E-DMN - May 26, 2009

May 26, 2009

Editor's Column: Great Expectations
In My Opinion: One Size Does Not Fit All
Dean Mentzer Takes Personal Leave From WSU Med School Post
AMA Health Care Reform Update
PPO Trade Group, AMA Partner On New Contracting Toolkit
WSUSOM Celebrates Newly Endowed Chairs
Wayne State Residents Make Impact At National Meeting
Mentorship Leads To Egyptian Cancer Research Lab

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Editor's Column: Great Expectations

By JOSEPH WEISS, MD
The Wayne County Delegation to the 2009 MSMS House of Delegates Meeting in Grand Rapids witnessed a marvelous moment, a point of arrival, an occurrence we are not likely to see again. On Saturday night at the Presidential Inaugural, The physician taking the emblems of presidency was Richard Smith, from Wayne County, the present president transferring the emblems was Michael Sandler of Wayne County, the Secretary of the MSMS Board of Directors administering the oath of office was Chris Bush of the Wayne County Medical Society, and the first person to offer congratulations to the new president was the MSMS president elect, Daniel Michael, from Wayne County.

The applause for the ceremony was a tribute not only to the four people standing at the podium, but also to the vigor, ability, commitment, and talent that characterizes our County Society.

Otherwise, I thought the energy of the convention delegates was ill-used, as most of the meeting went into a debate on the merits and/or evils of the single payer system. The debate is irrelevant.

The problem health care in America faces is not what carrier but what cost. It does not matter if the country settles on single pay, private pay, a combination of government and private pay, or whether we have a one tiered or two tiered system. No matter what structure we arrive at, that structure will crack under the strain of cost.

At this time we cannot determine how much care an individual should receive and at what cost. Add the American view on the necessity of choice and the need for equality of access and the result is a further unrelenting acceleration of cost.

Until we control cost, no plan of care will succeed. Unfortunately, the ideas on how we can control cost are draconian and would only raise anger or alarm given the attitudes that prevail today.

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In My Opinion: One Size Does Not Fit All

By ALLAN DOBZYNIAK, MD
There is no question that in a country as wealthy as the United States, a safety net should exist for the provision of health care for the truly needy. Can this logic be extended to mean that all citizens should be included in a one-size-fits-all, government-run health care insurance program? I would hope that the American people have the time and opportunity to consider the implications of relinquishing decisions regarding their own personal health care to others. For another person or committee to decide on such a basic personal freedom as managing one’s very own health care or that of their loved ones is the very antithesis of personal freedom. Choice in a non-competitive, artificially regulated, tax-managed marketplace is neither a marketplace nor a choice.

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Dean Mentzer Takes Personal Leave From Med School Post

By PAUL NATINSKY
The Detroit Free Press reported incorrectly last week that Wayne State University School of Medicine Dean Robert Mentzer, MD, resigned and requested that the university “appoint someone to serve in my place and stead.” The newspaper also reported that Dr. Mentzer “had been at odds with WSU President Dr. Jay Noren about key programs and training at the school.”

In fact, Dr. Noren issued a May 21 memo that stated, in part: “Dean Mentzer has informed me today that due to personal concerns, he will be unable to fulfill his responsibilities as dean for a period of time, and has asked that I designate someone to act in his stead.”

The memo further states: “I have asked Vice Dean Valerie Parisi to act in Dean Mentzer’s place. Until further notice, Dean Parisi will act with the full authority of Dean in all respects.”

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AMA Health Care Reform Update

Editor’s Note: The following is a May 18 update of ongoing health care reform efforts from the American Medical Association.

AMA pledge focuses on lower rate of growth in total health spending
AMA President-elect J. James Rohack, MD, elaborated on a mid May meeting between the AMA and several other health care stakeholders with President Barack Obama in multiple media formats, commenting twice on Fox Business Network and discussing the issue in a guest column on KevinMD.com. The pledge to reduce the rate of growth in health spending has been misconstrued by some observers; the focus is on eliminating unnecessary costs, such as administrative burdens from health insurers, and for physicians to apply best practices to avoid unnecessary utilization of services, such as hospital readmissions. View a question-and-answer document from the AMA about last week's meeting.

Operating plan for HIT provisions of stimulus law now available
The Office of the National Coordinator (ONC) for Health Information Technology has released its operating plan for the Health Information Technology for Economic and Clinical Health Act provisions of the economic stimulus law.

Senate Committee releases second health policy options paper
Max Baucus (D-Mont.), chairman of the US Senate Finance Committee, and Charles Grassley (R-Iowa), the committee's ranking Republican, released for comment the second (PDF) of three papers containing policy options for comprehensive health system reform. Titled "Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans," the paper describes four alternatives for establishing a public health insurance plan option. The paper also proposes reforms for the small-group market, the creation of a health insurance exchange and the establishment of a standard benefit package. The committee will release one more paper this week to address financing issues and plans to mark up comprehensive health system reform legislation in June.

Obama outlines main goals for reform, presses Congress to act President Obama continued his push for health system reform last week, meeting with the Democratic leadership of the House of Representatives to urge Congress to pass legislation by July 31. In his remarks, the president outlined his three main goals for reform, saying, "first, that the rising costs of health care have to be brought down; second, that Americans have to be able to choose their own doctor and their own health plan; and, third, all Americans have to have quality, affordable health care." He added, "We've got to get it done this year, both in the House and the Senate. We don't have any excuses."

House Blue Dog Coalition issues health reform principles
The House Blue Dog Coalition, a group of 51 fiscally conservative Democrats, released its principles for health system reform (PDF) last week. The principles include recommendations that are intended to control health care costs, increase health care quality and value, and improve access to coverage and care. They also state that reform must be bipartisan, preserve patients' choice of provider, and maintain competition in the marketplace.

Officials join HHS Office of Health Reform
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced several appointments to the new HHS Office of Health Reform. Along with the White House Office of Health Reform, this group will coordinate the Obama administration's efforts on this issue. Jeanne Lambrew, who served in the Clinton administration and most recently was a senior fellow at the Center for American Progress, will direct the HHS office. Mike Hash, formerly a senior official at the Centers for Medicare & Medicaid Services (CMS) and a staff member of the House Energy and Commerce Committee, will serve as a senior advisor. Meena Seshamani, MD, an otolaryngology resident at Johns Hopkins Hospital in Baltimore, joins the office as director of policy analysis. And Caya Lewis, formerly a staff member of the Senate Committee on Health, Education, Labor, and Pensions (HELP), will direct outreach and public health policy. Several other new HHS officials played key roles during Obama's election campaign, including Neera Tanden, Linda Douglass, Jennifer Cannistra, Karen Richardson and Michael Halle.

Medicare Trustees Report demonstrates urgent need for reform
This year's annual report by the Medicare Board of Trustees shows an increasingly bleak forecast for the Medicare Trust Funds. The program already faced an enormous gap between forecast revenues from Medicare payroll taxes and expected costs, but the economic crisis and high unemployment have exacerbated the problem. The trustees, who issued their report May 12, also continue to forecast steep cuts in Medicare physician payment rates due to the program's sustainable growth rate (SGR), starting with a 21.5 percent cut in 2010 and growing to a total of 38 percent by 2014. Mark McClellan, former CMS administrator, and Bill Thomas, former chair of the House Ways and Means Committee, commented on the report at an American Enterprise Institute forum, saying it shows the urgent need to reduce growth in health care costs, reform Medicare payment systems to promote efficiency and accountability, reform Medicare's financing and completely repeal the SGR formula.

Congress continues hearings on health system reform
The Senate Finance Committee held the third in a series of health care reform roundtable discussions on financing comprehensive health system reform, and discussion centered on scaling back or capping the employer tax exclusion for health care benefits offered to employees to help pay for health system reform legislation. Baucus, the committee's chairman, expressed his strong opposition to a complete repeal of the tax exclusion. However, he left on the table the idea of capping the amount of federal tax exclusion based on the size of the health benefits package or individual/family income levels.

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PPO Trade Group, AMA Partner On New Contracting Toolkit

To help physicians, preferred provider networks (PPNs) and payers develop a common understanding during contracting discussions, the American Association of Preferred Provider Organizations (AAPPO) and the American Medical Association (AMA) partnered to develop an educational guide, available May 19. The “Provider Contracting Toolkit” is designed to create a common ground for discussions between physicians, PPNs and payers by fostering a better understanding of contractual agreements and diminish the potential for problems or misunderstandings that arise after the contract is executed.

“With more than 69 percent of Americans enrolled in PPOs, our industry needs to do all we can to ensure that all parties understand the contracting process for preferred provider networks,” said Karen Greenrose, president and CEO of AAPPO. “AAPPO believes that continued collaboration with AMA will enhance communication among our members and providers.”

“No physician should sign a health plan agreement without a thorough understanding of the implications for their practice,” said AMA Board Member Cecil B. Wilson, MD “The new toolkit will help physicians get straight answers and useful information up front during the contract negotiation process, which can help establish a fairer and more balanced business relationship over the course of the contract.”

Physicians are often solicited to participate in PPNs, and clarity and transparency in the contract agreements are the foundation for a fair, long-term business relationship. Given the focus on provider contracting at the state legislative level, as well as the desire of both the PPNs and physicians to work together to ensure transparent and fair contracts, the new toolkit will serve as an educational resource so that both parties better understand the process.

The toolkit provides quick reference documents on several key issues that arise during the contracting process, including:

Responsibilities of PPNs/Payers

Physicians Contracting with PPNs

Assessing Network Value

Primary/Secondary Network Matrix

Understanding Silent PPOs

The toolkit is available in hard copy, or can be accessed online at AAPPO and AMA websites.

The toolkit is not intended to be a source of legal advice. An experienced counsel should be sought for assistance in negotiations. Additionally, some states have laws regulating PPNs. Contact the local state medical association for more information on the laws in a specific state.

About the American Association of Preferred Provider Organizations (AAPPO)

Founded in 1983, AAPPO is the leading national association of preferred provider organizations (PPOs). PPOs put control for medical decisions in the hands of the physician and patient, resulting in easy access to the right care, provided by the right doctor, at the right time. AAPPO creates a forum for discussion and dissemination of PPO best practices.

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WSUSOM Celebrates Newly Endowed Chairs

Wayne State University School of Medicine leaders and faculty members gathered recently to celebrate the establishment of two new endowed chairs in the Department of Obstetrics and Gynecology.

Hosted by Robert M. Mentzer Jr., dean of the School of Medicine and senior advisor to the president for Medical Affairs, the May 20 reception convened the family and colleagues of Robert J. Sokol, MD, and John M. Malone Jr., MD, to mark the establishment of the John M. Malone Jr., MD, Endowed Chair and Director of the C.S. Mott Center for Human Growth and Development, and the Robert J. Sokol, MD, Chair in Molecular Genetics and Gynecology.

“I'm proud to report that the department now has eight endowed chairs and joins pediatrics as one of the best-endowed departments in the school,” Dean Mentzer said. “This illustrates our commitment to women and children's health and how investing in these disciplines serves the world health community.

“The men we are honoring tonight, Drs. Malone and Sokol, represent the ideals of the department and the medical school. Dr. Malone, as I'm sure you all know, was much loved and was renowned for caring for patients, academic pursuits and teaching medical students. We honor his memory through an endowed chair in his name and uphold his commitment to improving women's health. Bob Sokol was dean of the medical school for nearly a decade and now successfully directs the Mott Center. Dr. Sokol has been pivotal in securing the Perinatology Research Branch and now Wayne State's portion of the National Children's Study. These initiatives provide substantial federal funding to the school and continue our involvement in the most important research in the county.”

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Wayne State Residents Make Impact At National Meeting

Neurology residents from the Wayne State University School of Medicine were hard at work in Seattle for the 2009 American Academy of Neurology’s annual meeting.

An outstanding effort was made this year in the number of posters and participation in the annual meeting. More than 12 posters were presented this year from residents and fellows alone, including some being selected for special poster presentation and integrated neuroscience courses.

Many members of the neurology staff, in addition to acting as mentors, led by example, also presenting posters, scientific sessions and integrated neuroscience courses.

The topics covered ranged from endovascular techniques such as stenting to the imaging techniques in Alzheimer's. Below are examples of the work displayed at the meeting:

Ambooj Tiwari, MD: "In-Stent Restenosis on Follow-Up Angiography among Patients Treated with Stenting in Acute Ischemic Stroke" and "Safety of Stent Supported Intracranial Revascularization in the Setting of Acute Ischemic Stroke."

Amit Kansara, MD: “Late Stent Thrombosis following Self-expanding Intracranial Stent Placement" and “Stenting in acute basilar artery occlusion beyond 8 hours of stroke onset."

Mahmoud Rayes, MD: "Peri-Procedural Complications During Endovascular Treatment Of Intracranial Aneurysms Managed By Interventional Neurologists" and “Safety Of Treatment Of More Multiple Aneurysms In The Same Session.”

Pratik Bhattacharya, MD: “Radiographic Characteristics and Their Effects on Outcomes of Spontaneous Intracerebral Hemorrhage,” “Effect of Comorbidities and Complications on Outcomes of Spontaneous Intracerebral Hemorrhage” and "Automated Data Mining: An Innovative and Efficient Web Based Approach to Maintain Resident Case Logs."

Temenuzhka G. Mihaylova, MD: “Cervical Anterior Horn Cell Loss from Subdural Hygroma – A Late Sequela of Spontaneous CSF Leak.”

Yvan Tran, MD: “Cranial Imaging in Prolonged Refractory Status Epilepticus.”

Antao Du, MD: “Susceptibility-Weighted Imaging in Mild Cognitive Impairment.”

Jai Perumal, MD: “Six Year Prospective Multi-Voxel Brain MRS Study of Two Cohorts in RRMS To Examine The Effect of Glatiramer Acetate on Neuronal/Axonal Metabolic Injury” and “Long-Term Safety And Efficacy of Intense Immunosuppression As First Line Therapy in Clinically Active Relapsing MS: A New Treatment Algorithm.”

The meeting provided a great arena for exploration and presentation of novel concepts, giving residents a chance to add their discoveries into the ever-expanding universe of scientific knowledge.

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Mentorship Leads To Egyptian Cancer Research Lab

A mentorship with a Wayne State University School of Medicine professor has led to the establishment of Egypt’s first lab devoted to research of inflammatory breast cancer, a disease that affects 1 percent to 5 percent of women in the United States, but makes up at least 15 percent of breast cancer cases in North Africa.

Bonnie Sloane, PhD, chairwoman of the Department of Pharmacology for the School of Medicine, recently flew to Egypt to attend the opening of the new lab, one result of her relationship with Mona Mostafa Mohamed, PhD. Dr. Mohamed is associate professor of the Physiology and Molecular Biology Department of Zoology at Cairo University. And now, because of Dr. Sloane’s assistance, she is director of the Cancer Biology Research Laboratory at her university.

Dr. Sloane met Dr. Mohamed when the Egyptian mother of two daughters applied for, and was accepted into, the Avon Foundation’s American Association for Cancer Research International Scholars-In-Training Program. The program, according to the foundation, “enhances the quality of cancer research internationally through competitive awards to junior faculty members who reside in and conduct breast cancer research in countries with limited opportunities for specialized training.” Avon Scholars receive a two-year placement at a university or organization in the United States. They are teamed with a prominent scientist – in this case Dr. Sloane – who serves as a mentor and provides research oversight. At the end of the fellowship, the scholars are supposed to return to their countries to continue their research and improve breast cancer care.

“It is a crucial part of the Avon program that the scholars return to their home country and bring their skills back with them to improve research there and better the lives of women there,” said Dr. Sloane, who also is a Distinguished Professor of the Karmanos Cancer Institute. “Some of them end up preferring to remain in the U.S., but right from the start Mona was adamant about returning to Egypt to establish her own lab.”

Dr. Mohamed arrived in the United States in 2005, and worked with Dr. Sloane in her lab, researching inflammatory breast cancer, an aggressive form of cancer that is prevalent in North Africa, including Egypt.

Dr. Mohamed returned to Egypt in April 2007 and began working to establish her own breast cancer research lab at Cairo University. With additional assistance from the Avon Foundation, she developed her lab – the first of its kind in Egypt -- and in February 2009 invited Dr. Sloane to attend its opening.

Dr. Sloane noted that at the university she was given the “red carpet treatment” quite literally, as a red carpet was indeed rolled out to greet her. She was given the honor of cutting the ribbon for the lab’s official opening at the university. The university presented her with three medals and plaques for her dedication to research and her assistance with establishing and equipping Dr. Mohamed’s lab.

Dr. Sloane and Dr. Mohamed were interviewed by Egypt television, which aired an extensive 30-minute program on the lab and inflammatory breast cancer right after the national evening news.

“We could not have created this lab without Dr. Sloane’s assistance. I deeply appreciate her help and everything I learned at Wayne State University,” Dr. Mohamed said. “This will allow us to continue working to find a cure for inflammatory breast cancer.”

The lab will now allow Dr. Mohamed to begin applying for grants of her own to fund her research.

While the two will continue research collaboration, the lab, Dr. Mohamed said, will allow her to collect and study breast cancer tissue from the primary population it affects most significantly. She noted that a cultural modesty prevents many Egyptian women from seeking medical aid for breast cancer in its early stages, a decision that often costs them their lives. However, she is working to break down those cultural barriers and educate women about breast cancer, self-examination and treatment. She has an ally in Mohamed El-Shinawi, MD., assistant professor of General Surgery at Ain Shams University in Cairo. Dr. El-Shinawi, she said, convinces women being treated for the cancer to donate tissue samples for study in the lab.

While this was Dr. Sloane’s first trip to Egypt, her collaboration with Dr. Mohamed assures it won’t be her last. But no matter how many times she visits, Dr. Sloane said, she will never get over the size of Cairo University, which has an enrollment of 260,000 students.

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