E-DMN - September 14, 2009

September 14, 2009

Mayo Clinic Weighs In On Health Care Reform
In My Opinion: Thank You Mayo Clinic
Open Letter To The President
AMA Reaction To President Obama's Speech
Capitol Check-Up
Henry Ford Pathologist Elected To State Post
Oakwood To Work On Initiative For Non-English Speaking Patients
Crain's Health Care Leadership Summit

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Mayo Clinic Weighs In On Health Care Reform

By PAUL NATINSKY
The Mayo Clinic, heralded by many to be a potential model for a rebuilt health care system, recently published policy recommendations emphasizing a retooled Medicare payment scheme based on bundled charges for services and a “value index” intended to marry outcomes to costs. The Mayo suggestions also include an “insurance for all” provision that would require all Americans to buy health insurance, institute sliding premium scales to help the poor buy insurance, prohibit insurers from denying coverage based on a patient’s preexisting condition and define a minimum health benefit package.

Details of the plan can be viewed by visiting:

http://www.mayoclinic.org
/healthpolicycenter/recommendations.html

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In My Opinion: Thank You Mayo Clinic

By ALLAN DOBZYNIAK, MD
Physicians should thank the Mayo Clinic for the excellent analysis and reform suggestions for US health care. The initial and obvious conclusion is that a transformation of US health care founded on principles of value by creating methodologies for improved quality, patient safety, reimbursement, patient satisfaction, optimal care delivery strategies and ultimately appropriate cost is more than a two-week, two-month or even six-month challenge. Establishing a foundation for evolutionary, incremental reform is a more rational legislative goal than radical change with its unknown and potentially harmful consequences. Their firm stand against a government option and the needed changes in Medicare together with the marketplace revision in behavior resulting from the ability of all Americans to purchase health care insurance coverage from a menu of options is laudable and oriented toward traditional American values.

If any of the following comments are viewed as negative critique of this generally superlative analysis; that is not the intent. Mayo Clinic is an integrated delivery system and thus some bias reflective of this model would be anticipated. Additional perspectives should simply be viewed as more fully enumerating the complexity of issues encompassed in the US health care system.

Major stakeholders are defined as doctors/hospitals, patients, payers and the government. This excludes many other entities that influence and are influenced by the health care system. It must not be forgotten that the health care industry is a significant contributor to the US economy, deserves its rightful position and should not be sacrificed. Arbitrary dismantling of the best parts of health care would be tragic. For reform to be optimal other stakeholders such as chiropractic, alternative medicine, medical engineering and device makers, the pharmaceutical industry, service unions, medical suppliers, even the educational system and probably others should be included. If best practice is the clinical destination, linking this to the term lower-cost is probably incorrect and to the term reasonable cost is vague. Best practice will however delineate appropriate cost.

The winds of politics are not consistent. Ideologies change. Some stability in the process of health care reform unfortunately must supersede politics. Reform that includes every present and future US citizen and is founded in clinical and cost optimization should not be political. Left, right, Democrat, Republican are not relevant to reform. Irreconcilable political debate is a sure sign of incorrect strategies and misguided goals. Focusing on reimbursement schemes to change provider behavior is limited regarding outcome if the behavior of patients, politicians and lawyers are not similarly modified. Organized entrepreneurial activities by providers should actually be encouraged as long as they are based on value principles. These provider companies should be allowed to collectively negotiate in a competitive market place.

That performance policies must be risk adjusted cannot be overemphasized. Consider outcome measures such as hospital admissions, emergency room utilization, readmission rates, mortality rates, and patient satisfaction at an inner city hospital versus one located in affluent suburb. Risk adjusting based on the social milieu and regional differences is a still considerable challenge. Also, without valid risk adjusting methodologies, avoidance of high risk patients with predictably poorer outcomes is likely to occur.

Bundled payments for organized delivery systems is a more easily incorporated strategy for an integrated delivery system such as the Mayo Clinic. Virtual integration with private physicians and independent hospitals is a greater challenge. The traditional models of hospital management and community care would need revision. Efficient, value based clinical care delivery would necessitate increased levels of collaboration and accountability between hospital management and medical leadership. A reinvented organized medical staff that is competent and empowered should function in parallel with and be supported by hospital management. Traditional debates over elected versus appointed leadership, independence, business versus clinical care and who is in the power position would by necessity be replaced by goals, performance, outcomes and accountability.

Keeping the reform apolitical is a major challenge. Thus the operational framework should be quasi-independent sort of like the Federal Reserve. Members of this commission could be selected from a pool of applicants suggested by major stakeholders with staggered tenure. This would be one of the most difficult tasks both in terms of definition and population, but necessary.

Summary

The legislation must be targeted to the creation of clinical value, not to control or power. Political ideology should be marginalized. Reform should be market based with costs appropriate to optimal care. There should be avoidance of rationing. Individual health care decisions should rely on personal decision making. The abuse of medical liability as a growth industry for tort lawyers should demand concomitant and equal scrutiny.

The two treatises on reforming health care, “A Foundation for Health Care Reform Legislation” and “A Perspective on Health Reform Issues From Mayo Clinic” should be read by all physicians to provide a valuable perspective to our profession.

Thank You Mayo Clinic.

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Open Letter To The President

Editor’s Note: The following is a letter to President Barack Obama and members of Congress penned by AMA President Dr. James Rohack Sept. 8, 2009.

As our nation’s elected leaders, you have an historic opportunity to improve the health and well-being of the American public. On behalf of America’s physicians and their patients, we strongly urge you to reach agreement this year on health system reforms that include the following seven critical elements:

• Provide health insurance coverage for all Americans

• Enact insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions

• Assure that health care decisions are made by patients and their physicians, not by insurance companies or government officials

• Provide investments and incentives for quality improvement, prevention and wellness initiatives

• Repeal the Medicare physician payment formula that will trigger steep cuts and threaten seniors’ access to care

• Implement medical liability reforms to reduce the cost of defensive medicine

• Streamline and standardize insurance claims processing requirements to eliminate unnecessary costs and administrative burdens

The challenges in our health care system are many and complex. Enactment of the above policies will create the foundation for a stronger, better performing health care system, improve access to affordable, high-quality care and reduce unnecessary costs. Further, those who are currently insured, including Medicare patients, and those who are uninsured will all benefit from greater security and stability.

The American Medical Association and our individual members are working hard to improve health care delivery and quality through a broad range of initiatives to promote best practices and reduce unnecessary costs.

We reaffirm our commitment to work with each of you to adopt and implement health system reforms that will benefit all Americans.

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AMA Reaction To President Obama's Speech

Editor’s Note: The following is reaction from AMA President James Rohack, MD, to President Obama’s speech on health care reform last week.

“It is clear that the status quo is unacceptable. The AMA will continue to work for reform that makes the system work better for patients and physicians. We must seize this opportunity this year to achieve meaningful health reform for America’s patients and physicians.

“The President outlined three essential goals that are vital to reform efforts in this country, including: ensuring the current system remains secure and stable for those who already have insurance coverage and are happy with it; making insurance coverage affordable and accessible to those who need it; and reducing unnecessary costs and waste in the current system.

“The AMA believes these core goals are ones that the majority of the American people can and do support, and we urge Congress to find common ground in achieving them.

“President Obama recognized what physicians have long known – that medical liability reform is needed to bring down the cost of health care, and he is directing the Department of Health and Human Services to take action now. Recognizing the critical need for medical liability reform is an important step toward reducing unnecessary costs. Everyday physicians across the country are forced to consider the broken medical liability system when making decisions, resulting in defensive medicine that adds to unnecessary health costs. We cannot ignore this problem if health-system reform is going to address the growing cost of care.

“Just yesterday, the AMA sent a letter to President Obama and Congress urging them to reach agreement on health reform that includes seven critical elements. Health coverage for all Americans, insurance market reforms that expand choice and eliminate denials for pre-existing conditions, assurance that medical decisions will remain between the patient and physician, medical liability reforms to reduce the cost of defensive medicine, and repeal of the broken Medicare physicians payment formula that threatens seniors’ access to care are among them.

“We have a historic opportunity to implement needed reforms to address shortcomings in the current system, while keeping in tact all that is working well. We will stay constructively engaged in the legislative process to ensure the final bill improves the health system for patients and the dedicated physicians who care for them.”

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Capitol Check-Up

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Henry Ford Pathologist Elected To State Post

Richard J. Zarbo, MD, DMD, senior vice president for Pathology and Laboratory Medicine at Henry Ford Health System, was voted President-elect of the Michigan Society of Pathologists.

Dr. Zarbo also is chair of the Department of Pathology at Henry Ford Hospital.

The purpose of the Society, headquartered in Northville, is to empower Michigan pathologists through advocacy, education, research and excellence in the practice of pathology and laboratory medicine.

A prolific author, Dr. Zarbo has written more than 200 scientific publications in the fields of surgical pathology and quality assurance. He serves on the editorial review boards of Modern Pathology, the American Journal of Clinical Pathology, the American Journal of Surgical Pathology, Applied Immunohistochemistry and the International Journal of Surgical Pathology.

He received his medical degree from the University of Connecticut School of Medicine and his doctor of dental medicine (DMD) degree from the University of Connecticut School of Dental Medicine. Dr. Zarbo completed his residency training in anatomic and surgical pathology at the University of Michigan and his residency training in clinical pathology at Hartford Hospital in Hartford, Conn.

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Oakwood To Work On Initiative For Non-English Speaking Patients

Dearborn’s Oakwood Hospital & Medical Center (OHMC) is one of nine US hospitals selected by the Robert Wood Johnson Foundation (RWJF) to participate in its initiative, Aligning Forces for Quality: Language Quality Improvement Collaborative (Language QI Collaborative), announced on Aug. 25.

The 16-month project, coordinated locally by the Greater Detroit Area Health Council, will identify and test ways in which all hospitals can provide more timely, effective language services to patients who speak or understand little or no English.

“Our primary service area is more richly varied than any other in southeast Michigan by language, race, ethnicity, national origin, culture, religion and other factors,” according to Moe Rustom, director of clinical language services, Oakwood Healthcare System. “Oakwood is unique among major healthcare providers in having cultivated our market’s diversity as an organizational strength for more than twenty years.”

Every patient has a right to healthcare by professionals who can correctly interpret and understand the patient’s concerns and expectations, and who can effectively convey health and medical information. When a lack of language proficiency limits patient-provider communication, the result can be missed diagnoses, medical errors and poor compliance with advice and instructions.

The Language QI Collaborative is part of the RWJF signature Aligning Forces for Quality (AF4Q) program, aimed at lifting the overall quality of health care, reducing racial and ethnic disparities, and creating models for real reform.

“The Language QI Collaborative will enable Oakwood to share best practices with other hospitals across the nation to minimize language challenges and enhance communication techniques,” said Sara Atwell, chief quality & patient safety officer, OHMC. “Our participation will lead to a safer, higher quality experience for all patients and staff, especially for those who speak little to no English.”

During the project, current Oakwood customers may notice little difference in patient reception and interview practices, since Oakwood Healthcare System already provides a host of culturally sensitive, language-appropriate services.

“We have taken the lead in creating language resources, programs and practices where they did not already exist,” said Rustom. “But our most important contribution to uniformly excellent healthcare in such a broadly diverse community is our culturally competent workforce, which we have worked for years to develop and maintain,”

These initiatives have included a local-access cable show to orient non-Western people to Western medicine, English-Arabic prenatal classes, videos and documents explaining illnesses and disorders, procedures, rights and obligations to non-English speakers, onsite Spanish and Arabic interpreters, on-call American Sign Language interpreters, three-way interpreter telephones in more than 140 languages in all patient areas, online guides to assist all employees in pronouncing common non-English words and understanding non-U.S. cultural perceptions and customs, and multi-lingual welcome and direction signage throughout Oakwood’s patient and visitor areas.

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Crain's Health Care Leadership Summit

Crain's Health Care Leadership Summit

Thursday, Oct. 15, 2009

Hospital trustees, physicians, researchers, administrators and business leaders will gather Oct. 15 to tackle health-care issues and opportunities in Southeast Michigan. Some of the region's top names in health care will participate in a unique on-stage discussion. Breakouts will cover such topics as reducing cost and medical errors, electronic medical records, federal stimulus dollars, patient-centered homes, health care as an economic driver and new ideas for handling uninsured people. A luncheon program will honor Crain's "Health Care Heroes."

Date: Thursday, Oct. 15

Time: 8 a.m. - 5 p.m.

Tickets: $50 Luncheon ONLY

$149 Full Day Conference (Includes 1 yr. subscription to Crain's Detroit Business

$140 each for groups of 5 or more (for group tickets call 313.446.1652

Location: Rock Financial Showplace, 46100 Grand River, Novi, MI. 48374

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