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November 9, 2009 |
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IN THIS ISSUE
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 |
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Click Here To Contact Us
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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 24th
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:
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