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November 30,
2009
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IN
THIS ISSUE
Editor's Column:
Engaging The Public In Health Care Reform
Important Medicare Notice
Simulated Training For Ultrasound Procedures
Improves Safety
AARP, AMA Join To Debunk Medicare Myths
Will Congress Reduce Medicare Payments
21 Percent On January 1?
2009 Children's Holiday Party Contributors
Details Of The Policies Inside The
Senate's Health Overhaul Bill
Classifieds
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Editor's
Column: Engaging The Public In Health Care Reform
By
JOSEPH WEISS, MD
What is the most effective way to engage the public in health care
reform?
While it is inappropriate to use the time of a patient visit
to forward a personal point of view on reform, a physician
can leave political material in the office waiting room.
However, make certain that such material is objective,
with the issues framed in a manner to provide information
rather than an attack on either political party. The public
information put out by the AMA and the American College
of Physicians are examples that meet this criterion.
When addressing the public, a physician should avoid presenting
reform as a threat to a practitioner’s freedom and finances.
Instead, find grounds for a stand by society that is in
line with what medicine stands for.
Thus, in discussions with the public on the Michigan Legislature’s
proposed 3 percent tax on physicians income, for example,
physicians shouldn’t emphasize what they may have lost
in income. Rather, they should present the issue as one
in which providing health care is a responsibility for
the whole of society. Therefore, the state legislature
should levy an increase tax on everyone not just physicians.
(Editor’s note: this column was written before the resolution
of the tax issue. The example, however, is relevant as
a guide to an approach that applies to similar issues,
including the possible revisiting of the physician tax
in coming years.)
The reason to end the SGR ( Sustainable Growth Rate) is not
because the formula limits doctor’s income, but because
the SGR formula creates ongoing distortions in the manpower,
resources and technology the public needs to prevent sickness
and treat ill health.
We must be careful when we speak on costs of care, the need
for more physicians, the numbers of uninsured now and the
scale of coverage in proposed legislation. Remember Fox
News has its bias, figures from the Lewin Group are suspect
because it is a subsidiary of United Health Care. In general,
data from the New York Times and Wall Street Journal, (the
Journal’s editorial page excepted) are reliable. In Michigan,
beware of Mackinac Center for Public Policy reports as
that group is unabashedly conservative.
No matter what your opinion, counter foolishness. Don’t let
anyone get away with asserting that health reform will
support death decisions for older people or allow illegal
immigrants to obtain care ahead of people legitimately
on the rolls of Medicare and the country’s health insurers.
Our role in engaging the public in health reform is to forward
the cause of the medical community. We should undertake
that responsibility by presenting our case in a calm and
honest fashion, by avoiding hyperbole and cliché, and by
using our personal experience to illustrate the truth
of our position.
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Important
Medicare Notice
BCBSM
will conduct a Medicare recovery on Dec. 1 and 2, 2009.
Affected providers were notified on Nov. 2, 2009. For each
claim being recovered, BCBSM has confirmed primacy with
CMS's coordination of benefits contractor; however, we
understand that primacy determinations are not completely
static. Whether or not affected providers agree that CMS
is primary to BCBSM, it is imperative they bill claims
with dates of service prior to Oct. 1, 2008 to CMS by Dec.
31, 2009. Billing CMS will allow affected providers to
continue to work with CMS following the Dec. 31, 2009 timely
filing limit or to resubmit claims to BCBSM for special
consideration. Special consideration will only be provided
by BCBSM if CMS was billed by Dec. 31, 2009.
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Simulated
Training For Ultrasound Procedures Improves Safety
Using
mannequins to teach doctors-in-training how to do ultrasound-guided
procedures is an effective way to improve their skills
without compromising patient care and safety, according
to a new study from Henry Ford Hospital.
The
study shows that this simulation-based training course
can be a valuable tool to improve medical residents' knowledge,
dexterity and confidence for performing some of the more
common ultrasound-guided procedures, including breast biopsies,
liver biopsies, thyroid biopsies and the removal of fluid
in the body. Plus, a simulated model allows for standardization
of medical education.
"The
mannequins allow us to simulate actual ultrasound guided
procedures, which offers residents a unique training opportunity
prior to working on real patients," says study co-author
John W. Bonnett, M.D., a radiologist at Henry Ford Hospital. "Ultimately,
the residents in our study became more proficient and efficient
in performing these procedures."
Study
results were presented by co-author Mishal Mendirata Lala,
M.D., at the Radiological Society of North America Annual
Meeting, taking place Nov. 29 - Dec. 4 in Chicago.
For
the study, researchers enrolled 29 radiology residents
from all four levels of training. The residents were given
written, video, and live interactive training from staff
on the basics of ultrasound guided procedures.
Residents
had six months to practice these skills at the 12,000-square-foot
Center for Simulation, Education and Research at Henry
Ford Hospital, the largest surgery simulation center in
the Midwest. The facility houses two operating theatres,
six clinical rooms, a minimally invasive procedure lab
with more than 30 stations, and two classrooms. Fully-equipped,
reconfigurable rooms simulate surgery, labor and delivery,
intensive care, emergency and routine hospital scenarios.
As
part of the study, residents used phantom mannequins that
contained both hypo- and hyperechoic nodules to simulate
the ultrasound procedure. Written and practical examinations
were given before and after training to assess for changes
in competency and proficiency.
Study
results show a significant improvement between the residents'
pre- and post-test scores on both the written and practical
exams. After training, residents also demonstrated improved
dexterity in the technical aspects of ultrasound guided
procedures.
On
the survey questionnaire, residents said that the course
improved their knowledge level and technical ability for
ultrasound guided procedures. It also boosted their confidence
for performing biopsies.
In
all, the researchers say, this additional simulation training
translates to improved patient care and safety, as well
as patient satisfaction, decreased risk of complications,
decreased procedural time, and the ability to improvise
in difficult or unexpected situations.
As
a result of these study findings, Henry Ford Hospital has
expanded this course to include simulated training for
CT-guided interventional procedures.
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AARP,
AMA Join To Debunk Medicare Myths
As
health reform reaches a critical juncture in Congress,
AARP and AMA are joining forces to cut through the noise
and focus on the benefits of health reform for older Americans
who depend on Medicare and the physicians who care for
them. Nov. 23, AARP and AMA launched a national television
ad that separates fact from fiction and highlights how
health reform will improve Medicare by lowering prescription
drug costs and making certain that neither government nor
insurance bureaucrats come between Medicare patients and
their doctors when making important health decisions.
"We
know opponents of health care reform won't rest," said
AARP Executive Vice President Nancy LeaMond. "We'll
continue to fight for older Americans and to protect and
strengthen Medicare, not only for today, but for generations
to come."
"Together,
AMA and AARP are working to put the scare tactics to bed
once and for all and inform patients about the benefits
of health reform," said AMA President J. James Rohack,
M.D. "Preserving the patient-physician relationship,
improving the private insurance market so that coverage
can't be denied if you get sick or lose your job, and finally
fixing the Medicare physician payment formula that puts
seniors' access to care at risk are some of the key goals
we're working for this year."
As
debate continues in the halls of Congress and across America,
so do the myths and scare tactics designed to mislead seniors
about what health care reform will mean for their Medicare.
Special interests have pumped millions of dollars into
distorting reform proposals and confusing seniors.
"AARP
is fighting to protect and improve the sacred promise of
Medicare made to the millions of older Americans who depend
upon it," said AARP Executive Vice President Nancy
LeaMond. "Now, special interests are using myths and
misinformation to distort the truth and wrongly suggesting
that Medicare will be harmed. After a lifetime of hard
work, don't seniors deserve better?"
The
new TV ad features a physician and a "spin doctor" each
sharing their perspective on health reform, with the physician
correcting misinformation about health reform.
This
ad is just one part of a multi-faceted education campaign
AARP and AMA have undertaken and will continue as they
educate their members and others about the truth behind
health care reform. In 2009 alone, AARP has sponsored or
has been featured in 649 town hall meetings, tele-town
hall meetings, forums and roundtables, and has reached
over 50 million readers and viewers through its publications
and television, radio and print ads. AMA has reached millionsthrough
grassroots patient and physician outreach, news conferences,
satellite media tours, media appearances, social media,
direct mail, and TV, radio and print advertising.
View
the AMA/AARP ad.
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Will
Congress Reduce Medicare Payments 21 Percent on January
1?
(Editor’s
note: the following is an update from the AMA on the status
of this issue.)
Background
Under
current law, Medicare physician payments are scheduled
to be cut 21 percent, effective Jan. 1, 2010. House and
Senate leaders on both sides of the aisle have emphatically
said that action will be taken to avert the cut. President
Obama has taken several steps to assist efforts to prevent
future cuts and implement a more favorable Medicare physician
payment framework.
As
a result of AMA advocacy, the US House of Representatives
recently passed H.R. 3961 to permanently repeal the current
Medicare physician payment policy (so-called sustainable
growth rate or SGR) and establish a new framework that
eliminates all of the forecasted SGR cuts and corrects
serious deficiencies in the update formula. The health
system reform bill under consideration by the full Senate,
H.R. 3590, provides for a modest update of 0.5 percent
in 2010 but retains the flawed SGR formula and subjects
physicians to a 23 percent cut in 2011. It would also make
a permanent solution more expensive than it is today. The
AMA opposes temporary band-aids to the SGR problem that
grow the cost of permanent repeal and increase the size
of future cuts. In October, the Senate failed to approve
a cloture motion on S. 1776—a bill that would have repealed
the SGR and eliminated the deficit that accumulated as
a result of previous temporary fixes. The votes against
cloture were about deficits and offsetting the cost of
the policy change. Nonetheless, Senate action is still
required.
Near-term
prospects
The
AMA is continuing to press Congress to permanently repeal
the SGR. Congress separated the SGR from health reform
legislation to remain within the $900 billion spending
cap and deficit neutrality principles established by President
Obama. While SGR repeal is an essential element of health
reform, it is being pursued through separate legislative
vehicles for budgetary purposes.
There
are a number of other time-sensitive issues requiring congressional
action before the end of the year. These include appropriations
bills, a change in the estate tax and an extension of the
current federal debt limit. If Congress is unable to complete
action on pending legislation to repeal the SGR before
Dec. 31, the best course of action would be to pass legislation
for a very short-term extension of current payment levels
for a 30-day period to facilitate final action to enact
a permanent repeal of the SGR.
In
July, 2008 scheduled cuts were delayed for a couple of
weeks to allow Congress to pass legislation. However, there
are concerns about creating a large claims backlog as well
as cash flow problems for physician practices if Congress
delayed action beyond a two-week period.
The
AMA does not support any more one- or two-year band-aids
that temporarily kick the can and continue to grow the
problem. The time for repealing this flawed formula is
long overdue. Democrats and Republicans have repeatedly
said the SGR is bad policy. It's time for Congress to carry
out its promises.
In
recognition of the uncertainty of the Medicare physician
payment situation, the Centers for Medicare and Medicaid
Services has extended the time period for physicians to
change the status as participating or non-participating
physicians until Jan. 31, 2010. Visit the AMA Web site
for more information about Medicare participation options.
We
will keep you posted on action Congress takes over the
next few weeks to avert the 21 percent cut.
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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
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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Details
Of The Policies Inside The Senate's Health Overhaul
Bill
NOV
30, 2009
Hot-button
provisions in the Senate health Bill, such as the
public option, cost controls and subsidies to expand coverage
continue to get a lot of attention, while some interesting
details have gone with little notice.
Kaiser
Health News reports on some of these
bill provisions, including requirements for "reasonable" time
off at work for nursing mothers, $400 million
for sex education and "adult preparation" to
help teens transition to adulthood. It also would clamp
down on nonprofit Blue Cross Blue Shield plans that
behave like their for-profit cousins by revoking their
favorable tax status if their overhead tops 15 percent.
Medicare would boost payments for bone density scans
under the legislation, and would require some limits
on what uninsured people have to pay for emergency
room care (Carey, Galewitz, and McGinley, 11/30).
The
Hill reports on "seven key issues" that
warrant attention: "Senators will be asked to
cast their votes on numerous amendments as they begin
a debate to reshape the country's healthcare system.
Some amendments will be designed to improve the bill,
some to satisfy a special interest or pet peeve. Still
others will be presented as poison pill." The
Hill's list includes: the public option, abortion,
a tax on so-called "Cadillac" health plans,
prescription drugs, affordability, insurance exchanges
and Medicare cuts. "Because these cuts are essential
to financing the rest of the bill, however, they're
here to stay – though some could be scaled back. The
deep cuts to private Medicare Advantage plans, for
instance, could be mitigated to assuage senators from
states with large senior populations" (Young,
11/29).
The
New York Times reports that plastic surgeons,
and some of their patients, are outraged by a 5 percent
tax on cosmetic surgeries proposed in the legislation.
The tax would not apply to cosmetic surgeries that are
already tax deductible, including those to correct deformities.
Surgeons "say they are being singled out because
of an outdated perception that people who have cosmetic
procedures are well-to-do" (McKinley, 11/29).
Related
KHN story: Plastic
Surgeons Cry Foul Over 'Botax' In Senate Bill (Galewitz,
11/20)
One detail Democrats chose to leave out in order to keep the bill's
cost lower is Medicare funding for 15,000 additional graduate medical
residencies in primary care and general surgery, The
Wall Street Journal reports. That could complicate the
planned expansion of health coverage to 30 million more Americans,
given that in some places, doctors are already in high demand (Adamy,
11/27).
Big and small, the proposed reforms, such as one protecting people
from being denied coverage may take longer to take effect than
many expect, assuming the bill clears Congress, The
Washington Post reports. "The delay in implementing
some key reforms contrasts with the urgency of [President] Obama's
call for action. ... (who) said in July, 'We shouldn't have to wait
a long time to make sure that people don't lose their insurance because
of a preexisting condition.' Delaying relief until 2014 means that
Obama could face reelection -- and Congress be transformed by two
elections -- before voters begin feeling the legislation's full effect.
It would also reduce the cost of the bill during the 10-year budget
window measured by the Congressional Budget Office" (Hilzenrath,
11/30).
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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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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