E-DMN - May 11, 2009

May 11, 2009

Editor's Column: For Everything Else There's Mastercard
Health Care Reform Faces Stiff Deadline
Physicians Must React To Medicaid Cuts
Save The Date
Henry Ford Announces 2008 Financial Performance
Oakwood's Bobby Lee, MD, Earns Fellowship
Four Wayne State Medical Students To Present Posters
WSUSOM 'Buzz It For Boards' To Benefit St. Jude

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Editor's Column: For Everything Else There's Mastercard

By JOSEPH WEISS, MD
That advertising phrase reminds us that money cannot buy everything. Physicians should keep that thought in mind when approaching Congress for reimbursement reform. More money won’t bring us all that we need. To work well, we also need an atmosphere free of excessive regulation and superfluous reporting.

We should tie our monetary working condition needs to what Congress sees as a better working health system for the nation. If we don’t tie bar* what we want to changes Congress wants, we will be saddled with their version of pay-for-performance, their concepts of Electronic Health Records, and the deals they broker on pubic/private health insurers.

First, we should urge universal coverage with a basic health plan that the medical community develops and that includes provision for coverage regardless of employment status. Second, physicians should find a way to cooperate with commercial retail store clinics, a movement that, though small, is definitely established on the American health care scene. Third, we should look deeply at the concept of the patient registry, and develop a registry ourselves that promotes quality without onerous requirements on office staff and physicians. Fourth, we should consider how Web technology could create a patient health record we could access. Finally, we should bring a physician perspective to chronic disease case management and remote monitoring,

We need to go to Congress not just to ask for more money. We must show the legislature that we can couple reimbursement with innovation. We must fashion change so it will lead to improved health for Americans and better working conditions for ourselves.

*Editor’s Note: A “tie bar” is a legislative strategy comprised of writing language into a bill linking it to another piece or pieces of legislation. Often it is used to link related bills altering different areas of law. Typically, the legislative intent is that the bills be considered as a “package,” rather than individually. In the somewhat figurative sense used here, the tie bar would be used to cement a physician-Congress agreement on the issue in question into the text of a bill.

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Health Care Reform Faces Stiff Deadline

By PAUL NATINSKY
FLINT-While the dreadful state of the US economy, several wars and the plight of the US auto industry has occupied much of the time the nascent Obama administration has spent on policy, the embers of health care reform that were debated so hotly during last autumn’s campaigns still burn.

US Surgeon General candidate Herbert Smitherman, Jr., MD, MPH presented a status check on health care reform and painted a dismal economic picture as backdrop at the Flint Golf Club May 7. Dr. Smitherman is Assistant Dean, Community and Urban Health at the Wayne State University School of Medicine.

He said Obama has tasked five congressional committees, two in the Senate and three in the House) with delivering a consensus bill to his desk by December 2009. The administration expects the bill to be reflective of policy pledges Obama made during his presidential campaign, namely to build on the current system, leave Medicare alone and expand Medicaid and the State Children’s Health Insurance Program (SCHIP). The bill is expected to contain what Dr. Smitherman called “the most controversial element,” a public insurance plan. He said consensus is forming around a few ideas, including individual insurance mandates bolstered by subsidies, an insurance exchange proposed by the Obama campaign and intended to function as a cost-saving clearing house for insurance policies, and expansions of Medicaid coverage, which is occurring in 33 states so far.

Even insurance companies and Blue Cross, both of which have opposed past health care reform efforts, are getting on board. Dr. Smitherman said the two sent a March 24 letter to Congress offering to not consider pre-existing medical conditions when writing policies and to not vary premiums among insureds (community rating) in exchange for inclusion of an insurance mandate.

While the deadline is short in legislative terms and the task daunting, MSMS President Richard Smith, MD, said he experienced a surge of “enthusiasm and energy” for health care reform during a recent trip to Washington, DC. He acknowledged that while “health care reform has been taking place since doctors realized they had to wash their hands before delivering babies,” significant and sweeping reform might be on the horizon.

Dr. Smith was on hand in Flint as a reactor. He wondered aloud about how the recent federal rescue funds targeted for health care are now thought to be slated for to make up for general fund shortfalls in Michigan’s budget.

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Physicians Must React To Medicaid Cuts

Last week, MSMS Immediate Past President Michael A. Sandler, MD, and Michigan Health and Hospital President Spencer Johnson hosted a press conference to bring attention to proposed cuts to the Medicaid program anticipated in the governor's executive order. According to legislators and staff familiar with the negotiations, a 4 percent cut to the physician line item appropriation as well as an identical cut to other providers will be included in the executive order.

Executive orders are directives issued by the governor related to a number of functions within the government. Most notably, executive orders are used to reduce expenditures authorized by appropriation acts whenever it appears that actual revenues for a fiscal period will fall below the revenue estimates on which the appropriations for that period were based. By statute, any recommendation for the reduction of expenditures must be approved or disapproved by both of the appropriations committees within ten days after the recommendation is made. A reduction cannot be made without approval from both committees.

Since it is unlikely that revenue projections will improve in the coming days, it is expected that both the House and Senate will act swiftly to vote on the executive order. The proposed executive order is expected to include roughly $300 million in cuts to various programs. The cut to the physician line is approximately $2.5 million and will only apply to the fourth quarter of the fiscal year. Should the House or Senate fail to act it is entirely probable that they could be faced with an even bigger task should revenue projections continue to erode. Politically, many legislators view this as a simple choice of vote for the executive order or support a tax increase to fund current levels of spending. Neither of these options is very palatable.

Physician action is needed for two reasons. First, there is still a possibility that the legislature will reject the executive order and force the governor to re-submit a new proposal without cuts to physicians. Second, this cut is temporary and applies only to the current fiscal year. If physicians do not weigh in on this cut, legislators will be emboldened to maintain this cut for next year's budget.

Colin J. Ford
Director, State and Federal Government Relations
Michigan State Medical Society
(517) 336-5737
fax:(517) 337-2490
cford@msms.org

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Save The Date

Date: June 24, 2009
Location: Henry Ford Hospital Wyandotte
Time: 10 a.m.-Noon
Topic: Disruptive Behavior Among Physicians/Health Care Professionals
Speaker: James Goodyear, MD

Background from the American Medical Association:
Disruptive Behavior amongst physicians and other health care professionals in hospitals impacts patient safety and the quality of care that is provided and has increasingly become an issue in the present health care system. In response, The Joint Commission has created a new standard that took effect in January 2009. This new standard, will require hospital administrators to adopt codes of defining disruptive behavior against the codes of conduct and developing procedures to invoke discipline.

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Henry Ford Announces 2008 Financial Performance

For the sixth consecutive year, Henry Ford Health System experienced positive revenue growth and net income.

Henry Ford reported total revenues of $3.69 billion in 2008, an increase of $217 million from the $3.47 billion total revenues in 2007. Overall, Henry Ford reported a $8.5 million net income for 2008 as compared to $105 million in 2007.

The single largest contributor to the decrease in net income was the losses experienced from investments, an economic fact experienced by most hospitals in the country.

"While Henry Ford is not immune from the economic realities facing the country, the state and the metro area, we are in a better position than most other hospitals and health care systems," says James Connelly, Henry Ford's chief financial officer.

"During the past six years, we have built a strong financial structure and solid foundation, with a stable bond rating. Recently Standard and Poor's reaffirmed our 'A' bond rating and stable outlook," adds Connelly.

For instance, admissions to Henry Ford hospitals increased 1.7 percent from 89,197 in 2007 to 90,709 last year. For the entire southeast region, there was a slight dip in admissions between 2007 and 2008, according to the Southeast Michigan Hospital Monthly Self-Report data.

"The increased unemployment combined with the loss of health benefits continues to lessen health care demand in the region," says Nancy Schlichting, president and chief executive officer for Henry Ford.

"In addition, the number of people without insurance and those on Medicaid is rapidly increasing. For instance, the state's Medicaid caseload shot up to 1.6 million people last fall, the highest ever in Michigan's history," she says.

At Henry Ford, uncompensated care for patients increased 22 percent from 2007 to 2008 ($132 million to $160 million). The biggest increase resulted from bad debt (from $47 million to $60 million) and charity care (from $25 million to $37 million).

However, the Henry Ford system also experienced growth in its business:

The 191-bed Henry Ford West Bloomfield Hospital opened. The demand for services at the hospital has exceeded projections. With average occupancy running at more than 90 percent, the hospital recently began hiring an additional 240 employees.

The first phase of the two-story, $35-million Henry Ford II (West) Pavilion expansion project opened, offering patients and their families access to 40 new private rooms. The expansion is part of the $310 million investment in the Henry Ford Hospital Campus. Once completed, it will house 80 private rooms including 20 intensive care rooms on two floors, bringing the total number of ICU beds at Henry Ford to 162 - the largest ICU in Detroit.

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Oakwood's Bobby Lee, MD, Earns Fellowship

Oakwood Healthcare System (OHS) is proud to announce that Bobby G. Lee, MD, of Oakwood Hospital and Medical Center (OHMC), has earned the Fellow in Hospital Medicine (FHM) designation. Becoming a Fellow is an avenue for special recognition by the Society of Hospital Medicine (SHM) members who have distinguished themselves among their colleagues and the hospital medicine specialty.

To be designated as a Fellow in Hospital Medicine, an applicant must be a hospitalist for five years, a member of SHM for three years, demonstrate their dedication to quality and process improvement, commitment to organizational teamwork and leadership, as well as lifelong learning and education.

Approximately 500 Hospitalists will be inducted in the inaugural class of Fellows this May at Hospital Medicine 1009 in Chicago, IL.

Oakwood Hospital & Medical Center (OHMC) in Dearborn has served southeast Michigan for more than 50 years. This 623-bed full-service teaching hospital offers state-of- the-art emergency medicine, general medicine and surgery. OHMC is home to three medical residency programs in partnership with the Wayne State University School of Medicine.

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Four Wayne State Medical Students To Present Posters

Four Wayne State University School of Medicine students are presenting posters at the annual meeting of the Association for Research in Vision and Ophthalmology.

The students have the opportunity to speak about their research with members of the world’s largest vision research organization, which is meeting in Fort Lauderdale, Fla., this week. The theme for this year’s meeting is “Reducing Disparities in Eye Disease and Treatment.”

Maheen Haque, a fourth-year student, will present “The Effect of Selective Laser Trabeculoplasty With Heavy Versus Light Pigmentation of the Trabecular Meshwork.”

Michael Siegel, a fourth-year student, will present “The Effect of Intravitreal Bevacizumab (Avastin) on Intraocular Pressure in Patients With and Without Glaucoma.”

Clint Simpson, a fourth-year student, will present “The Effect of Brimonidine on IOP Spike Prophylaxis After Argon Laser Trabeculoplasty or Selective Laser Trabeculoplasty Procedures in Chronic vs. Non-chronic Users of Brimonidine.”

Andrea McNab, a third-year student, will present “The Effect of Cataract Surgery on Intraocular Pressures in Patients With and Without Glaucoma.

Bret A. Hughes, MD, associate professor of the Department of Ophthalmology for the Wayne Sate University School of Medicine and physician at the Kresge Eye Institute, worked with all four students, and Anju Goyal, M.D., assistant professor of the Department of Ophthalmology for the School of Medicine and physician at the Kresge Eye Institute, assisted with Simpson’s and McNab’s projects.

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WSUSOM 'Buzz It For Boards' To Benefit St. Jude

It’s fairly common knowledge that medical students are under a lot of pressure, especially during exams.

Looking for a way to ease that strain, create some camaraderie and benefit medical research, the Wayne State University School of Medicine’s Class of 2011 has come up with “Buzz it for Boards.”

The class is recruiting students and faculty to shave their heads – or at least get a crew cut -- before May 19 as part of a fundraiser to benefit St. Jude Children's Research Hospital.

“The Class of 2011 will be tackling the United States Medical Licensing Examination Step 1 in a few short weeks and we believe this is a great way to unite the second-year class and any other supporters while raising money for charity in the process,” said Brandon Mancini, Student Senate president for the Class of 2011, who came up with the idea.

There are two ways to participate: If you shave your head between now and May 19, the Class of 2011 will donate $5 on your behalf to St. Jude Children’s Research Hospital to assist children battling cancer. Those who are gun shy of parting with their own locks can either make a lump sum donation to the cause or pledge an amount for each head shaved.

“Since we are shaving our heads for a cause, we thought that it would be appropriate to donate to a research hospital for cancer patients who unfortunately lose their hair due to the treatment they receive,” Mancini said. “With this in mind, we wanted to contribute to St. Jude Research Hospital, which helps so many children diagnosed with cancer. We hope that future classes will continue this tradition and select a variety of charities to support over the years.”

So far, 17 students have committed to shaving their heads. While no faculty members or administrators have yet opted for the Yul Brynner look, a number have made monetary contributions.

Mancini himself will head to a barber shop for an appointment with a razor Monday immediately after his final pathophysiology exam.

On May 19, those with freshly shaven scalps will gather at Scott Hall for a group photo, which will be sent, along with the collected funds, to St. Jude Children’s Research Hospital.

Because the fundraiser got a late start this year, Mancini said, organizers don’t expect women to shave their heads. However, next year they hope to recruit female students early in the year to grow their hair long and commit to donating their tresses to Locks of Love, which provides wigs for female cancer patients.

For more information, email Mancini at bmancini@med.wayne.edu .

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