E-DMN - November 9, 2009

November 9, 2009

Editor's Column: 1776 All Over Again
Learning About Liability
NIH/WSU Study Could Reveal Preeclampsia Cases Earlier
Docs Face Deep Cuts In Medicare Ruling, Ask Congress For Help
Narrow House Vote Is Prologue To Senate Health Care Reform Battle
2009 Children's Holiday Party Contributors
St. John Hospital & Medical Center CME Seminar
Inspiris: Physician Opportunities

Click Here To Contact Us

Editor's Column: 1776 All Over Again

By JOSEPH WEISS, MD
Physicians owe Michigan Sen. Debbie Stabenow a hug. On Oct. 12 she introduced S.1776: The Medicare Physicians Fairness Act. All aspects of this bill ring true. The number 1776 recalls the beginning of a war against tyranny, S. 1776 represents the same campaign against economic oppression.

The bill is eight lines long. The first five lines wipe out the last six years of debt accumulated by the SGR ( Sustainable Growth rate) formula against physicians’ reimbursement. The last three lines eliminate the SGR formula for future determinations of physicians’ compensation. In total, the bill repeals the SGR formula.

Because S.1776 both overrides past legislation and has revenue implications, the bill requires a 60 vote majority passage on three distinct roll calls:

- a closure vote- to allow the bill to move forward expeditiously

- a vote to waive Budge Act requirements

- a vote on final passage

The bill is a test of the conservative attitude toward health care reform. S. 1776 is a half page long and readily understood, no one can complain about its length or complexity. The purpose of the bill is a principle both Democrats and Republicans have long agreed upon, namely that the SGR must end. There is little reason for opposition except to argue the repeal should also carry its replacement; critics may also fault the bill as a financial trick rather than a fiscal strategy for reform.

The bill illustrates the role of medical societies. Only persistent effort by the AMA brought this bill to the Senate floor, only follow up by state and specialty medical societies will ensure that the bill passes.

Michigan should be proud that one of its senators-Debbie Stabenow-took the action needed to bring the bill to life. Michigan physicians should also give credit to the Michigan State Medical Society for its ongoing relation with Sen. Stabenow that made her a logical and willing person to introduce this major reform legislation.

In politics, almost every seeming breakthrough follows from persistent effort combined with thoughtful planning. Physicians seeking change should not demand instant victories or believe that delay is the fault of our leaders and lobbyists. In health reform, success depends on our strength of purpose and our stamina to carry on.

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Learning About Liability

By PAUL NATINSKY
Medical students were treated to three veteran voices on medical liability Nov. 7 at the Margherio Auditorium in the new Mazurek medical education facility on the Wayne State University School of Medicine Campus.

Students found out that navigating the waters of medical liability is almost as difficult as winding your way from Scott Hall to the Mazurek on a Saturday morning, only maybe not as much fun.

Dan Michael, MD, PhD, led off and gave students a crash course on the basics of medical liability, including the duties of attorneys for both sides in the process, the difference between civil courts (where money is the issue) and criminal courts (where proceedings are about legal penalties), and economic damages versus non-economic damages—the former cover the costs of medical care, lost wages and other similar items, the latter compensation for pain and suffering.

Dr. Michael is a longtime stalwart in organized medicine who has served in numerous offices with both MSMS and WCMSSM.

The Wayne State University School of Medicine Co-Curricular Seminar was titled Malpractice Liability Challenges, and speakers enumerated scores of them. Dr. Michael focused his talk on the procedures and timelines involved in medical liability cases. In Michigan, cases begin with a “notice of intent” accompanied by an “affidavit of merit.” That means someone has decided to sue a physician and has found a physician of the same specialty as the defendant to assert that the standard of practice has been violated. For things to go any further, a patient’s attorney must prove a link between the violation of a standard of care and injury to the patient and that harm was caused to the patient as a result of the standard-of-care breach.

Dr. Michael was quick to point out that the odds are very much in favor of the physician in most cases. He said 60 percent of cases are withdrawn without any payment awarded to plaintiffs and 90 percent of cases that go to trial end up with a ruling of “no cause,” with no penalties to the physician.

He referred to medical liability trials as “the Big Dance,” and said, “I’ve been there twice. There was a finding of ‘no cause.’ I won. It was not a pleasant experience.

WCMSSM President-Elect Cheryl Gibson Fountain, MD, gave a sobering account of how the medical liability environment has changed the way her specialty—OB/GYN—is practiced.

Dr. Gibson Fountain practices at William Beaumont Hospital-Grosse Pointe and is on the Board of MSMS. She quoted extensively from a national survey of OB/GYNs, conducted between Jan. 1, 2006 and Dec. 31, 2008. Among the findings she reported:

63 percent of physicians made changes in their practice since 2006 because of the fear of a malpractice lawsuit.
60 percent made changes because of the lack of affordable medical liability insurance.
30 percent of OBs decreased the number of high-risk patients they saw.
14.7 percent are performing fewer surgeries.
90 percent had at least one med mal claim against them during their career.

Dr. Gibson said the most troubling statistic was the decrease in the number of high-risk patients seen by OB/GYNs. She said nurse midwives and nurse practitioners can handle most routine pregnancies, but it is the high-risk patients that require extensive physician involvement, and physicians’ training centers on that group. She also pointed out as disturbing that the average age at which a physician stops taking OB patients is 48 years, an age that used to be the prime age of practice.

All three of the day’s speakers pointed out that communication issues are the primary cause of medical liability lawsuits.

Plaintiffs’ attorney David Winter emphasized this point the strongest. “Every one (of my) cases is a failure to communicate,” he said. Winter, who is with the firm Sommers Schwartz and has been representing plaintiffs in medical liability cases for 31 years, handles three or four cases at a time, every one of them a catastrophic injury case. He said he settles 99 percent of his cases.

He urged physicians to be cautious and thorough in their dealings with patients, and to establish a relationship with them.

“We are in the service industry,” he said. “You serve your patient and I serve my client.”

He likened the care delivery process and liability lawsuits to a restaurant experience.

“I went to dinner with my wife and ordered a beer,” he said. The waiter brought the wrong beer, spilled wine on his wife and delivered a burger not cooked as ordered.

“I’ve never owned a restaurant or worked in one, but I didn’t need that expertise to know I got bad service.

“(In a medical liability case) If I can prove bad service, I don’t have to argue the medicine.”

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NIH/WSU Study Could Reveal Preeclampsia Cases Earlier

A new study conducted by the National Institutes of Health’s Perinatology Research Branch at the Wayne State University School of Medicine has taken a major leap toward determining the risk of a pregnant woman developing preeclampsia. The study’s findings will help clinicians around the world identify and monitor patients who are at risk for developing this life-threatening condition.

The study, published in the November issue of The Journal of Maternal-Fetal & Neonatal Medicine, set out to determine the diagnostic indications and predictive value of biomarkers measured in maternal blood in the first and second trimester of pregnancy. The goal was to determine whether the biomarkers could predict the subsequent development of preeclampsia. The findings of the study -- the largest of its kind ever undertaken -- will help clinicians assess the risk for preeclampsia, and monitor mothers and their unborn babies at risk for the silent killer.

Estimates indicate that preeclampsia is responsible for 76,000 maternal deaths and more than 500,000 infant deaths every year, according to the Preeclampsia Foundation. Preeclampsia occurs only during pregnancy and sometimes after delivery. It is characterized by high blood pressure and the presence of protein in maternal urine. Preeclampsia can affect the liver, kidney and brain. Sometimes mothers develop seizures (eclampsia) and suffer intracranial hemorrhage, the main cause of death in those who develop the disorder. Some women develop blindness.

“Our study found that maternal plasma concentrations of angiogenic and antiangiogenic factors, together with a combination of other demographic, biochemical and biophysical factors, are useful in assigning risk for the subsequent development of early-onset preeclampsia,” said Roberto Romero, MD, chief of the Perinatology Research Branch of NICHD, NIH, who is one of the world’s leading experts on this condition and in the study of complications of pregnancy.

“The establishment of an accurate means to assess the risk for preeclampsia would enable health care practitioners to identify women who require more intensive monitoring to safeguard both mother and baby from this devastating condition,” said Dr. Romero, a professor of Molecular Obstetrics and Genetics with the WSU Center for Molecular Medicine and Genetics. “This study is the first of its kind in which women were prospectively followed from the beginning of pregnancy to determine if simple blood measurements can predict early onset preeclampsia. The results are very encouraging and suggest that the biomarkers studied can be used to identify women at risk in the second trimester, many weeks before the clinical onset of the disease.”

The results of the study will encourage laboratories and clinicians to use biomarkers to track the health of pregnant women. Several companies are developing rapid methods to measure these biomarkers and make them available for clinical use in hospitals throughout the world.

Dr. Romero explained that these tests would allow health care practitioners to identify women at risk and to intensify monitoring. An important challenge still lies in finding methods to treat preeclampsia. He noted that defective angiogenesis may be observed in other complications of pregnancy such as premature labor, fetal death and intrauterine growth restriction. The markers are likely to identify not only patients with preeclampsia, but those at risk for other complications of pregnancy.

“This research breaks new ground and will lead to healthier outcomes for mothers and infants,” said Valerie Parisi, MD, MPH, MBA, interim dean of the School of Medicine. “This is a prime example of the bench-to-bedside research being conducted in the heart of Detroit.”

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Docs Face Deep Cuts In Medicare Ruling, Ask Congress For Help

Editor’s Note: The following is from J. James Rohack, MD, President, American Medical Association

“Medicare’s final 2010 payment rule confirms that in 60 days physicians face steep cuts of 21.2 percent – the largest payment cut since Congress adopted the fatally flawed Medicare physician payment formula. Access to care and choice of physician for seniors, baby boomers and military families is at serious risk – and Congress must fix the payment formula once and for all this year.

“Permanent repeal of the payment formula is an essential element of comprehensive reform to improve the health system for patients and physicians. Security and stability for America’s seniors will not be achieved without a permanent solution to the broken Medicare physician payment formula. The House of Representatives will soon vote on legislation (HR 3961) to permanently repeal the current Medicare physician payment formula, and Congress must fulfill their existing obligation to America’s seniors as they work to create new commitments to the American people through health reform.

“Short-term fixes have grown the problem. In four years the cost of a permanent solution ballooned from $49 billion to more than $200 billion and cuts increased from under five percent to a whopping 21.2 percent.

“The Medicare rule formalizes the removal of physician-administered drugs from the physician payment formula. This is a long overdue step on the road to permanent reform as it significantly lowers the cost of fixing the formula once and for all. AMA called for this action, and thanks the Obama administration for its recognition that physician-administered drugs do not belong in the payment formula.

“To help Medicare update its data on the cost of providing 21st century medical care, the AMA and 72 other medical professional organizations conducted a statistically valid, collaborative and transparent survey on practice expenses. The Physician Practice Information (PPI) Survey data meets all the criteria that CMS established to replace the existing data. These criteria include confidentiality, approved survey instrument and protocols, experienced survey contractor, randomly selected sample, representative responses, and level of precision. This group effort was spearheaded by AMA at the request of national medical specialty societies and Medicare, and it is the first time in nearly a decade that this information has been updated for all medical specialties. All specialty medical societies had the opportunity to assist in the survey development process. The input from this survey helped Medicare determine payment rates for all medical specialties, which are published in this rule.”

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Narrow House Vote Is Prologue To Senate Health Reform Battle

Nov 09, 2009

The 220-215 pencil-thin margin of victory for the House Democrats' health reform bill foreshadows a potentially tougher fight in the Senate, The Wall Street Journal reports. "Senate Democrats are struggling to agree on how to pay for the overhaul and whether to create a new public insurance plan to compete with private insurers, as the House did. Friction over how the bill treats abortion, which almost derailed the House vote, is likely to divide the Senate too." Sen. Charles Schumer, D-N.Y., said it is "almost always easier to pass a bill in the House than in the Senate" (Adamy and Bendavid, 11/9).

Kaiser Health News: "Despite months of debate, disputes remain between liberal and moderate Democrats and between the House and the Senate on a raft of core issues. They include how much to spend on an overhaul; how to pay for it; how to deal with a government-run insurance option, and the scope of coverage and subsidies for the uninsured." One thing is clear, KHN reports, the bill passed in the House is "almost certainly the high-water mark of liberal aspirations. On most issues, Democrats will likely have to tack to the right to win the support of Senate moderates" (Pianin and Carey, 11/9).

Politico: "Even before Saturday's House vote, senators had begun to question why Reid suddenly shifted course two weeks ago and threw his weight behind a public option plan, laying bare the deep divisions in his caucus between liberals and moderates." Those divisions are stalling Reid's timeline, possibly delaying debate until after Thanksgiving; Reid has implied that the Senate may not pass a bill until next year (Brown and Raju, 11/8).

Reuters: In the Senate, "Democrats have no margin for error -- they control exactly 60 seats in the 100-member Senate" the number needed to pass legislation, because less than that can lead to a filibuster by opponents. "Some moderate Democrats have rebelled at Reid's plan to include a new government-run insurance program, known as the 'public option,' in the bill" (Whitesides, 11/9).

Associated Press: "A government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate. They're locked in a battle with liberals, with the fate of President Barack Obama's signature issue at stake" (Alonso-Zaldivar, 11/9).

Roll Call: On one hand, llinois Sen. Roland "Burris is hardly the lone Senate Democrat who supports a public insurance option, but unlike other backers, … [he] has made headlines recently for what appears to be an uncompromising stance on the bill: He will oppose it — and may even support a filibuster — if the measure does not include a robust public option (Pierce, 11/9).

Boston Globe: On the other, Sen. Joe Lieberman, I-Conn., has vowed "to support a Republican filibuster of health care legislation if it contains a public health insurance option" (Issenberg, 9/11).

This information was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

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2009 Children's Holiday Party Contributors

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children. This year’s event is Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

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St. John Hospital & Medical Center CME Seminar

Arrhythmia-Electrophysiology Update
Wednesday, December 2, 2009
11:30 a.m. – 6 p.m.
Grosse Pointe Farms
Call (313) 343-3877
Click Here For More Information

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Inspiris: Physician Opportunities

INSPIRIS, a unique care and care management company focused on improving thehealth care and the quality of life for the medically complex, chronically ill, frail and elderly patient is looking for physicians in:

Detroit, Grand Rapids and Lansing, MI
CLICK HERE FOR MORE INFORMATION

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