November 23, 2009

IN THIS ISSUE

Editor's Column: Bring Health Care Reform To Medicare
Jury Favors Physician In WCMSSM/ABOTA Mock Liability Trial
Senators Prepare For Upcoming Health Reform Battles
Republican Reform Proposal Spurs Lively Discussion
GOP Strikes Back On Senate Health Vote
House Repeals SGR, Reform To Follow?
2009 Children's Holiday Party Contributors
Classifieds

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Editor's Column: Bring Health Care Reform To Medicare

By JOSEPH WEISS, MD
Between Nov. 15 and Dec. 31, seniors must renew their Medicare plans. In Michigan this means choosing from some 40 plans and 85 combinations of plan and drug benefits, the one plan or combination that suits the individual’s needs and finances for 2010.

Medicare represents choice taken to folly; a road with an infinite number of side avenues, all of which end in a circle of confusion. Seniors know they have Part A already paid for from past payroll taxes and Part B participation assured by premiums taken from their Social Security check. As an example of the arcane side of Medicare, seniors may or may not know that if they do not take Part D when they start Medicare, then the government will assess a 1 percent per month penalty if the senior signs up for a drug coverage program at a later date.

Newspaper articles, pamphlets, the federal government’s publication (Medicare and You) and numerous websites including Medicare.gov offer seniors advice through words, charts, and side bars. All advice ends with the warning that each of the hundreds of plans and combinations offered can change their terms and rearrange their drug formularies, both of drugs and tier grouping, at any time. Advisors are quick to point out that what benefits the policies provide today may have little to do with what the senior can expect or receive if illness strikes tomorrow.

Advisors then admonish the senior to make decisions in the best interest of their health. Such counsel ignores the senior’s world of unknown illnesses, accidents, cancers or medically induced morbidity to come.

Choosing a Medicare plan today is little better than putting your monthly premium on the roulette number that matches your favorite color. Too many dollars seniors spend on health are lost as each plan takes a large cut to pay its CEO, office staff, information technology specialists and the cost of software, hardware and maintenance these specialists command.

Medicare works. With good reason seniors fight any attempt that in their eyes would take away any benefit that Medicare now gives. However, obtaining a Medicare policy suited to the individual need presents as an unnecessarily difficult undertaking and the money spent on administration that should go to benefits not business, remains an excessive medical loss.  

As much as we need reform in health care for the nation’s children and working adults so we need an equal degree of reform in Medicare. A change in physician payment policy should be the beginning not the end.

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Jury Favors Physician In WCMSSM/ABOTA Mock Liability Trial

By PAUL NATINSKY
A very realistic-appearing mock medical malpractice trial that was two years in the making taught a number of valuable and interesting lessons.

The “trial” was a cooperative effort between WCMSSM and the Michigan Chapter of the American Board of Trial Advocates (ABOTA). It took place in a beautiful simulated courtroom on the Wayne State University Law School campus and featured a real judge, real lawyers, doctors and a jury composed of former actual jurors selected by a jury consultant. Only the plaintiff was an actor, albeit one who appeared authentic.

The proceedings took place in course of one eight-hour day, condensed from what would have been a week or more in an actual trial. But all of the key ingredients were there: opening and closing arguments, the plaintiff and defendant and attendant experts for both sides, actual jury deliberation.

While the breaks and panel discussions between phases were friendly and collegial, the exchanges during the trial were intense and contentious.

The issue at hand was whether a change in drug treatment for a heart surgery patient was negligent and caused his subsequent stroke. The facts were pilfered from an actual case with names changed and some facts rearranged or omitted to make the case one that could go either way.

The facts of the case were complex and the timing of the stroke ominous; coming three days after the drug regimen was changed. The patient was a man in his 50s who was diabetic, overweight and a smoker. He had suffered a heart attack seven years prior to the stroke and had been placed on an anticoagulant to prevent clots in the months after the heart attack. Immediately prior to the stroke the patient had required a colonoscopy and had been taken off of the blood thinner to avoid bleeding complications. He then visited the cardiologist, who ended up as the defendant in the lawsuit, and was placed on what the cardiologist considered a more appropriate stroke prevention regimen of aspirin and a prescription drug.

The plaintiff’s attorneys attempted to establish that the stroke was of a type that could have been prevented by continuing the drug regimen that was put in place after the heart attack and that the cardiologist failed to perform adequate testing and evaluation to justify a change in drugs.

The defense argued that the physician followed standard treatment guidelines for cardiology and that the patient was non-compliant and continued to engage in behaviors that increased the likelihood of a stroke—smoking and gaining more than 50 pounds.

While the examinations and cross examinations of witnesses revealed what a hostile and manipulative process a trial can be, the most interesting part of the day was watching the jury deliberate on closed-circuit television. The jury segment showed just what a dice roll trials can become.

In the end, the jury found the physician not negligent by a vote of 7-1. However, during the deliberation process, the count was closer to even. Notable were the number of lay scientific theories expounded. While the defense did a thorough job of establishing that the initial drug regimen was not indicated for the patient, several jurors could not get past the fact that the stroke occurred so soon after the switch. Several also got hung up on the fact that the cardiologist did not order a wide battery of tests, despite very clear and plausible explanations of why they were not necessary under the circumstances.

Perhaps the most priceless comment during the deliberations (and I am just barely paraphrasing here) was from a juror who said we do all kinds of things to our bodies over the course of our lives and that’s why we have drugs to fix all of that later.

The saving grace for the defendant likely was the judge’s instructions to the jury and jurors clear understanding of the message. They were told that the first question they had to answer was whether the physician acted negligently, in a fashion that was outside of what could be expected of an average cardiologist confronted with the same case. Seven out of eight came around to the conclusion that the physician acted appropriately, despite the outcome. The one holdout, the jury foreman, was stuck on the issue of who continued to prescribe the initial drug for seven years after the heart attack. The juror was convinced it was the cardiologist, although the physician said he had not and the plaintiff’s attorneys did not submit proof that this was the case other than their plaintiff’s testimony that is was so.

While a number of physicians attended the event, the room was filled mostly with attorneys. Both sides likely learned from the event, but it would seem physicians could benefit more from experience as they have little or no exposure to such experiences during their education.

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Senators Prepare For Upcoming Reform Battles

The Wall Street Journal reports that, in a party-line vote Saturday night, "Democratic leaders finally moved their sweeping health bill to the Senate floor, where wheeling and dealing over major unresolved and divisive issues likely will shape the legislation before its next big test." Some centrists are busy saying they won't support a bill with a government-run public option in it. They are also divided over abortion. And, "Another growing concern even as the bill progresses is the political heat on Democrats over expanded government spending amid rising unemployment and deficit concerns."  The vote paves the way for three weeks of debate "and perhaps more in January, a struggle that is sure to color the 2010 fight for control of Congress" (Hitt and Adamy, 11/23).

McClatchy Newspapers: "They all voted yes Saturday, saying they were motivated by a desire to let debate proceed, but many Democrats still had qualms." Major flashpoints in the bill also include budget deficits and affordability. "Despite all these controversies, Democratic leaders said that near-universal coverage legislation, a goal of party leaders since the 1940s, has now proceeded further than ever before" (Lightman, 11/22).

And now, Senate Majority Leader Harry Reid is faced with the task of getting the Democrats to stick together as the bill undergoes  changes before a final vote, Roll Call reports. "Reid added that he is mindful that not all Democrats agree on the underlying substance of the bill, including over whether it should include a public insurance option to compete with private insurers. 'We've got some things to work out, but we’re going to get a bill,' he said." Reid said moderate Sen. Mary Landrieu, D-La., plans to work with "Sens. Charles Schumer (D-N.Y.) and Tom Carper (D-Del.) on a 'public option that's acceptable to all Democrats'" (Pierce, 11/23).

The Christian Science Monitor: "In discussions with Senator Reid, Senator Landrieu won more than $100 million to help her state, still reeling from hurricane Katrina, to help pay for healthcare for the poor. Yet her support remained tepid. … To rally all 60 members of the Democratic caucus for the first key procedural vote on this legislation Saturday was an epic challenge for Reid, who faces his own tough reelection race next year" (Russell Chaddock, 11/22).

The Associated Press reports that Schumer said Monday morning that Democrats are ready to move with or without Republicans to advance their health bill. "'We prefer to go at it with Republicans if we can reach compromises in some areas,' said (Schumer) 'But we're not going to not pass a bill.' Schumer dueled with Republican Sen. Kay Bailey Hutchison on a network morning news show  ... (she) argued that "you're going to put taxes and mandates on business" that would be a drag on an economy still struggling to recover from recession" (Alonso-Zaldivar, 11/23).

The Los Angeles Times: "With the Senate's 60-39 vote to proceed to debate, after Thanksgiving, on a healthcare bill that the president is seeking by year's end, the debate of the 2010 midterm elections has been joined." Democrats, who control Congress and the White House, "will present the congressional elections as a question of fulfilling an agenda of progress and change and keeping 'the party of no,' ... in check. Republicans will frame the midterms as a chance to reclaim at least part of Congress from a party trying to take over not just healthcare and imposing big government, big spending and taxation on every aspect of life" (Silva, 11/22).

Finally, Politico reports on the filibuster and the Senate health bill. "Filibusters are far more common than most realize … (b)ut instead of the spectacular verbal endurance tests … senators now use 'silent filibusters,' in which the opposition announces its intent to filibuster a bill, thereby forcing the party in power to assemble a 60-40 supermajority in order to move forward — even if no one is actually standing up on the floor to stop them." Politico included a photo from the classic film "Mr. Smith Goes To Washington" (Coller, 11/23).

Kaiser Health News tracked weekend developments and provides news summaries of the important events, including Saturday's Senate vote and comments made during the Sunday morning news programs.

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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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Republican Reform Proposal Spurs Lively Discussion

By PAUL NATINSKY
As the main health care reform bill heads for climactic debate in the Senate this week, alternative ideas about reform slowly simmer on congressional back burners. One of those belongs to Oklahoma Sen. Tom Coburn (R). His surrogate, Jim Rowsey, MD, provided details to an intimate forum of physicians and guests at the WCMSSM General Membership Meeting Nov. 18.

Dr. Rowsey, an esteemed ophthalmologist, medical educator and administrator, described Coburn’s proposal, S. 1099, as a wide-ranging solution to many of the nation’s health care challenges that would cost less than both the current health care system and the proposal currently under consideration by the Senate.

“You’ve had nothing but a Democratic view (of health care reform),” said Dr. Rowsey. “This is a Republican view of health care reform.”

The plan is predicated on health care savings accounts and tax credits and subsidies. The limits on health savings accounts would be set at $3,000 per month for individuals and $5,950 per month for families, along with an advanceable tax credit of between about $2,200 and $5,700 per year. Subsidies ranging from $2,000 to $5,000 are provided to low-income individuals and families up to 200 percent of the poverty level.

The plan also uncouples health insurance from employers, eliminating the income tax exclusion employers receive for providing health insurance (they can still deduct, as a business expense, money contributed to employee health care). But patients are clearly put in the driver’s seat in this plan. They can choose from a wide open market, or insurance exchange, in which states set up a marketplace for competing plans not subject to mandates. Curiously, the bill requires that no plan offer less than what is offered members of Congress, but Dr. Rowsey said this provision would likely be removed from the bill by other senators if deliberations proceeded. The provisions, taken together, allow individuals to pay for needed care out of the savings account and buy catastrophic coverage for major illnesses or buy premiums for the first-dollar plan of their choosing. Either way, the tax-free dollars and employer exclusion make health care dollars portable.

The bill covers controversial Medicare Advantage plans, which some have criticized for being heavy in administrative costs, by establishing competitive bidding among plans.

Also in the Medicare arena is a provision to establish Accountable Care Organization pilots in which groups of physicians would receive monetary rewards for providing efficient care.

Liability reform is included in the form of “health courts” established from enhanced Medicaid payments that would feature specialist panels of judges to determine fault in medical liability cases.

For a detailed description of the bill’s provisions, CLICK HERE.

The presentation received a mixed reaction, with criticism centered on the difficulty of getting the poor enrolled and active in a somewhat sophisticated health care program. Dr. Rowsey said outreach programs providing education and transportation could be amended into to bill, but he acknowledged the bill does not account for the cost of such services.

Others concerns were raised with regard insurance companies and the likelihood of them offering adequate coverage in plans that contain no mandates.

Dr. Rowsey said he feels as though he has been “tarred and feathered” when he presents the bill in the Northeast and is applauded in the Southwest. In the Midwest, he said it’s about 50/50.

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GOP Strikes Back On Senate Health Vote

GOP Strikes Back On Senate Health Vote

Republican senators turned out to criticize the Democratic health overhaul on Sunday talk shows, saying it is "something Bernie Madoff would really envy," would expand a "medical ghetto," and may "collapse of its own weight," The Hill reports. Supporting the bill, which cleared an initial Senate vote to bring the legislation to the floor Saturday night, is tantamount to ignoring "the wishes of the American people," the Senate Minority Leader Mitch McConnell, R-Ky., said Sunday (Johnson, 11/22).

Saturday's vote, according to TIME magazine, "gave a clear picture of the Republican messaging strategy as the legislation moves forward into what promises to be weeks of tendentious debate after the Thanksgiving recess. The minority intends to launch a series of surgical strikes on key parts of the bill, and to raise questions about whether it all adds up to what the Democrats are claiming" (Tumulty, 11/23).

Republicans are anticipating the 2010 elections, The Wall Street Journal reports. Though "ensuring that Democrats bear full responsibility for [the health care] legislation the GOP sees as increasingly unpopular with Americans" will be a top priority, Republicans are also expected to challenge them for taking their focus off unemployment issues and the economy (Hitt, 11/23).

Meanwhile, "Anxious that Saturday's party-line Senate vote to open debate on a health care overhaul gives them little maneuvering room, Obama administration officials and their Congressional allies are stepping up overtures to select Senate Republicans in hopes of winning their ultimate support," The New York Times reports. Sens. Susan Collins and Olympia Snowe, both Maine Republicans, have been encouraged to "bring forward their ideas and concerns" by Majority Leader Harry Reid, D-Nev. Collins received a visit from former senator, and now Interior Secretary, Ken Salazar as well (Hulse, 11/22).

Not every prominent member of the Republican Party is altogether against a health care overhaul. The Milwaukee Journal Sentinel reports, Tommy Thompson, a former Wisconsin governor and Bush health secretary, has been pushing the message "that the health care system needs a major overhaul, that 80% of what's in the current health care proposals is stuff everyone can agree on and that the country needs to pay more attention to wellness, disease prevention and chronic illness" (Marrero, 11/22).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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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House Repeals SGR, Reform To Follow?

Statement attributable to:

J. James Rohack, MD

President, American Medical Association

“The US House of Representatives passed legislation (last week) that permanently repeals the broken Medicare physician payment formula that hurts access to care for seniors, baby boomers and military families. This vote is an important step toward ensuring a more stable and secure Medicare system for the patients it serves. The American Medical Association thanks the members of Congress who put patients above politics and voted yes on HR 3961, the “Medicare Physician Payment Reform Act of 2009.”  

“Support of the bill by AMA, AARP and the Military Officers Association of America helped drive home the real-life impact cuts would have on access to care for seniors, baby boomers and military families. Without action by both houses of Congress, Medicare will cut payments to physicians by 21 percent in 2010, with more in years to come. Today’s House vote is the first step toward preventing this cut and eliminating the formula that creates a roller coaster of uncertainty for seniors and the physicians who care for them.  Promises have been made to seniors and military families – and the House recognizes that those promises must be kept.

“Seniors who rely on Medicare now and the baby boomers who reach age 65 in less than two years expect access to care and choice of physician. The House recognizes that the best way to achieve access and choice for patients is to repeal the broken physician payment formula. The House also acted on behalf of military families whose health care is at risk, as TRICARE ties its payment rates to Medicare.

“The AMA urges the Senate to act quickly before the cut begins on January 1. Fixing the Medicare physician payment formula once and for all is an essential element of comprehensive health reform. Congress needs to fulfill its current commitments as it considers expanding its obligations. Physicians must be assured of stable payments so they can continue to care for seniors, baby boomers and military families.”

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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

Clarence H. Schultz, MD

Dr. Stephen Lemos

Robert G. Borchak, MD

Dr. & Mrs. William J. Cosgrove, Jr.

Dr. and Mrs. Mark A. Kelley

Steven A. & Deborah L. Portney

Hassan Amirikia, MD

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

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

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

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

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Classifieds

Psychiatrist

St. Clair County Community Mental Health Authority (www.scccmh.org) is seeking to fill the position of FT/PT Psychiatrist.  Applicants should be a Board Certified/Board Eligible child and/or adult Psychiatrist.  Position may be full or part-time (negotiable with the successful applicant) and will provide psychiatric assessments and medication management as part of a multidisciplinary team.  St. Clair County Community Mental Health Authority provides outpatient treatment primarily through their directly staffed clinics.  Services include medication management, outpatient therapy, skill building, case-management and residential treatment, as well as coordination of treatment with psychiatric hospitals and primary care providers, when clinically necessary.     

St. Clair County Community Mental Health Authority offers an excellent benefit package that includes health insurance, generous paid leave, retirement, professional liability insurance.  Salary and hours are negotiable. 

St. Clair County Community Mental Health Authority administrative offices are located in Port Huron, Michigan, on the shoreline of Lake Huron and the St. Clair River   Southeast Michigan is a great location from which to enjoy historic towns, fine dining, beaches, fishing, golf, arts and much more.  Driving from this area to Detroit, Chicago or Toronto are easy, pleasant trips, with rail travel optional. 

Please send CV and letter of application to Human Resources, St. Clair County Community Mental Health Authority, 3111 Electric Avenue, Port Huron, MI  48060; phone 810-966-7899 or email pmclellan@scccmh.org or fax 810-966-3393.  Applicants with questions can contact Dr. John Baugh, Medical Director, at jbaugh@scccmh.org .  St. Clair County Community Mental Health Authority is an equal opportunity employer. 

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