E-DMN - June 1, 2009

June 1, 2009

Editor's Column: The Washington Scene
In My Opinion: Opt Out, Humm?
WSUSOM Dean's Office Update
Attorney General Challenges Blues Rate Hike
Mazurek Education Commons Unveils Friday
Oakwood Annapolis Hospital Wins National Award
Ethics In Brief: Physician Responsibilities In An Epidemic
Wayne State Docs Win Statewide Research Awards

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Editor's Column: The Washington Scene

By JOSEPH WEISS, MD
Washington is almost aglow with the energy created by the fireflies of health care: the lobbyists, the press, the politicians, and the medical societies. What will come out of the rhetoric and effort?

The nation is likely to see universal health care coverage. The Democratic majority has the votes and sufficient unity to put a universal health care plan in place, though the private-public mix remains unclear.

What won’t change is Congress’s reliance on the Sustainable Growth Rate (SGR) formula. Not that Congress will enforce it. Rather, the legislators will again reenact the ritual of the last-minute reprieve and 1 percent increase as a gesture of mercy and charity to our profession. Congress believes that repudiation of the SGR is easy and necessary, but finding a replacement is too difficult and time consuming to undertake at this time.

The federal government likely will pass bills designed to increase numbers of students entering medicine and encourage medical students to enter primary care. Congress feels that if it passes a bill for universal coverage, which it will do, the action will have little meaning if there are no doctors available to render care. At this time no one has pointed out that it takes at least seven years to train a new doctor, and if universal coverage passes tomorrow, the people covered will want care the following day.

Overall, it appears that this year’s Congress will bat .333. Coverage will pass, a change in the SGR will be a strikeout, at least as far as physicians see it. The effort to address physician manpower, while well-intended, is off the mark like a long fly ball when the team needs a hit.

Physicians will need to continue to come to Washington. This Congress will likely set in motion changes we will need to modify, while it maintains administrative rules that need modification. The only health care lobbyists with homes for sale are those who are moving to bigger quarters.

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In My Opinion: Opt Out, Humm?

By ALLAN DOBZYNIAK, MD
Whether you agree with government financial bailouts of selected private sector institutions or not, the effect of shrinking executive compensation for these businesses will have consequences. Heavily regulated businesses with salary restrictions will not be talent magnets.

Of interest, this same issue is rarely recognized as applicable to health care. In his Wall Street Journal article of 4/17/09, Dr. Marc Siegel states correctly that “Health insurance does not automatically lead to health care.” Eventually, economics will trump altruism and egalitarianism (as it should). If the economics are unreasonable, the consequences are predictable. If it does not make financial sense to participate with a private insurer, physicians will reject participation. If it does not make financial sense to participate with Medicaid, physicians will cancel the relationship. If it does not make sense to participate with Medicare or some future hybrid thereof, physicians will not. If it does not make economic or financial sense to consider medicine as a career, then sufficient numbers of the most talented will not. This reality is already evident as more physicians are currently acknowledging their untenable economics and leaving third-party relationships for private-pay options (sort of back to the future). The very best doctors of course have the most flexible choices. This is actually an interesting example of competitive market forces driving excellence.

For physicians to battle for financial survival in the current reimbursement model is enigmatic. Could it be the desire of physicians to create the impossible circumstance of a risk-free model of stable, and even increasing, economic prosperity? If there is no financial risk, the business is likely unimaginative and heavily regulated with limited, if any, potential for economic progress as an outcome. Over time the situation only worsens as a result of talent deficiency and technological inertia. The irony is that this perceived path to risk-free economic success is an illusion. It is actually the road to economic dependence, limited prosperity and professional stagnation.

Financial risk taking and profitability are the engines of both economic prosperity and business excellence, the old American dream. You can’t have it both ways.

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WSUSOM Dean's Office Update

Editor’s Note: The source for the following information is a Wayne State University School of Medicine weekly update that chronicles media references to the medical school.

Dr. Robert Mentzer, dean of Wayne State University School of Medicine, announced last week he is taking an indefinite leave of absence to help take care of his sick mother-in-law in Germany.

Vice Dean Dr. Valerie Parisi will assume Mentzer's duties as acting dean while he is gone, said Michael Wright, Wayne State's associate vice president of marketing and communications.

In a May 21 letter to Dr. Jay Noren, Wayne State's president, Mentzer said he would return to campus for the June 2 medical school commencement and the June 5 grand opening of the Mazurek Education Commons building.

Mentzer did not give Noren any other information of his future plans.

However, Wright said Noren has been aware that Mentzer's mother-in-law has been sick. Mentzer, a cardiologist, has made several trips to Germany over the last few weeks to provide support, he said.

Sue Ellen Eisenberg, a Bloomfield Hills labor lawyer who represents Mentzer, confirmed Mentzer has been helping his wife take care of his mother-in-law. Eisenberg said the mother-in-law, who is elderly, has had several surgeries over the last month.

Over the last several months, Mentzer has been at odds with Noren about the future of the Wayne State University Physician Group. Noren wanted to explore the possibility of transferring some of the group's faculty practice plans to the Detroit Medical Center.

However, that proposed plan fell apart recently when many of the faculty plan chairs objected to losing clinical control over their departments.

In February, a small group of tenured physician faculty members and researchers also signed a letter of no confidence over Mentzer's leadership of the medical school. (Detroit Free Press, Detroit News, Crain’s Detroit Business).

The DMC vs. WSU War: Last week Dr. Robert Mentzer, the dean of Wayne State University's medical school, resigned abruptly, after many months in which the school has battled with the Detroit Medical Center (meaning longtime politico Mike Duggan) over various issues, especially how the school and the independent medical center provide training to students.Here's what a veteran political very-insider told me about this: "Mike Duggan wants the dean to work for him, essentially. In this case, the dean has been correct on the issues, but the situation, unfortunately, pitted an academic surgeon against a street-fighter Irish pol ...

"Duggan needs to realize that no one wants DMC to fail and people are willing to help him, but not anoint him." As for new Wayne State president Jay Noren, he "has never had to work for the like of the [highly political] Board of Governors ... one hopes he will acclimate quickly and get someone into the deanship who can deal with both Duggan and the board."

Given that, if anyone asked me who that should be, I would nominate former congressman and state senator John Joseph Schwarz, M.D.

But they won't ask. Incidentally, though I teach at Wayne State, I am as far removed from anything going on at the medical school as from Sri Lanka. (Metro Times)

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Attorney General Challenges Blues Rate Hike

By PAUL NATINSKY
Attorney General Mike Cox May 21 filed a petition for a rate hearing with the Office of Financial and Insurance Regulation (OFIR) for the purpose of opposing Blue Cross and Blue Shield of Michigan's (BCBSM) proposed 31 percent increase in its Medigap coverage for senior citizens. Cox's ability to question the rate increase would have been eliminated under legislation stopped during legislative "lame duck" last year. The same restrictions on consumer protection are included in the new version of those bills, recently introduced by state Rep. Marc Corriveau, (D-Northville).

"This is all about revenues for Blue Cross, not health care for Michigan seniors," said Cox in a statement provided by the AG’s office. "If this new legislative package is passed, more than 200,000 Michigan seniors would be paying more for health care, automatically."

Cox announced his opposition to both the rate increase and proposed elimination of consumer protections that empower the Attorney General to question proposed rate increases during remarks to the Area Agencies on Aging Association annual conference in East Lansing. OFIR has 30 days from June 2 to begin the hearing process.

Last year, Cox and a diverse collection of consumer advocate organizations, including AARP and the UAW, defeated an attempt by Blue Cross to force through a package of anti-consumer bills during a lame duck legislative session. Those bills, and the similar bills recently introduced by Rep. Corriveau, would allow BCBSM to enact this and other rate increases without a proper hearing on behalf of Michigan consumers.

“We do not like to be in the position of asking for rate increases,” Blues Spokeswoman Helen Stojic told the Detroit News May 21. “Unfortunately, our broken regulatory system puts us in this uncomfortable position.”

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Mazurek Education Commons Unveils Friday

Wayne State University celebrates opening of the Richard J. Mazurek, M.D. Medical Education Commons, Friday, June 5, 2009.

The Wayne State University School of Medicine will host a grand opening dedication and open house for its new Richard J. Mazurek, M.D. Medical Education Commons. The $35 million facility will represent the new face of the nation’s largest single-campus medical college.

3 p.m. to 5:30 p.m. on Friday, June 5, 2009

The Wayne State University School of Medicine, Scott Hall, 540 E. Canfield, Detroit, MI.

Complimentary parking is available for invited guests and media in Lot #75.

MORE INFO:

The three-story, 53,000-square-foot commons will house training facilities that will be among the best and most challenging in the nation. The building, built entirely with private donations, is named for Richard J. Mazurek, MD, a 1961 graduate of the School of Medicine. Dr. Mazurek, now deceased, was honored with a naming gift of $10.2 million by his partner, Nick Labedz.

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Oakwood Annapolis Hospital Wins National Award

Oakwood Annapolis Hospital (OAH) recently received the Thomas Reuter Advantage award for improving emergency department performance without sacrificing quality of care and increasing referrals by 12 percent to appropriate health centers for patients without a primary care physician.

The Advantage Awards are given each year to hospitals, health systems, health plans, large employers and government agencies. OAH was honored in the strategy and growth category.

“This award further validates the growing achievement in reaching our goal of becoming a recognized leader in quality, service and value. It also demonstrates Annapolis’ commitment to Oakwood’s mission by assuring every patient receives excellent care, every shift, every time,” said Eric W. Widner, President of Oakwood Western Region.

The awards were presented at the annual gathering of Reuters’ healthcare customers at the Healthcare Advantage Conference in San Diego, California earlier this month.

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Ethics In Brief: Physician Responsibilities In An Epidemic

As swine influenza A, or H1N1, becomes a global epidemic, physicians must be cognizant of their ethical obligations to provide urgent medical care to individual patients—even in the face of greater-than-usual risks to their own safety, health or life. And physicians must be aware of their duties to protect the public’s health.

In the event that quarantine and isolation measures are needed, physicians should ensure that the least restrictive measures are employed in a manner that does not discriminate against particular socioeconomic, racial or ethnic groups. Physicians also should educate patients about personal and public benefits and encourage patients to comply voluntarily. And when a patient refuses to comply with recommended isolation or quarantine, physicians should support mandatory measures. All the while, physicians should protect patient confidentiality to the greatest extent possible, consistent with any mandated public health reporting.

Physicians have a responsibility to protect their own health to ensure that they can continue to provide needed medical services and should take steps to minimize the risk of physician-to-patient transmission. In addition to acquiring and maintaining relevant knowledge, frontline physicians should avail themselves of safe, effective protective and preventive measures (including appropriate vaccination), seek medical evaluation and treatment, and adhere to sound public health practices.

For more information about a physician’s responsibilities in an epidemic or other disaster, visit http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9067.shtml to view the AMA Code of Medical Ethics opinion “Physician Obligation in Disaster Preparedness and Response and http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion225.shtml to view the AMA Code of Medical Ethics opinion “The Use of Quarantine and Isolation as Public Health Interventions.”

Visit http://www.ama-assn.org/ama/pub/physician-resources/medical-science/infectious-diseases/topics-interest/swine-flu.shtml to learn more about the swine flu and to view the latest updates.
Source: American Medical Association

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Wayne State Docs Win Statewide Research Awards

The Wayne State University School of Medicine was well-represented at the 32nd annual Michigan Family Medicine Research Day, a statewide research conference.

A number of members of the Department of Family Medicine and Public Health Sciences won awards for their presentations at the May 21 conference, which next year will be held at Wayne State University.

School of Medicine winners included:

Michael Kopec, who won in the student research category for his presentation, “Factors Associated with Depressive Symptoms among Adolescents Attending School-based Health Centers.”

Sanket Kunde, MD, won in the resident chronic disease research category for his presentation, “Self-Monitoring of Blood Pressure among MetroNet Primary Care Patients: A Cross-Sectional Survey Study.”

Dawn Misra, PhD, won in the faculty research category for her presentation, “Fathers Matter: Depressive Symptoms Among Black Fathers in the Prenatal Period.”

William Murdoch, MD, gave a faculty presentation, and other resident poster presenters included Tywanda Crawford-Johnson, M.D.; Shamoon Din, MD; Aisha Khan, MD; and Basil Qandil, MD.

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