Wayne County Medical Society of Southeast Michigan

March 30, 2009

Editor's Column: If There Is No SGR, What Will Sustain Us?
National Doctors' Day Provides Opportunities Close To Home
CMU President Discusses New Medical School With Board
Updated 'Red Flags Rule' Legal Alert And Upcoming Webcasts
Dr. Parisi Appointed To Medical Specialties Board
Dr. Humes Wins Lifetime Achievement Award
Primed Symposium April 18
AMA President Writes Time Magazine

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Editor's Column: If There Is No SGR, What Will Sustain Us?

By JOSEPH WEISS, MD
The SGR (Sustainable Growth Rate Formula) is dead. Remember the formula?

UAF(xxxx)=TARGET(xxxx-1)-ACTUALx0.75+TARGET4/96-xx/xx-ACTUAL4/96 xx/xx x 0.33
ACTUAL(xxxx-1) ACTUAL(xxxx-1) x(1+SGR(xxxx)

(You recall of course, that UAF stands for the update adjustment factor). However, as much as we loved it, Congress on both the Democratic and Republican sides of the aisle has withdrawn support for the formula as the basis for physician reimbursement under Medicare.

The question arises: if not the SGR then what?

To date, four vague and seriously flawed alternatives have received attention:

Revise the formula by removing drugs from the target calculations. However, the SGR has other serious flaws such as underestimating the cost of chronic care and underestimating technology that allows mortality to extend to prolonged morbidity.
Use six buckets of SGR, such as one for radiology, one for general medicine, one for surgery etc. Unfortunately, the SGR is out of alignment with the real financing of medical care, more use of the formula only worsens the problem of reaching equitable physician reimbursement.

· Rely on the Medicare Economic Index (MEI). The MEI is already a part of the physician fee schedule conversion factor. Any plan for physician compensation must include the MEI but its weight is insufficient to make the MEI the sole determinant in Medicare physician pay.

· Tie payment to quality. As yet this suggestion remains unaligned to any specific approach or formula; the idea receives an enthusiastic listener response but no one has explained how to make the connection of payment to quality.

At present, Congress’s default position is to wait for Sen. Max Baucus’ Senate Finance Committee to come out with its recommendations on physician pay.

Physicians, do not wait. Our leadership should stop urging us to defeat continuation of the SGR; there is no need for such instruction. Instead, we need a specific plan now to either to present to Congress or to match it with what the Senate Finance Committee will present on Capitol Hill. Calling for change is not enough; we need to craft the change we want.

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National Doctors' Day Presents Opportunities Close To Home

By PAUL NATINSKY
Yes, National Doctors’ Day, an official holiday since 1990 and an unofficial one since 1933, is upon us once more. The idea was germinated by a the wife of a Georgia physician who thought it would be nice to send greeting cards to honor living doctors and place red carnations on the graves of those who had passed on (the full history, as well as the first President Bush’s proclamation appear in full below).

The holiday’s meaning and traditions have morphed a bit over the years. In one sense it has become a greeting card holiday. Personalized gifts including cards, balloons and travel coffee mugs can be bought and sent at the holiday’s official website, http://www.doctorsday.org/ .

However, the doctorsday.org people have added some pragmatic concerns to the celebration, soliciting donations to a medical school scholarship fund at the University of Alabama at Birmingham. The organizers of this campaign point out in detail the daunting debt that most physicians take home with them as a parting gift from medical school.

In Wayne County and Michigan in general, there are numerous funds that accept contributions to help offset medical school debt.

One that has been around for years is the Charles Vincent Memorial Scholarship offered to a promising medical student each year by WCMSSM.

A new fund looks beyond medical training toward helping shape physician leaders. In recognition of his lifelong leadership and mentorship of countless individuals, the MSMS Foundation established the Kevin A. Kelly Leadership Fund, which will be used to inspire future leaders to follow the late Kevin Kelly’s extraordinary example. The fund will support scholarships on an ongoing basis for promising medical students, residents and young physicians to attend MSMS and AMA leadership training and conferences. MSMS will match contributions to the fund up to $10,000.

The greeting cards and coffee mugs are nice, but with the United States, particularly Michigan and especially Wayne County facing an impending physician shortage, what better way to honor the profession than by remaining true to an old adage: charity starts at home.

History of National Doctors' Day

The first Doctor's Day observance was March 30, 1933 in Winder, Georgia. Eudora Brown Almond, wife of Dr. Charles B. Almond, decided to set aside a day to honor physicians. This first observance included the mailing greeting cards and placing flowers on graves of deceased doctors. The red carnation is commonly used as the symbolic flower for National Doctor's Day.

On March 30, 1958, a Resolution Commemorating Doctors' Day was adopted by the United States House of Representatives. In 1990, legislation was introduced in the House and Senate to establish a national Doctor's Day. Following overwhelming approval by the United States Senate and the House of Representatives, on October 30, 1990, President George Bush signed S.J. RES. #366 (which became Public Law 101-473) designating March 30th as "National Doctor's Day."

What is the National Doctors' Day Organization?

The National Doctors' Day Organization exists to raise awareness of the growing costs of medical school and the financial burden that exists for today's graduates. According to the Association of American Medical Colleges, new medical school graduates reported higher debt upon graduation and concern for the increasing demands of the health care system. Results from their 2008 AAMC Graduate Questionnaire (GQ) showed graduates reported 17.7 percent of graduates had educational loans of $200,000 or more—more than triple the 4.9 percent who had that amount in 2004. Students reported an average debt load of $141,751, more than $10,000 higher than 2007 GQ data." Among the more moving results from this survey, is that students showed more interest in primary care specialties and in working with needy and vulnerable populations.

The National Doctors' Day Organization was developed to support the Medical Scholorship Fund for the University of Alabama at Birmingham. For more information call 800-849-1727. For more information call 800-849-1727 or email info@doctorsday.org.

Origin of National Doctors' Day
George Bush
Proclamation 6253 - National Doctors Day, 1991

February 21, 1991

By the President of the United States of America

A Proclamation

More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellowman understand the tremendous responsibility it entails. Referring to the work of physicians, Dr. Elmer Hess, a former president of the American Medical Association, once wrote: "There is no greater reward in our profession than the knowledge that God has entrusted us with the physical care of His people. The Almighty has reserved for Himself the power to create life, but He has assigned to a few of us the responsibility of keeping in good repair the bodies in which this life is sustained." Accordingly, reverence for human life and individual dignity is both the hallmark of a good physician and the key to truly beneficial advances in medicine.

The day-to-day work of healing conducted by physicians throughout the United States has been shaped, in large part, by great pioneers in medical research. Many of those pioneers have been Americans. Indeed, today we gratefully remember physicians such as Dr. Daniel Hale Williams and Dr. Charles Drew, who not only advanced their respective fields but also brought great honor and pride to their fellow Black Americans. We pay tribute to doctors such as Albert Sabin and Jonas Salk, whose vaccines for poliomyelitis helped to overcome one of the world's most dread childhood diseases. We also recall the far-reaching humanitarian efforts of Americans such as Dr. Thomas Dooley, as well as the forward-looking labors of pioneers such as members of the National Institutes of Health, who are helping to lead the Nation's fight against AIDS, cancer, and other life-threatening diseases. These and other celebrated American physicians have enabled mankind to make significant strides in the ongoing struggle against disease.

However, in addition to the doctors whose name we easily recognize, there are countless others who carry on the quite work of healing each day in communities throughout the United States -- indeed, throughout the world. Common to the experience of each of them, from the specialist in research to the general practitioner, are hard work, stress, and sacrifice. All those Americans who serve as licensed physicians have engaged in years of study and training, often at great financial cost. Most endure long and unpredictable hours, and many must cope with the conflicting demands of work and family life.

As we recognize our Nation's physicians for their leadership in the prevention and treatment of illness and injury, it is fitting that we pay special tribute to those who serve as members of the Armed Forces and Reserves and are now deployed in support of Operation Desert Storm. Whether they carry the tools of healing into the heat of battle or stand duty at medical facilities in the Persian Gulf and elsewhere, these dedicated physicians -- along with thousands of nurses and other medical personnel -- are ital to the success of our mission. We salute them for their courage and sacrifice, and we pray for their safety. We also pray for all those who come in need of their care.

In honor of America's physicians, the Congress, by Senate Joint Resolution 366 (Public Law 101-473), has designated March 30, 1991, as "National Doctors Day" and has authorized and requested the President to issue a proclamation in observance of this day.

NOW, THEREFORE, I, GEORGE BUSH, President of the United States of America, do hereby proclaim March 30, 1991, as National Doctors Day. I encourage all Americans to observe this day with appropriate programs and activities.

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CMU President Discusses New Medical School With Board

Central Michigan University President Michael Rao, PhD, spoke to the MSMS Board of Directors about the university’s new medical school, and answered a number of questions about GME funding, the physician shortage, and clinical training.

“We are absolutely terrified about the physician shortage above the mid-Michigan line,” said Doctor Rao. “Access to primary care is a big problem for us now, and it’s only going to get worse.” He continued by asserting that, in spite of current caps on Medicare graduate medical education (GME) and the lack of new monies from the state of Michigan, establishing a medical school at CMU would ultimately improve access to primary care in rural areas because students would spend their entire medical education in that geographic area.

As previously reported, MSMS is working to convene a group with representatives from the medical schools, MSMS, Michigan Health and Hospital Association, Michigan Osteopathic Association, and the Michigan Health Council. The purpose is to better leverage issues surrounding the status of medical education, new medical schools, physician supply, graduate medical education funding, and other activities of mutual interest.

For more information, contact Rebecca Blake at 517-336-5729 or rblake@msms.org.

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Updated 'Red Flags Rule' Legal Alert And Upcoming Webcasts

Although the debate about whether or not physicians are subject to the Identity Theft “Red Flags Rule” continues at the federal level, MSMS is preparing educational tools to assist members should the Federal Trade Commission refuse to change its position that physicians who regularly bill their patients for services rendered (including co-payments and co-insurance) are creditors and must comply with the Rule.

MSMS Legal Counsel has prepared an updated Legal Alert entitled “Red Flags Rule” Update and Actions Physicians Should Take to Ensure Compliance by May 1, 2009. The Legal Alert was written to help MSMS members implement an identity theft prevention program in compliance with the “Red Flags Rule” and includes a sample Identity Theft Prevention Program.

Upcoming Webcasts: The MSMS Foundation will be offering one-hour Webcasts from noon to 1 p.m. on April 8, 28, and 29 to assist practices in understanding their responsibilities under the Red Flags Rule prior to the May 1 deadline. Dan Schulte, JD, MSMS Legal Counsel, will be the featured speaker. Cost is $40 for members and $50 for non-members. To register for a Webcast, contact Marcie Shattuck at 517-336-5724 or mshattuck@msms.org.

For more information about the Red Flags Rule, contact Stacey Hettiger at 517-336-5766 or shettiger@msms.org.

Read the Legal Alert Red Flags Update.

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Dr. Parisi Appointed To Medical Specialties Board

Valerie M. Parisi, MD, MPH, vice dean of Hospital Relations & Clinical Affairs for the Wayne State University School of Medicine, has been appointed to the board of directors and a two-year term as secretary-treasurer of the American Board of Medical Specialties.

The ABMS, said President and CEO Kevin B. Weiss, MD, is the medical organization overseeing physician certification in the United States. It assists member boards in developing and implementing educational and professional standards for the evaluation and certification of physician specialists. The organization is recognized by health care credentialing agencies as a primary source of board certification information.

“This is an exciting time for ABMS as we advance several new initiatives designed to improve the quality of US health care,” Dr. Weiss said. “We are pleased to have Dr. Parisi in a leadership position to help guide ABMS and its member boards to address the public’s need for a more effective health care system.”

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Dr. Humes Wins Lifetime Achievement Award

Richard A. Humes, MD, a professor of Pediatrics for the Wayne State University School of Medicine and chief of the Division of Cardiology for Children’s Hospital of Michigan, will be honored with a lifetime achievement award from the American Heart Association.

Dr. Humes will receive the association’s Seymour Gordon Award of Lifetime Achievement during the annual Heart Ball in April.

“I am honored to receive this prestigious award from the American Heart Association,” Dr. Humes said. “The AHA emphasizes research and advocacy in the larger areas of heart attack, stroke and hypertension -- diseases which affect a large proportion of our population. The area which I serve within the cardiology community represents a small but important niche of patients -- children. Children are generally not affected by these same disease processes, but more frequently are seen with congenital heart defects. I have spent the majority of my working career in the management of this group of patients. I have also been very active in the education of both the medical community as well as the lay population on the problems associated with this subset of problems.”

The association’s 2009 Medical Committee, made up of leading cardiologists from all health systems in southeast Michigan, selected Dr. Humes for the honor.

“The selection process is taken very seriously, with an initial nominations session commenced by the committee, a narrowing down of top candidates, and then a final session for a vote on the winning candidate,” said Kathy Kauffmann, vice president of Development for the American Heart Association.

Kauffman said Dr. Humes is the first pediatric cardiologist to win the award.

“Dr. Humes has been at the forefront of pediatric cardiology for the Detroit Medical Center,” she added. “He is recognized as the expert in his field and continues to lead the way for all pediatric cardiologists in Michigan and throughout the nation. We are humbled and honored to have his acceptance of this prestigious award.”

Dr. Humes has agreed to become the first pediatric cardiologist on the Southeast Michigan Board of the American Heart Association, Kauffman said. He is a Fellow of the national American heart Association and has served on the national affiliate as a member of the executive board of the Council on Cardiovascular Disease in the Young as well as a member of the Congenital Cardiac Defects Committee.

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Primed Symposium April 18

The Wayne State University School of Medicine, the Student National Medical Association and the American Medical Student Association will present the fifth annual Primed Symposium on April 18 for students interested in pursuing a career in medicine.

Potential medical students will gain insight from information sessions on admissions to medical school, application, interviews and curriculum. In addition to hearing from faculty members, students will have the opportunity to meet with current medical students and members of the school’s Admissions Committee.

Students may also choose four of eight available breakout sessions during the day. They include a work session to gain a better understanding of what an admissions committee seeks in medical school applicants, a glimpse into the lives of current medical students, tips on preparing for your personal interview, questions about the admissions process and the school, a workshop on preparing for the MCAT and a tour of the new Richard J. Mazurek, MD, Medical Education Commons under construction on the campus.

The symposium, which runs from 9:30 a.m. to 3 p.m., takes place at Scott Hall on the medical school campus.

There is no charge for the symposium, which is presented by the school’s Office of Admissions. Symposium planners request that each person attending bring an item to be donated to the Wayne County Family Center. All donations are appreciated, but specific items that are needed include hand soap, baby wipes, toothbrushes, laundry soap, sanitary napkins or tampons, used or new books, diapers, toothpaste, body soap, shampoo and deodorant.

In addition, participants are encouraged to bring the aluminum pull tops from beverage cans to assist in raising funds for the Detroit Ronald McDonald House, which provides a place to stay for families of children receiving treatment at Children’s Hospital of Michigan.

Admission to the symposium is limited to the first 400 registered participants. Registration forms must be completed by April 10. Online registration, which is preferred, can be completed at www.med.wayne.edu/admissions.

For more information and to obtain a registration form, call the Admissions Office at (313) 577-1466.

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AMA President Writes Time Magazine

Below is the text of a letter written by AMA President Nancy Nielsen, MD, and published by Time Magazine.

March 30, 2009 (published)

To the Editor:

TIME's cover story was a poignant look at one person's struggle to get the health care he needs [March 16]. Even more tragic, this story is repeated too many times each year in this country. As illustrated in your piece, physicians often provide care without charge when patients are in need, but we need a system that does a much better job of supporting patients and physicians. Your reform points are key. A full 75% of total health-care spending is linked to chronic health problems, many of which are preventable. If we can help Americans live healthier, we can reduce disease and decrease health-care spending. The American Medical Association is committed to reform that covers everyone with a choice of portable insurance, increases the value our nation receives from its health-care spending and enhances prevention and wellness. We need a better system for America's patients and the physicians who care for them.

Nancy H. Nielsen, MD

President, American Medical Association

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