E-DMN - November 30, 2009

November 30, 2009

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 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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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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