March 16, 2009

IN THIS ISSUE

Editor's Column: What The Patient Centered Medical Home Means To Us
In My Opinion: Physicians Ignored
A New Twist In WSU-DMC Relationship
Two Wayne Count Hospitals Chosen For Quality Collaborative
Congressional Chairs To Lead Health Care Reform Effort
WSU Hosts House Health Committee
Researchers Devise New Way To Explore DNA
WSUSOM Students Step Up For Lung Association

Click Here To Contact Us
 

What The Patient Centered Medical Home Means To Us

By JOSEPH WEISS, MD
The Patient Centered Medical Home will fail in it’s present form. The structure is ponderous and the reimbursements proposed are inadequate.

However, the Patient Centered Medical Home will change the practice of medicine more than MRI or the introduction of cell receptor blockade. The Patient Centered Medical Home will be remembered as having introduced The Patient Registry into the practice of general medicine.

The Patient Registry is not just a repository containing a patient’s name and insurance number. Rather, the Registry contains cells, calling for particular data on the registered patient. At present, the Registry confines its attention to the information on patients with diabetes and congestive heart failure; it is the physician’s responsibility to fill in the results the Registry mandates. In the case of diabetes, the information includes the HbA1c values, urinalysis results, eye examinations, etc. If the physician leaves a cell blank, then the Registry responds with a rebuke.

But there is more. At present, if a physician completes the information that the Registry requires, then the physician is eligible for a bonus. However, after 2014, not completing all the information the Registry requires will initiate a loss of the usual reimbursement.

Physicians should keep in mind that the cost of obtaining the information for which the Registry calls and for keying in that data falls on the physician. The cost of maintaining the registry and of any other registry-related software, hardware, information technician time, and new employee hire will be an ongoing physician expense.

Physicians may have heaped scorn upon BCBS as a slow-witted and clumsy giant, but in this matter of the Patient Registry, BCBS has moved with speed and precision. The Blues see before we do that the registry will allow the company to establish a hold over us never possible previously. BCBS will dictate their concepts of quality and pay us according to their interpretations of how well we fulfill the rules, commands and demands the Blues put into the Registry.

In addition, we will see more of our practice becoming not a matter of judgment, but of carefully following their rules. Quite possibly, the medical community will find it faces a doctor surplus, as the Registry’s need for data increases and the need for health care technicians and diminishes the revenue generating power of the doctor.

Furthermore, the Registry will generate an immense amount of data on the patterns of disease and therapy that the insurance companies will hide as proprietary and throw away as not being relevant to reimbursement strategy.

The Registry once introduced will not disappear; the insurers will repair its errors and inadequacies, as the control the Registry will give them over physicians will be too compelling to ignore.

Physicians will need to accept the requirement to work harder for less reward.

Share Your Thoughts on this Article

  Back to top

In My Opinion: Physicians Ignored

By Allan Dobzyniak, MD
There is little disagreement that Americans deserve access to affordable, quality health care, though the meaning of the word, deserve, and the definition of Americans are controversial. The noise surrounding this issue is deafening, and there will be change. There has been no lack of contrary views, debate, posturing and politics regarding the issue of health care. Articles, editorials and books espousing analysis and solutions are as prolific as opinions. Everyone has one.

Curiously, what has not been addressed is the effect all these proposed solutions will have on the medical profession. Actions have consequences, and what seems like a wonderful conclusion can have a disastrous outcome. In fact, some seem to even disregard the medical profession as inconsequential to the debate let alone acknowledge the profession’s relationship to health care access, quality and delivery. To hear my fellow physicians vigorously influence their children against a career in medicine speaks volumes about the state of the profession.

If it is suggested that a demoralized, non-engaged, unenthusiastic physician group is compatible with improving health care value, the conclusion is gravely erroneous. To the contrary, an engaged, enthusiastic, energized medical profession is absolutely imperative to any chance for an optimal outcome.

A realistic concern is the process of health care evolution will continue to disregard the need for a healthy medical profession. This will certainly be the case if physicians remain passive and allow others to define physician value. To continue to punish providers is guaranteed to result in the diminished excellence intrinsic to the medical profession and further exacerbate the rapidly evolving physician shortfall. The effect of each decision on the health and continued excellence of the profession is integral to achieving a sustained new system of health care delivery, especially if quality is as important as cost.

The best answers pertaining to these issues are to be found with physicians engaged in the daily practice of patient care. Academia and organized medicine are disengaged and populist in philosophy, marginalizing their opinions regarding the true reality of the physician relationship to patient needs. The destruction or even partial destruction of the medical profession, its ethics and its intrinsic goals of excellence, innovation and progress would be an unconscionable act.

   Share Your Thoughts on this Article

  Back to top

A New Twist In WSU-DMC Relationship

Crain’s Detroit Business reported last week that plans are circulating between DMC CEO Mike Duggan and Wayne State University President Dr. Jay Noren that could result in a deal that places many of the university’s academic physicians under DMC control.

Neither principal was available for comment in the story, but Crain’s obtained documents describing a proposal by Duggan that would create a non-profit corporation called the Wayne State University Practice Group. The group’s president would be appointed by DMC and would include the practice groups for internal medicine, neurology, neurosurgery, obstetrics-gynecology, ophthalmology, pathology, physical medicine and rehabilitation, psychiatry, radiation oncology and surgery.

The DMC practice group would get contractual rights for anesthesiology, emergency medicine, pediatrics and radiology.

WSU would continue to operate the University Physicians Group, but with only dermatology, family medicine, orthopedics, otolaryngology and urology.

Crain’s reported that WSU issued a press release saying in part, “Neither the DMC nor WSU would agree to any restructuring without first having the extensive involvement and support of the chairs of the clinical departments of the School of Medicine, who also lead DMC’s clinical activities. Any suggestion to the contrary is inaccurate and unfortunate.”

Still, the newspaper reported that WSUSOM Dean Robert Mentzer, MD, hired a spokeswoman and has called a series of emergency meetings, including a gathering of the University Physicians Group’s executive committee at which a resolution was passed asking Duggan and Noren to cease negotiations. There is no indication that they will.

Crain’s reported that Duggan’s proposal is based on a model employed by the University of Pittsburgh School of Medicine 10 years ago, which, according to Duggan’s proposal, has grown annual federal research funding from $100 million to nearly $400 million, which, according to the proposal, would put it ahead of Harvard, Columbia and the University of Michigan.

Share Your Thoughts on this Article

Back to top

Two Wayne County Hospitals Chosen For Quality Collaborative

The Greater Detroit Area Health Council (GDAHC) announced last week that Garden City Hospital, Mt. Clemens Regional Medical Center and Sinai-Grace Hospital have been selected by the Robert Wood Johnson Foundation (RWJF) to participate in a new effort to improve the quality of care in hospitals. The program will help nurses and other frontline staff identify, test and implement changes that will improve the quality and safety of patient care in their medical and surgical units.

The program is part of RWJF’s Aligning Forces for Quality (AF4Q) initiative, a cornerstone of the Foundation’s $300 million commitment to improving quality in specific regions across the United States. The Greater Detroit Area Health Council’s Save Lives Save Dollars initiative coordinates local efforts for the program. Detroit was selected last year as one of 14 AF4Q communities nationwide.

The new nurse-led program is based on successful pilot efforts by the Foundation to transform care at the bedside, by making hospital staff who spend the most time directly caring for patients the key drivers of quality improvement. Hospitals that have already participated in the program report a cultural shift on their medical-surgical units that has produced better clinical outcomes, more time spent with patients by staff, and lower turnover of nursing jobs.

"We know that the quality of health care can be improved in every community in the nation, and the more people who get involved, the more likely we are to succeed," said Vernice Anthony, president and CEO of the Greater Detroit Area Health Council. "Having local hospital leaders involved in our efforts is an important part of our strategy to improve quality of care. Not only will they learn new ways to improve care in our community, but they will share what works in our community with other hospitals around the nation that need our insights."

Experts say the effort to transform care at the bedside is unusual in its focus on engaging nurses and other frontline staff to develop and lead the quality improvement efforts. Ideas for improving care come not from the hospital’s executives, but from the nurses who treat patients every day. Nurse-led teams identify where change is needed on their unit, suggest and test potential solutions, and decide whether and how those innovations should be implemented.

"We are excited to be chosen as one of the select hospitals participating in the TCAB Collaborative and look forward to working with AF4Q to share and spread our success to improve quality," said Debra Williams, R.N., BSN, MBA, vice president and chief nursing officer for Garden City Hospital. "This is a unique initiative that offers us a new way to approach quality improvement."

"Because they spend so much of their day with patients and their families, our nurses are in unique positions to know exactly where – and how – quality can be improved" said Kathy Baker, vice president of nursing at Mt. Clemens Regional Medical Center. "Nothing is more important than high-quality care and I’m glad our team was picked to be part of this effort."

"The nurses in our hospital are well-prepared to systematically rethink and redesign processes for patient care," said Judy Paul, vice president of Patient Care Services at Sinai-Grace Hospital. "We can always take a fresh look at our systems to see how we can improve, and we look forward to sharing with others what works best in our own hospital."

Led by RWJF, the TCAB Collaborative will be overseen by The Center for Health Care Quality at The George Washington University Medical Center School of Public Health and Health Services, which serves as the national program office for the Aligning Forces for Quality initiative. Technical assistance will be provided by the American Organization of Nurse Executives. The Institute for Healthcare Improvement will convene training workshops for participants. The first cohort will kick-off this month and the second cohort launches fall of 2009.

In every region involved in the Aligning Forces for Quality initiative, including Detroit, broad-based teams of people who get care, give care, and pay for care are working together to improve health care quality. By aligning people from across the community in different AF4Q initiatives, the Greater Detroit Area Health Council hopes to help achieve community-wide transformation of health care.

For more information, visit www.gdahc.org or www.rwjf.org.

Share Your Thoughts on this Article

 Back to top

Congressional Chairs To Lead Health Care Reform Effort

Congressional committee chairs "are gearing up to play a leading role" in health care reform, which will require them to "overcome years of policy deadlock, ... keep their own committees in line, ... massage their leaders, ... deal with a GOP minority that wants its say and will probably oppose many ideas the Democrats try to push through" and "satisfy the Obama White House," CQ Today reports.

According to CQ Today, House Energy and Commerce Committee Chair Henry Waxman (D-Calif.), House Ways and Means Committee Chair Charles Rangel (D-N.Y.) and House Education and Labor Committee Chair George Miller (D-Calif.) "will have a primary hand in the health care overhaul" in the House. In a letter sent to President Obama on March 11, they promised to move to pass "similar" health care reform bills this year.

In the Senate, Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) will lead the health care reform effort (Epstein/Richert, CQ Today, 3/13). Baucus on Wednesday during a speech to the National Business Group on Health said, "I've served in the Senate for 30 years, and this is the hardest legislative challenge of my lifetime" (Lengell, Washington Times, 3/15).

Other senators who likely will participate in the health care reform effort include Senate Budget Committee Chair Kent Conrad (D-N.D.) and ranking member Judd Gregg (R-N.H.); Senate Finance Committee ranking member Chuck Grassley (R-Iowa); Senate HELP Committee ranking member Mike Enzi (R-Wyo.); and Sens. Chris Dodd (D-Conn.), Orrin Hatch (R-Utah) and Jay Rockefeller (D-W.Va.) (Budoff Brown, Politico, 3/16).

Possible Obstacles
The "bulk of Democrats ... are likely to go along with any plan Obama endorses and help him rally support for it," but "most Republicans probably will vote against a health care overhaul, which likely will involve some expansion of public health programs," CQ Today reports. In addition, "Obama and his allies face problems among two other groups: liberals and conservatives within their party," according to CQ Today.

According to CQ Today, many liberals remain "adamant that the country should sweep away private health insurance companies and implement a single-payer, government-run health care system," a proposal not supported by Obama. In addition, fiscally conservative Democrats, such as members of the House Blue Dog Coalition, have concerns about the cost of health care reform (Wayne, CQ Today, 3/13).

Obama has sought to "pre-empt opponents of his plan" by "inviting a vast spectrum of stakeholders to collaborate with the White House on its health care reform push," Roll Call reports (Murray, Roll Call, 3/16).

Health Insurance Industry
The "health insurance industry is working on a transformation" to attempt to portray themselves "as indispensable partners in health care overhaul," rather than "villains for denying coverage or refusing to pay for treatment," the AP/Kansas City Star reports. According to the AP/Star, health insurers "say they are in a unique position to help improve quality and root out waste, saving money so everyone can be covered."

Health insurers have called for a requirement that all U.S. residents obtain health insurance as part of health care reform legislation. "If the industry's pitch succeeds, insurers will be guaranteed many more customers," according to the AP/Star. However, "if the overhaul that President Barack Obama has promised goes against them, insurers could find themselves trying to compete against a new government-run health plan offering cut-rate premiums to middle-class families," the AP/Star reports.

America's Health Insurance Plans President and CEO Karen Ignagni said, "We understand we need to come to the table with very specific solutions."

AARP public policy Director John Rother said of health insurers, "They are making inroads," adding, "They are getting past the rhetoric and starting to talk about more concrete ideas for improving quality and getting value" (Alonso-Zaldivar, AP/Kansas City Star, 3/15).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/healthpolicy . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved."

  Share Your Thoughts on this Article

Back to top

WSU Hosts House Health Committee

The Wayne State University School of Medicine hosted a public hearing of the Community Health subcommittee of the state House Appropriations Committee. The March 13 hearing was intended to gather public comment relative to the funding of community health issues in light of the state’s potential budget reductions for long-term home and protective care.

Chairman Gary McDowell said the subcommittee was looking for public perspective around the state in terms of what the state’s priorities ought to be. The subcommittee went to Traverse City and Grand Rapids prior to coming to Detroit. Said McDowell, “While areas of our state seem diverse, we have more in common than people think.”

Other representatives on the subcommittee are Vice Chairwoman Shanelle Jackson, Hugh Crawford, Vincent Gregory and Fred Miller.

Jaffar Auditorium in Scott Hall was filled to overflowing with concerned people, many of whom were afflicted with long-term disease or injury that make them dependent on others for care and support.

Former representative Morris Hood III attended and made comments as a concerned resident regarding the ongoing work of his father’s namesake, the Wayne State University Morris J. Hood Jr. Comprehensive Diabetes Center.

James Gutai, M.D., a School of Medicine professor of pediatric endocrinology, knows the issues of diabetes in children better than most. Since 1989, he has been at the helm of a community-based program that brings teams comprised of a physician, dietitian, diabetes educator and social worker to Detroit-area communities and distant areas of the state to educate children about diabetes and help them control the disease. He was at the hearing, he said, because “Someone needs to speak for the children. They have no voice of their own."

Also commenting from the SOM were Herbert Smitherman, MD, assistant dean of Community and Urban Health; Manuel Tancer, MD, chair of the Department of Psychiatry and Behavioral Neurosciences; and Jason Young, a second-year medical student.

   Share Your Thoughts on this Article

 Back to top

Researchers Devise New Way To Explore DNA

A team that includes researchers from the National Institutes of Health (NIH) has found a new way of detecting functional regions in the human genome. The novel approach involves looking at the three-dimensional shape of the genome’s DNA and not just reading the sequence of the four-letter alphabet of its DNA bases.

In a paper published in the early online edition of Science, a team led by Elliott Margulies, PhD, of the National Human Genome Research Institute (NHGRI), and Thomas Tullius, PhD, of Boston University, described an innovative approach for detecting functional genomic regions. By combining chemical and computer analyses, the researchers are able to survey the landscape, or topography, of DNA structure for areas likely to play a key role in biological function.

The method involves identifying all of the grooves, bumps and turns of the DNA that make up the human genome and then comparing those structural features to those seen in the genomes of other animal species. Structural features that have been preserved across many species are likely to play important roles in how the human body functions, while those that have changed over the course of evolution may play a less central role or no role at all.

"This new approach is an exciting advance that will speed our efforts to identify functional elements in the genome, which is one of the major challenges facing genomic researchers today," said NHGRI Scientific Director Eric Green, MD, PhD. "Coupled with continued innovations in DNA sequencing, this topography-informed approach will expand our ongoing efforts to use genomic information to improve human health."

The sequence of the 3 billion DNA base pairs that make up the human genome holds the answers to many questions pertaining to human development, health and disease. Consequently, much research aimed at understanding the genome has focused on establishing the information encoded by the linear order of DNA bases. In the new study, however, researchers focused on how those bases chemically interact with each other to coil and fold the DNA molecule into a variety of shapes.

"We often think of DNA as a string of letters on a computer screen and forget that this string of letters is a three-dimensional molecule. But shape really matters," said Dr. Margulies, who is an investigator in NHGRI’s Genomic Technology Branch. "Proteins that influence biological function by binding to DNA recognize more than just the sequence of bases. These binding proteins also see the surface of the DNA molecule and are looking for a shape that allows a lock-and-key fit."

In 2003, an international team of researchers finished a reference sequence of the human genome, an achievement that greatly sped efforts to find genes, which reflect the approximately 2 percent of the genome that codes for proteins. At one time, the remaining 98 percent of the genome was referred to as junk DNA. Researchers now know that this non-coding DNA contains elements that carry out important biological functions, such as turning genes off or on. However, little information exists about where these non-coding functional elements are located and how they work.

The new approach to identifying functional elements in non-coding DNA builds upon the individual efforts of Dr. Tullius, a chemistry professor who has spent more than 20 years developing methods to examine the 3-D structure of DNA, and of Dr. Margulies, a molecular biologist who uses computer methods to compare the genomes of different species.

"We brought together two diverse fields to think about this problem in a new way," said Dr. Margulies. "It took the combined expertise of a DNA chemist and computational biologist to figure out that this chemical technique could advance our understanding of comparative genomics."

"By considering the three-dimensional structure of DNA, you can better explain the biology of the genome,” said Dr. Tullius. “For this achievement, Stephen Parker, a Boston University graduate student, deserves much of the credit for his development of the algorithm that incorporated DNA structure into evolutionary analysis."

In their Science paper, the researchers compared the topography of the human genome with that of 36 other mammalian species, including mouse, rabbit, elephant and chimpanzee. Using this topographic approach, they found that about 12 percent of the non-coding DNA in the human genome appears to be functionally important — twice the amount detected using methods that simply compared DNA sequences.

What accounts for the difference? Researchers say DNA sequence is not always a good indicator of function. They found that very similar DNA sequences may assume very different topographical shapes, which can have a major impact on their function or lack of function. On the other hand, different DNA sequences may assume very similar topographical shapes and perform very similar functions. So, in many instances, DNA structure may be a better predictor of function than DNA sequence.

The researchers went on to mine data organized by the PhenCode Project to see whether one-base variations in DNA sequence, called single-nucleotide polymorphisms (SNPs), in non-coding regions can cause structural changes that might lead to disease. Specifically, they conducted a topographic survey of 734 non-coding SNPs known to be associated with signs and symptoms of disease. The non-coding SNPs associated with disease tended to produce larger changes in the shape of DNA than a set of SNPs not linked to disease.

The entire study made extensive use of data sets generated by the NHGRI-funded ENCyclopedia of DNA Elements (ENCODE) project, which is a multi-institution effort to compile a parts list of the biologically functional elements in the human genome. In addition, some of Dr. Tullius’s work in developing the new technology was funded through the ENCODE project.

For an artist's depiction of DNA packaging and topography, go to http://www.genome.gov/pressDisplay.cfm?photoID=20150.

NHGRI is one of the 27 institutes and centers at the NIH, an agency of the Department of Health and Human Services. The NHGRI Division of Intramural Research develops and implements technology to understand, diagnose and treat genomic and genetic diseases. Additional information about NHGRI can be found at its Web site, www.genome.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

   Share Your Thoughts on this Article

 Back to top

WSUSOM Students Step Up For Lung Association

A pair of medical students at the Wayne State University School of Medicine will climb a few steps – actually 1,035 steps -- for a worthy cause

Christopher Cooke, 27, of Troy, and Andrew Isaacson, 25, of Dearborn, will take part in the American Lung Association of Michigan’s Climb Detroit event March 8, racing up the 70 floors of stairs in the Detroit Marriott Tower of the Renaissance Center.

The duo, taking part as Team Wayne State Medical School, are seeking pledges for their effort to raise funds for the Lung Association., which supports lung health research, education and advocacy in Michigan.

The second-year medical students both plan to go into orthopedic surgery.

Isaacson competed in the challenge two years ago, and placed in the top 10 for his age group and in the top 20 overall. This year marks Cooke’s third consecutive appearance in the challenge. Last year he placed 20th overall.

“And I beat Andy, which is the most important thing,” he joked.

Cooke trains for the event by climbing 20 flights of stairs while wearing a 20-pound weight vest three times a week. Isaacson said he has been climbing stairs and cycling to build stamina for the event.

“I originally did this because climbing 70 flights of stairs sounds completely crazy and I am overly competitive,” Cooke said, “but it is a great day for a great cause, and that keeps me coming back.”

“It’s a good cause, and I like the physical challenge,” Isaacson added.

Next year, Isaacson and Cooke hope to recruit 10 to 20 classmates to join the School of Medicine team in the climb.

The pair admitted that fundraising is going a bit slower than in past years, perhaps because of the economy. Donations can be made to support their effort to assist the Lung Association by visiting http://www.mrsnv.com/evt/home.jsp?id=2211 and searching for the pledge site for either student.

   Share Your Thoughts on this Article

 Back to top 

This publication brought to you by Natinsky Publishing Network.

Problems seeing this email? You may view it online at http://www.wcmssm.org
To subscribe or unsubscribe to this newsletter contact info@wcmssm.org