June 8, 2009

IN THIS ISSUE

Editor's Column: The Hilarious Lie Contains A Serious Truth
The 'Mazurek' Makes A Grand Entrance
Local Physicians Win Research Awards
Former Surgeon General Keynotes WSUSOM Commencement
WSUSOM Student Wins 'Editor's Choice Award'
MSMS Analysis Of House, Senate Health Care Reform Proposals
Smoke-free Workplace Bill Moves To Senate
MSMS, AMA Support Federal Bill Targeting Physician Shortage

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The Hilarious Lie Contains A Serious Truth

By JOSEPH WEISS, MD
On Monday May 11, in a letter to President Barack Obama, the Health Insurance Plans  of America (BCBS, Atena, Humana Wellpoint, United Healthcare, Kaiser etc) stated that they, as a group, would voluntarily achieve savings that would slow the rate of insurance increases from 6.2 percent per year to 5 percent a year, a change that would result in savings of $600 billion by 2019.

The press, television commentators, Internet scribes and numerous individuals who wrote letters to newspapers rightfully greeted the announcement with attitudes ranging from laughter to scorn. However, physicians would be wise to refrain from such a stance.

The insurance industry likely has a strong intent to reduce its cost, but not for the public good. Rather, for corporation profit. The industry will hide its resolve under the cloak of the May 11th promise made to the president.

Physicians likely will be the insurance companies’ prime targets; the companies’ main weapon will be the patient registry. Keep in mind that the registry is not just a line on a page, but a mandate of practice that contains a series of insurance company-prescribed tasks that require physicians to complete and document them. For example, a service, such as a mid-level visit from a diabetic, may come with a high reimbursement. However, physicians will gain full return only if the health insurance company is satisfied that the physician has completed all the elements the company deems necessary. Anything less then the company’s definition of completion will entail a cut in the reimbursement of the claim.

As a course of action, first, our medical societies, and particularly the AMA, should keep surveillance on Aetna, BCBS, WellPoint and especially United Healthcare, to see what policies these companies will initiate to fulfill their pledge. Second, the nation’s medical societies should more then watch, but challenge each and every criterion the health insurance companies impose as a mandate for reimbursement.

The medical profession must scrutinize the criteria the health insurance companies require as standard of care. We must consider the possibility that accrediting agencies such as the NCQA (National Committee for Quality Assurance) or prestigious institutions such as the National Quality Forum could become infiltrated with biased staff or be paid to make decisions in the insurers’ bet interests. Remember the strategy of United Healthcare in setting up the Ingenix to provide deliberately understated doctors fees in out-of-service claims.

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The 'Mazurek' Makes A Grand Entrance

By PAUL NATINSKY
It was unveiled amid Friday’s sparkling sunshine and its unofficial name is “the Mazurek.” Much like the case of a famous stadium, “The Joe,” or a famous airport “JFK,” those who dubbed it feel it needs no further descriptor.

Officially, it is called the Richard J. Mazurek, MD, Medical Education Commons. It needed a nickname.

The Mazurek is the Wayne State University School of Medicine’s new $35-million, 53,000-square-foot medical education building. It was built entirely from private donations and grants and doubles the class space at WSUSOM, according to university officials.

“The Mazurek meets contemporary medical education needs as well as those anticipated for the foreseeable future,” Dean Mentzer said. “The Mazurek will shorten the practical learning curve as our students move from academics to clinical practice. Our students will be better prepared as diagnosticians and better prepared to provide clinical treatment because of their training in the Mazurek.”

The building, which includes an updated Shiffman Medical Library, 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 longtime friend and business partner, Nick Labedz. That gift stands as the largest single donation to Wayne State University.

“I’d like to extend my thanks to all of you as we, together, have breathed life into bricks and mortar and, in doing so, made Richard J. Mazurek live forever,” said Labedz, who helped cut the ribbon that marked the official opening of the building. “This center for learning will be a key part of training thousands of physicians and will result in the treatment of hundreds of thousands of patients. This will be the legacy of Richard Mazurek.”

“This building is simply the latest of many extraordinary things to happen in Midtown because of Wayne State University,” WSU President Jay Noren said. “For our School of Medicine, this is the right facility at the right time.”

Medical education in this country faces a number of challenges, among them rapid advances in biomedical knowledge and an anticipated shortage of possibly as many as 200,000 physicians by 2020, the Dr. Noren said.

The three-story commons connects to the School of Medicine’s Scott Hall via an elevated and enclosed walkway between the two buildings.

Among the building’s functions and capabilities are:

• The Clinical Skills Center, which includes four simulation labs, two of which are fully functioning operating rooms. Each of the labs contains patient mannequins that can speak, breathe, bleed and display a spectrum of symptoms to test medical students. Instructors can observe students in action from outside the rooms and challenge students by constantly tweaking the “patient’s” conditions.
• Examination rooms in which students and residents will interact with live “patients” trained to enact any number of symptoms and conditions. The exam rooms are fitted with cameras and all interactions are videotaped so that instructors may provide immediate feedback or review the tapes with students later.
• The building will serve as a hub for Continuing Medical Education courses. Physicians from around the state and country will have access to ongoing professional medical education at the Mazurek Medical Education Commons, bringing with them a regional economic boost in use of hotel rooms, taxis and dining expenses.

“This is a day of excitement and celebration for all administrators, faculty and students at the School of Medicine,” said Robert Frank, MD., executive vice dean for the School of Medicine, and master of ceremonies for the building opening festivities. “It is the day that vision has become reality; the day when medical education at Wayne Statest leaps into the 21 century; the day when all of you who committed your time, money and resources to this project can proudly witness what you have helped to achieve.

“There is no finer, contemporary, state-of-the-science medical education facility than the Mazurek,” Dr. Frank added. “We will train more and better physicians because of it. And we will do so in a facility that is aesthetically pleasing and friendly to the environment.”

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Local Physicians Win Research Awards

The Southeast Michigan Center for Medical Education, in collaboration with the Wayne State University School of Medicine and Oakland University, presented the 32nd annual Meadow Brook Lecture and the 31st annual SEMCME Research Forum at Meadow Brook Hall in Rochester on May 20.

The Meadow Brook Lecture featured Peter Libby, MD, from Harvard Medical School, who presented his noted research on inflammation and atherosclerosis.

The Research Forum involved more than 30 residents from the SEMCME member hospitals presenting research projects in the form of oral or poster presentations.  More than $4,000 in cash prizes and awards were handed out, including the coveted Donald Dawson Medallion named in honor of Dr. Dawson, a gifted medical researcher and educator from southeast Michigan.

This year’s winners were:

Farzan Siddiqui MD, PhD, Department of Radiation Oncology, Henry Ford Hospital: first place, oral competition, $1,500 and the Donald Dawson Medallion.

Jason L. Picconi, MD, PhD, Department of Obstetrics and Gynecology, Wayne State University School of Medicine-Detroit Medical Center, second place, oral competition, $500.

Christopher W. Seder, MD, Department of General Surgery, William Beaumont Hospital, first place, poster competition, $750 and engraved plaque.

Heinric Williams, MD, Department of Urology, Wayne State University School of Medicine and Karmanos Cancer Institute, second place, poster competition, $500.

Rachel McLaughlin, MD, Department of Obstetrics and Gynecology, St. Joseph Mercy Hospital Ann Arbor, winner, translation research competition, $250.

Those serving as judges from the School of Medicine faculty included Gloria Kuhn, DO, PhD, and Brian O’Neil, MD, from the Department of Emergency Medicine, and Rosalie Young, PhD, and Jinping Xu, MD, from the Department of Family Medicine.

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Former Surgeon General Keynotes WSUSOM Commencement

The Wayne State University School of Medicine graduated 243 students during commencement ceremonies for the Class of 2009 this week.

The annual ceremony took place June 2 at the Fox Theater in Detroit.

The graduating researchers and physicians now enter residencies and research programs across the nation and – in some cases – around the world.

Dean Robert M. Mentzer Jr., MD, advised the students to continue their education and to hold fast to their principles in doing what is best for their patients.

“Remember that those who would change the world for the better don’t do so through concession and capitulation,” said Dean Mentzer, who also serves as senior advisor to the president for Medical Affairs. “As soon-to-be graduates of one of the finest medical schools in the country, your dean asks you to be the ones who ask the hard questions, draw narrow conclusions, maintain a healthy skepticism and avoid easy answers. When in doubt, follow your moral compass and remember the ethical behaviors you have affirmed to uphold.

“As physicians, I encourage you to accept the leadership responsibilities that are inherent to our profession,” he added. “If you do so, you will regularly be called upon to examine the world around you, to separate the noise from the signal and be challenged to do the right thing. Do not assume that because of our education and life’s experiences that we will automatically do so. We need to consciously remember to act morally and with compassion.”

The Keynote Commencement Address was delivered by Jocelyn Elders, MD, former US Surgeon General under the Clinton administration.

“You will now be put into a position of leadership that you will have to develop for the rest of your life,” Dr. Elders told the graduates. “Despite all of our new technologies and developments, we have left a lot of work for you to do. Our current health system is not a health care system, but a very sick care system. You will have many opportunities to meet challenges such as our current health care system, and the problems associated with alcohol, drugs and obesity.”

Dr. Elders noted that the nation’s health care system -- and the graduating physicians -- face three crises: a crisis of vision, a crisis of anticipation and a crisis of creativity.

“We need to visualize a great health care system that is accessible, affordable, universal and purpose driven,” she said. Physicians must also use available resources to anticipate and act upon future problems. “Think outside the box and create a system that you are proud of. We need you to get involved and be advocates for our patients. We need you to create a new health care system.

“You have to be successful. You can’t afford to fail. The health of the nation depends on you,” said the 15th US Surgeon General, and the first black woman to hold the post, who now serves as a Distinguished Professor of Public Health at the University of Arkansas School of Public Health and a Distinguished Professor at the Clinton School of Public Policy.

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WSUSOM Student Wins 'Editor's Choice Award'

A paper written by a Wayne State University School of Medicine researcher and his MD/PhD student has received the Editor’s Choice Award from the Organization for Human Brain Mapping.

Bruce Berkowitz, PhD, professor and director of Small Animal MRI Facility in the Departments of Anatomy, Cell Biology and Ophthalmology, and David Bissig won the award for their article, “Manganese-enhanced MRI of layer-specific activity in the visual cortex from awake and free-moving rats.”

The award, which will be presented at the organization’s annual meeting, honors the best paper of the year in the journal NeuroImage. Through the generosity of the Departments of Anatomy and Cell Biology, and Ophthalmology, and the School of Medicine, Bissig will attend the June meeting in San Francisco to accept the award.

“Dr. Berkowitz and I are excited by this honor, which came as a complete surprise,” Bissig said. Dr. Berkowitz serves as his mentor in the MD/PhD program.

The research outlined in their article describes “a new method for using magnetic resonance imaging to measure brain activity non-destructively and in greater detail than is currently possible,” Dr. Berkowitz said. “With this technique, brain activity that occurred outside the magnet in awake and free-moving subjects is studied, and this provides a new area of research for brain studies.”

While the research and methods are only in experimental studies, Dr. Berkowitz and Bissig said, the findings establish an important “test bed” for investigating disease models and new treatment options.

An international association, the Organization for Human Brain Mapping is dedicated to neuroimaging research. One of its primary goals is providing an educational forum for the exchange of up-to-the-minute and groundbreaking research.

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MSMS Analysis Of House, Senate Health Care Reform Proposals

The Michigan House and Senate recently unveiled health care reform proposals. MSMS has been involved in discussions with both chambers to craft this legislation prior to the introduction of the packages. Both of the legislative packages are efforts to move Individual Market Reform (IMR) forward in the context of more comprehensive reforms.

Last session, efforts to enact individual market reform failed because the legislation tended to disproportionately favor Blue Cross. For different reasons, the House and the Senate have packaged individual market reforms with other health reforms. The House has attached regulatory reforms related to the individual health insurance market with several seemingly unrelated efforts. The Senate has included IMR as part of a larger package of reforms related health insurance and expansion of coverage.

Perhaps the most surprising aspect of both proposals is the apparent consensus on a form of high-risk pool. Both versions allow Blue Cross to maintain its insurer-of-last-resort status and contain a proposal for reinsurance to all carriers in the individual market for claims exceeding $25,000 in a single year. Both versions fund this mechanism via proportional contributions from the plans in the individual market. Both versions also rely on an independent board to administer this reinsurance. This represents a shift in thinking from last session when the concept of a high-risk pool was rejected by the Senate and many of the stakeholder groups that participated in these negotiations.

The versions differ in many technical areas regarding underwriting. The Senate version assumes that appropriate competition exists within the individual market and prohibits certain abuses. Under the Senate plan, rescinding coverage based on a medical condition would be prohibited as would closing books of business for the purpose of shedding “bad” risk obtained over time. The House version seeks more regulation in this area by legislatively specifying medical loss ratios (MLR) for various types of plans while placing limits on the highest rate an insurer can charge an individual relative to the lowest rate the carrier charges (rate bands). These differences are significant in that they reflect the divergent view among insurers as to the root cause of the problem. Blue Cross contends it needs rate bands and mandated MLR in order to protect itself from commercial insurers “cherry picking” the good risk. Commercial insurers contend that this phenomenon is overstated by Blue Cross and is part of its responsibility as insurer of last resort.

Both versions create health care coverage expansions for certain populations that are currently uninsured. The House version seeks to expand coverage for children by expanding MIChild coverage to children in households up to 300 per cent of the federal poverty level (for a family of four this would be $66,150).  This program would be funded by an assessment on non-profit insurers equal to their state and local tax exemptions. The Senate version takes a two-tiered approach to cover the uninsured regardless of age. For recipients up to 200 per cent of the federal poverty level, the program expands Medicaid coverage. For recipients up to 300 per cent, the program creates a sliding scale subsidy for coverage offered by insurers for products meeting certain criteria determined by an independent administrative board. The Senate version is funded via a combination of increases to the existing provider taxes and a one percent premiums tax on all insurers including third party administrators. At this time, a physician tax is not being considered.

In addition to these elements, the House package also includes several other health related legislative items. Legislation to create a state-operated database containing medical advance directives similar to the organ donation database maintained by the Secretary of State has been introduced. Legislation regarding single-use medical devices and e-prescribing has also been introduced. It is not clear if these items are legislative priorities, or simply unrelated items introduced for the purpose of broadening the scope of the underlying intent to pass individual market reform.

The proposals do not address all of the relevant issues, and MSMS can have even more influence on the direction of the discussion and injecting the critical elements of the Future of Medicine and market reform discussions MSMS has undertaken.

MSMS will keep members posted on any developments and opportunities for leadership and grassroots action.

For more information, contact Colin Ford at MSMS at 517-336-5737 or cford@msms.org .

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Smoke-free Workplace Bill Moves To Senate

The state House recently passed smoke-free workplace legislation that would exempt non-Indian casinos, cigar bars, and tobacco shops. Also, an amendment was added to make all casinos smoke-free after all Lower Peninsula tribal casinos go smoke-free. The bill is expected to move to the Senate early this month. MSMS urges you to use its Action Center (www.msms.org/action) to contact your senator and urge him/her to support smoke-free workplace legislation. MSMS supports smoke-free workplace legislation through its Future of Medicine wellness initiatives. For more information, contact Colin Ford at 517-336-5737 or cford@msms.org .

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MSMS, AMA Support Federal Bill Targeting Physician Shortage

Tying into its core Future of Medicine principle of preserving and improving access to care, MSMS, along with the AMA, is supporting the “Resident Physician Shortage Reduction Act of 2009.” Introduced in the Senate, the legislation would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots). MSMS encourages physicians and all other health care professionals to use its Action Center (www.msms.org/action ) to send a message to Sens. Carl Levin (D-MI) and Debbie Stabenow (D-MI) to ask for their support of the bill. For more information about federal legislative advocacy, visit www.msms.org/federal  or contact Colin Ford at 517-336-5737 or cford@msms.org.

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