantial funding for the physician community at a time when other health care stakeholders are facing steep cuts. The Congressional Budget Office estimated that the bill includes more than $230 billion in positive investments for physicians. Medicare primary care payments would be increased, without offsetting cuts in reimbursement for other physician services. Workforce investments would be made to address primary care shortages. Efficiency bonus payments would be provided for physicians in low-cost localities.”

Here is the AMA breakdown:

• $228.5 billion to eliminate the accumulated SGR cuts
• $1.6 billion for PQRI quality reporting changes (bonus payments only, no penalties for non-reporting)
• $5 billion for the primary care bonus
• $1.8 billion for the medical home pilot
• $1.3 billion to extend the floor on Medicare’s geographic adjustment for physician work”

The American College of Physicians and the American College of Surgeons also support HR 3200. This just came from the ACS:

“One of the most important priorities related to workforce is the need to address the underlying problems of the Sustainable Growth Rate (SGR), which is used to calculate Medicare physician payments.  This legislation (H.R. 3200) would allocate $284 billion to fix the Medicare physician payment system and eliminate the more than 40 percent cuts in payments to physicians that are scheduled to take place over the next four years, giving surgeons stability for the first time in 10 years.

“The bill would stop the pending 21.5 percent cut in Medicare reimbursement that will occur on January 1, 2010, and replace the cut with an increase based on the Medicare Economic Index.  Second, it would reset the budget baseline for the Medicare payment system to 2009.  Resetting the baseline … will finally provide a long-term solution to the difficulties that have plagued Medicare payment reform for the better part of a decade.  Also, rather than implementing untested models of care and reimbursement, H.R. 3200 would implement pilot programs to test various delivery system reforms that would build on models that have been shown to improve quality of care. Collectively, these measures would stop years of scheduled cuts in Medicare payments, better align incentives to improve quality, and ensure that surgeons will be able to care for patients without the annual concern of Medicare payment cuts.”

In short, all three physician organizations believe Congress when it tells them that physician payment will go up. They also believe the promise to implement pilot programs on various delivery systems, something Congress has promised before, but never delivered. When the CBO pronounced this program to be in a permanent deficit, Congress leaned on them enough to have them renounce the first estimate. Now Congress has stated clearly that they will find funding by decreasing Medicare payments.

So what will happen when this program inevitably turns out to be underfunded by billions of dollars? The initial plan to tax the rich will morph into a plan to also tax the near-rich, then anyone who can be tapped and looks even vaguely well-off. Then when funding still falls short, Congress with devise a variety of ways to squeeze the rest of the money out of health care providers. Just listen to Nancy Pelosi right now saying that she is sure that all the funding for the new program can be found right within the system. Who will be the ones to forego some of their pay to fund it?

The AMA, ACP and ACS are so anxious to be on the side of angels, to not block progressive reform, and to be on the good side of Congress for purposes of further bargaining that they have allowed themselves to believe the positively unbelievable. All those physicians and their patients who do not agree with these organizations have very little time left to send letters to the editor and to contact their Senators and Representatives.

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In My Opinion: Support For What?

By ALLAN DOBZYNIAK, MD
I wish to thank AMA Grass Roots for the update on HR 3200 (The US House health care reform bill). Please excuse the use of a cliche, but this is one of the very best examples of not seeing the forest for the trees. Health care represents 16 percent of the US economy. It is within this fact that the real political issue resides.

Consider the economics, please. Medicare is projected to have a $35 trillion shortfall. Add Medicaid and we are up to a projected $55 trillion. These are astronomical figures and ought to be enlightening when considering an increase in government managed health care entitlements. Now, to this almost incomprehensible number HR 3200 is projected to add another $1.5 to $2 trillion in spending. On top of this there is approximately 9 percent unemployment and climbing, recession, impending inflation, and a federal deficit that is by far the largest in history. To this is going to be added access for 45 million uninsured (this a despicable half-truth). Plus, there is an aging demographic and a relatively shrinking tax payer base. (God help our children and grand children.)

Economic growth (increasing GDP) will never be able to pay for all of this ungodly, preposterous, irresponsible and destructive deficit spending. EMRs and preventive care are economically irrelevant given this degree of debt.

However, there are absolutes that will result. Taxes will increase significantly, services will be restricted (rationing) and public reimbursements to providers will diminish. Concern about the SGR formula with an entitlement that is financially moribund is a waste of time. Ceding more influence to the government when private-sector options have not even been considered is ludicrous. Where is the consideration for tax relief on insurance premiums, tax credits for the truly needy to purchase health insurance in a real market, co-ops and consumerism? Where is the antitrust relief so that physicians can compete in a market driven by value? There cannot be any consequential health care reform unless reform to the present tort system is designed before or at least in conjunction with any legislation.

It is great to be liked. But the populist position again taken by the AMA is not good for patients and disastrous to the profession. How, I ask, in good conscience could the AMA leadership endorse a bill that has not even been written? Squandering the ability to negotiate for improved patient care and the health of the medical profession is inexcusable. This is not a political game; this is the future of all physicians and our patients.

A decision to honestly participate as a clear advocate for patients and physicians in the evolution of sensible and economically realistic reform is reasonable. Support for the outcome prior to its delineation is nonsensical. The AMA must backtrack from their present advocacy for HR 3200. A better strategy is mandatory. The very existence of the AMA is at stake.

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Docs Give Mixed Review To House Health Care Reform Bill

Despite the AMA’s support for HR 3200, the health care reform bill currently before the House Of Representatives, other physician groups are opposed to many of the bill’s provisions.

The AMA supports the America’s Affordable Health Choices Act (the bill’s more descriptive title) “partly on the strength of its Medicare payment reform plan, which would spend an estimated $245 billion over 10 years to align physician rates more closely with the costs of providing care,” according to an AMA report. The AMA also supports provisions which would expand health care coverage, offer coverage options through an insurance exchange and provide money to boost primary care services.

The American Academy of Family Physicians, American College of Physicians (both primary care physician groups), the American College of Obstetricians and Gynecologists and the American College of Surgeons support the bill for similar reasons.

A number of physician groups, including, the AMA reports, seven state medical societies and two former AMA presidents, oppose the legislation. Opponents find the bill’s provision calling for the establishment of a public plan problematic because they believe it will compete with private plans and drive down physician pay. Other objectors cite the poor performance of existing government plans, a distaste for mandates to buy insurance and a fear that all physicians would be forced to accept Medicare rates for all of their patients.

Below is a summary of the bill’s key points and a link to the House Energy and Commerce Committee pdf. Please use the “share your thought” link at the end of this story to let us know your opinion of the six highlighted provisions.

Medicare payment: Rebases the physician pay formula and gives doctors a pay increase in 2010 instead of a 21.5 percent cut. Establishes a new formula, starting in 2011, that allows annual spending targets to grow based on a rate of the gross domestic product plus 1 percent, with GDP plus 2 percent for evaluation and management services and preventive care. Provides a 5 percent Medicare bonus for physicians in primary care specialties.

Health insurance reform: Implements a national health insurance exchange that includes a government-sponsored, national public plan option financed only through premiums. Prohibits insurers from denying coverage based on preexisting conditions; establishing annual or lifetime limits; or basing premiums on anything other than age, geography or family size. Establishes an essential benefits package that all plans must offer.

Health care affordability: Offers scaled, income-based credits for the purchase of health insurance to people earning up to 400 percent of the poverty level. Caps annual out-of-pocket spending to prevent bankruptcies from medical costs. Expands Medicaid to all people earning up to 133 percent of the poverty level.

Coverage responsibility: Requires individuals who do not qualify for a hardship exemption to obtain health coverage or pay a penalty of 2.5 percent of modified adjusted gross income above a specified level. Requires employers who do not qualify for a small business exemption to offer health insurance to their workers or pay a phased-in penalty of up to 8 percent of their payroll.

Physician work force: Boosts funding for the National Health Service Corps, primary care physician training, and scholarships and loan forgiveness for physicians who work in underserved areas. Redistributes unused graduate medical education residency slots to train more primary care doctors.

Physician-owned hospitals: Prohibits self-referral of Medicare patients by physician-owned hospitals that did not have a Medicare agreement in place by Jan. 1, 2009.

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Henry Ford Hospital Ranked Among America's Best

Henry Ford Hospital has been ranked in six medical specialties in US News's 2009-10 issue of America's Best Hospitals, available today online at www.usnews.com/besthospitals  and at newsstands.

The magazine, which features the top 50 of American's Best Hospitals in 16 specialties, ranked Henry Ford in the following six specialties:

Digestive Disorders

Ear, Nose & Throat

Heart & Heart Surgery

Neurology & Neurosurgery

Respiratory Disorders

Urology

The survey assesses hospitals based on an index related to quality of care, reputation, mortality, volume, nurse proficiency and technology.

Henry Ford Hospital is part of the Henry Ford Health System, one of the country's largest health care systems. Henry Ford Health System integrates primary and specialty care with research and education. It includes the 1,000-member Henry Ford Medical Group, seven owned hospitals, the 500,000-member Health Alliance Plan, 27 primary care centers and many other health-related entities located throughout southeastern Michigan. To learn more, visit www.henryford.com .

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Study Finds Pervasive Use Of Flawed Databases

A report by the US Senate staff found that flawed databases sold by UnitedHealth Group subsidiary Ingenix, targeted earlier this year by New York Attorney General Andrew Cuomo, are used extensively by health plans nationwide to determine out-of-network payments, according t HIT News.

“Deceptive practices by insurance companies are not only misleading and widespread, they are absolutely unacceptable to me and I won’t give up the fight for consumers until we bring this to a stop forever,” committee Chairman Jay Rockefeller (D-W.Va.) said in a written statement obtained by HIT.

Cuomo reached an agreement with UnitedHealth in January requiring that the company stop using two databases of physician charges, which the attorney general alleged were affected by conflicts of interest because they relied on subscribing insurers for their content. Use of the data, he said, left patients unexpectedly on the hook for big bills by causing their plans to underpay out-of-network physicians. Subsequently every health plan in New York reached agreements with the attorney general to stop using the Ingenix products and contribute data and money toward a not-for-profit alternative.

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We Need Your Input

WCMSSM and the Detroit Medical News have periodically sent out surveys, buy mail and electronically, and achieved mixed results.

In this time of turbulence in the practice of medicine and in health policy and health care business matters in general, we need your voice more than ever. And we need it on a wide range of topics, for a broad range of purposes.

Not everyone can serve on a committee or devote the time that they would like to major issues affecting their practice and their patients. We realize this and we are launching a concerted campaign make your voice heard. Better yet, we are going to make it very easy.

Each Monday the Detroit Medical News publishes an e-mail edition to keep WCMSSM members informed of latest breaking news and relevant commentary from colleagues and those who most affect the world of health care delivery, policy and business.

Shortly, we will begin to use our e-edition tool to bring your voice to the table. It only takes a minute or two for you to weigh in on any of our stories or items by clicking the “share your thoughts on this item” link at the end of each entry. We’ll be adding to this easy response vehicle by including a short, general survey each week at the end of the e-edition. The survey will contain questions about the Detroit Medical News; mainly about how you use it, what you like about it and what you would like to see changed or improved. We will also feature a short survey about current health care issues. We’ll ask simple, easy-to-answer questions about topics like national health care reform, Blue Cross and Blue Shield legislation, insurers’ business practices, medical liability issues, the patient centered medical home issue and more. We’ll provide a clickable link and will be glad to read, and possibly publish (with permission) short comments such as, “more needs to be done to improve Medicaid reimbursement,” to full-length essays on the ramifications of President Obama’s accelerated health care reform agenda.

Please help us. Just as there is no such thing as a stupid question, there is no such thing as too short or too simple a response (often, those are the best).

We use information like this to amplify your voice in the federation of medicine (counties, MSMS, AMA) and to improve the coverage and focus of our communications to you.

But we also use it to help market to advertisers who support our publications, to enter contests that bring prestigious awards to DMN, and thereby WCMSSM, and to better understand what most concerns our members, which has a significant impact on recruiting new members and keeping WCMSSM strong.

Rest assured, your name and commentary will NEVER be used without your permission.

Please help us help you. It will only take a few seconds a week.

Thank you,

Paul Natinsky
Managing Editor

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Reader Survey 2009

Detroit Medical News/WCMSSM Reader Survey August 2009

**Please feel free to cut and paste into an e-mail and send to

arj@msms.org or fax to (313) 874-1366**

What is your specialty:________________________________

What is your age:____________________________________

How often do you read the DMN magazine? (please circle one):

Every issue    Sometimes     Infrequently   Never

How often do you read the DMN weekly e-edition? (please circle one):

Every week    Sometimes     Infrequently   Never

For what do you read the magazine for most? (please circle one):

News   Features        Opinion pieces
Other (please describe):_________________________________

For what do you read the e-edition for most? (please circle one):

News   Features        Opinion pieces
Other (please describe):_________________________________

The magazine is published six times yearly. Is this (please circle one):

Too often      Not often enough      Just right

The e-edition is published weekly. Is this (please circle one):

Too often      Not often enough      Just right

Are you a member of social or business networking site?

Yes     No

If so, which one(s)?:

Facebook       Twitter                   Linked In       Sermo.com
Other:________________________

Are we covering the right issues in the magazine and e-edition?

Yes     No      Usually Sometimes     Not often       Never

What are the issues that most affect you:

1:__________________________________________

2:__________________________________________

3.__________________________________________

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