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September 21,
2009 |
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IN THIS ISSUE
Editor's Column: Without Heads Or Hearts
In My Opinion: Without Heads Or Hearts,
Disagreement
Children's Holiday Party Donors 2009
WSUSOM Members In The News
H1N1 Prep Information
AMA Weighs In On Latest Reform Bill
Capitol Check-Up
St. John Hospital CME |
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Without Heads Or Hearts
By JOSEPH WEISS, MD
The Aug. 24 Orlando (Florida) Sentinel headline read: HEART DOCTORS
PROTEST MEDICARE REIMBURSEMENT CUTS AT LAKE EOLA RALLY
The article states that : “…Cardiologists closed their
offices and descended on the hear of Orlando to protest proposed
reduction in their Medicare reimbursements.”
According to the news report, Dr. James Tarver, an Orlando
cardiologist, addressed a crowd of 1,500 stating that: “These cuts
will reduce the quality of care cardiologists will be allowed to
provide to patients. These cuts will result in large hospital stays,
longer wait times, and higher co-pays.”
Tarver told his audience that cardiologists will have no
choice but to stop practicing in Florida or go into other fields. He
called upon those present to lead the way in reversing what he
called: “This Medicare scheme against all the elderly.”
What is the background of this rant? What are the
implications of this action by the Florida cardiologists?
The payment cuts for cardiologists are part of an effort by
the Centers for Medicare and Medicaid Services (CMS) to increase
payments for primary care by reducing payments to selected aspects
of specialty care. Cardiology reductions would mainly come from
decreased reimbursement for transthoracic echo, left heart
catheterization, EKGs, and level 4 office visits.
Other specialties expected to lose reimbursements include
interventional radiology (-10 percent) and radiation oncology (-19
percent). Both CMS and the American College of Cardiology project
that the changes in Cardiology will lead to an 11 percent reduction
in income.
However, in 2008, the median income of cardiologists
was $482,000,
an increase of 5 percent despite the recession. Even if an 11
percent decrease in income occurred, cardiologists would still
remain in the top 1 percent of income in the United States.
What are the implications of the Florida cardiologists’
action?
Their action shows that they are greedy. Their incomes, even
with the worse scenario of cuts, keeps them in the upper echelon of
America’s highest incomes.
These cardiologists are divisive, acting solely for
themselves and further fragmenting the medical community. The
purpose of selective reimbursement reductions is to help primary
care. By acting only for themselves, these cardiologists encourage,
possibly even force, other specialties to come to defend their
individual financial stake in Medicare. We need cooperation at this
time, rather than internecine warfare.
The Florida cardiologists are saboteurs. Now, the medical
community needs to focus on Health Care Reform, particularly in
ridding ourselves of the ill named Sustainable Growth Rate (SGR).
Instead, the cardiologists call on the public to return to an
outdated SGR formula. Physician effort and influence would be
diverted from health reform to urgent support of proposed SGR
changes.
Finally, these cardiologists are lying, acting not as
professionals but as provocateurs. What truth exists in the threat
to leave Florida to practice elsewhere? Medicare acts nationwide,
the cuts will take place in not only for Florida cardiologists, but
wherever Dr. Tarver and his group care to go to do their
catheterizations and echos. Furthermore, does anyone believe that in
2010 Dr. Tarver will turn in his cardiology credentials to the
American College of Cardiology and start practicing Neurosurgery,
Orthopedics or Interventional Radiology?
At this time, physicians need cooperation and unity. We need
to bring our professional manner to its highest level as patients
turn to us for sensible advice on this interface between medical
care and public policy. The action of the Florida cardiologists is a
betrayal of trust both to their elderly patients and their fellow
physicians.
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In My Opinion: Without
Heads Or Hearts, Disagreement
By ALLAN DOBZYNIAK, MD
The tactic of decreasing physician reimbursement as a strategy to
control health care costs cannot work. Why? Because physician
reimbursement contributes inconsequentially to overall cost. It is a
fact that adjusted for inflation, physician reimbursements have not
increased since the early 1990s.
Most physicians run small businesses. Decreasing
their compensation will likely lead to employee layoffs to decrease
labor costs. Increasing patient volume to maintain cash flow is a
form of rationing based on the decreased time spent with each
patient. Asking cardiologists and other targeted specialists to
subsidize health care through decreased reimbursement rates is in
reality just a tax. What you tax, you will always get less of. We
already have a shortfall of cardiologists and this will certainly be
aggravated. Medical business overhead varies regionally. It is
higher in Florida especially as pertains to medical liability. It
does make sense for cardiologists to relocate to other states
leaving the citizens of Florida with an even greater shortfall in
cardiac services. Let us not forget the extraordinary clinical
benefits produced by our cardiologist colleagues including improved
overall outcomes for all cardiovascular disease, decreased mortality
and morbidity from acute coronary syndromes, and improved outcomes
for congestive heart failure to name a few.
For primary care physicians to accept an increase in
their fees by taking away from other specialists is more clearly a
demonstration of their own greed. It is usual and appropriate for
all specialties to advocate for their members but not at the expense
of their physician colleagues. To ignore the SGR when there is no
alternative other than to not participate with this nonsense
(probably the best idea) is not logical.
I say so what that cardiologists are compensated
highly. Further, it is presumptuous of anyone to determine the
economic value of another individual. This is truly a slippery slope
regarding the basic right of each individual to maximize the rewards
of their work, entrepreneurialism and risk taking. Remember,
compared to other highly skilled persons, physicians are not
overpaid. Lawyers defend their $1,000-an-hour fees based on heir
value to society.
Medicare is the problem. Changing the SGR, rationing
care, decreasing physician compensation, increasing taxes and
eliminating medicare advantage plans are not solutions. Increasing
the future age of eligibility, means testing, increasing co-pays,
and allowing competition based on medical value could work.
Please! It is not doctors who are the illness; it is
the government and its policies.
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Children's Holiday
Party Donors 2009
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
click here.
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
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WSUSOM Members In
The News
Patricia LoRusso,
DO,
director of the Phase I Clinical Trials Program at the Barbara Ann
Karmanos Cancer Institute and professor of Internal Medicine at the
Wayne State University School of Medicine, recently contributed to
two articles published in The New England Journal of Medicine.
“Inhibition of
the Hedgehog Pathway in Advanced Basal-Cell Carcinoma” was published
Sept. 2. The study focused on basal-cell carcinoma, the most common
skin cancer in the United States, and assessed the safety and
pharmacokinetics of GDC-0449, a small-molecule inhibitor of
smoothened homologue, and responses of metastatic or locally
advanced basal-cell carcinoma to the drug. The study concluded that
GDC-0449, an orally active small molecule that targets the hedgehog
pathway, appears to have anti-tumor activity in locally advanced or
metastatic basal-cell carcinoma. To view this article, click here.
The second
article, “Treatment of Medulloblastoma with Hedgehog Pathway
Inhibitor GDC-0449,” was also published Sept. 2. This study focused
on medulloblastoma, the most common malignant brain tumor in
children. The abnormal activation of the hedgehog signaling pathway
is strongly implicated in the development of some cases of
medulloblastoma. A 26-year-old man with metastatic medulloblastoma
that was refractory to multiple therapies was treated with a novel
hedgehog pathway inhibitor, GDC-0449, and treatment resulted in
rapid, although temporary, regression of the tumor and reduction of
symptoms. Molecular analyses of tumor specimens obtained before
treatment suggested that there was activation of the hedgehog
pathway, with loss of heterozygosity and somatic mutation of the
gene encoding patched homologue 1 (PTCH1), a key negative regulator
of hedgehog signaling. To view this article, click here.
Dr. LoRusso
developed the Phase I program at Karmanos, one of only 14 National
Cancer Institute-funded Phase I programs in the country, and the
only such program in Michigan
Dr. LoRusso has
been integrally involved in the early clinical development of five
of the last nine cancer drugs to become commercially available. She
is recognized as an international expert in early phase clinical
research. She has been awarded prestigious grants from the NCI and
the Michigan Economic Development Corporation, and serves as
co-chair of the NCI's Investigational Drug Steering Committee. She
has also served on both the Education and Scientific committees of
the American Society of Clinical Oncology, the Scientific Committee
of the American Association for Cancer Research, and as a parent
member of the NCI’s Quick Trials Clinical Subcommittee.
A member of the
American Osteopathic Association and the American Association for
Cancer Research, she has won numerous awards, including the 1999
Heroes of Breast Cancer and the 2004 Bennett J. Cohen Educational
Leadership Award for Medical Research.
A program that provides free breast cancer screening and treatment
for uninsured women and is overseen by a Wayne State University
School of Medicine professor has received $784,731 from the Susan G.
Komen Detroit Race for the Cure®.
Robert Burack, MD,
professor of Internal Medicine for the School of Medicine and the
Barbara Ann Karmanos Cancer Institute, will use the grant to extend
and enhance the services provided by the Wayne County Breast and
Cervical Cancer Control Program. The program provides breast
screening, follow up and treatment at no cost to uninsured women in
the Detroit region.
Since its inception, the program has provided nearly 60,000 free
screenings and potentially curative breast cancer treatment to
nearly 700 women. The grant will extend program services to an
additional 600 women this year, taking it from the current Michigan
Department of Community Health assigned caseload of 7,700 to the
proposed 8,300. The program will also enhance services, filling the
gap for eligible women by providing coverage for breast biopsy fees,
as well as treatment of breast cancer for those women denied
Medicaid.
In addition, the Karmanos Cancer Institute's Alexander J. Walt
Breast Center was awarded funds to cover breast diagnostic and
limited breast cancer treatment for women and men who are uninsured
or underinsured and who are not eligible for other community
support. Karmanos' services are performed by specially-trained
practitioners in an organized practice setting within a National
Cancer Institute-designated comprehensive cancer center -- one of 40
in the nation and the only one in metropolitan Detroit. The grant
will also assist with service gaps for patients enrolled in the
Wayne County BCCCP. Grant-supported staff will evaluate all requests
for financial assistance, provide Komen for the Cure educational
materials, assist with system navigation, encourage follow-up, and
help with transportation and outpatient prescription needs.
Each year, the Komen Detroit Race for the Cure® awards 75 percent of
the current year’s net proceeds to a diverse group of organizations
serving Wayne, Oakland and Macomb counties. Funds support breast
health education and breast cancer screening and treatment programs
for the medically underserved. The remaining 25 percent funds breast
cancer research and project grants awarded through Komen for the
Cure. Since 1992, the Komen Detroit Race for the Cure® has raised
more than $17.5 million.
Robert Lisak, MD,
chairman of the Department of Neurology at the Wayne State
University School of Medicine, has received a grant to investigate
the effect of a hormone on specific brain cells in an effort to
combat Multiple Sclerosis and other similar disorders of the central
nervous system.
The $318,808
grant from Questcor will fund the two-year investigation of an
adrenocorticotropic hormone, or ACTH, and its effects on the
function of glial cells in the central nervous system, including its
ability to modify the effects of inflammatory mediators on those
cells.
ACTH is a
naturally occurring hormone that has been used to treat Multiple
Sclerosis relapses. Questcor, a pharmaceutical company based in San
Francisco, Calif., produces H.P. Actha, a derivation of ACTH. The
product is used to treat a variety of disorders that include
inflammation, like MS.
“We will study
ACTH’s effect on certain population of brain cells, to see whether
the hormone is able to directly effect various functions of these
cells,” Dr. Lisak explained. “We will also see whether ACTH is able
to modify the deleterious effects of certain mediators of
inflammation on these brain cells since these mediators are
responsible for much of the damage to the nervous system in Multiple
Sclerosis and are recognized as contributing to brain cell damage in
other neurological diseases such as Alzheimer's disease, Parkinson's
disease and Amyotrophic Lateral Sclerosis (also known as Lou
Gehrig's disease).
“It is widely
assumed that the beneficial effect of ACTH in shortening the period
of disability from relapes of MS is entirely due to ACTH stimulating
the body to increase the amount of corticosteroid hormones, which in
turn inhibit the inflammatory cytokines,” he added. “Our study is
designed to determine whether ACTH could have a beneficial direct
effect on brain cells that is independent of the increased amount of
corticosteroids that a patient makes when responding.”
Joyce Benjamins,
Ph.D., associate chair of Research in the Department of Neurology,
will serve as co-principal investigator in the study.
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H1N1 Prep Information
Prepare for H1N1
flu with AMA webinar, Web page and e-mail updates
The 2009 H1N1
influenza has caused more than 9,079 hospitalizations and 593 deaths
nationwide as of Sept. 3. It’s more important than ever to be
informed about the latest developments regarding the 2009 H1N1 flu,
and the AMA is physicians’ source for timely, concise and up-to-date
clinical guidance, treatment information, resources and news.
Hear the
most accurate, current clinical guidelines for management
of the 2009 H1N1 influenza virus, including information on vaccine
ordering and delivery, as part of “Physicians: Prepare for the 2009
H1N1 flu,” an AMA webinar scheduled to take place at 7 p.m. CST
Sept. 22.
Hosted by the AMA
in cooperation with the Centers for Disease Control and Prevention
(CDC) and the Department of Health and Human Services (HHS), the
webinar also will cover recommendations for physicians from the
Advisory Committee on Immunization Practice and basic epidemiology
of the 2009 H1N1 flu virus. The AMA advises vaccination for seasonal
influenza and, where recommended, vaccination for 2009 H1N1 flu.
Anthony Fiore,
MD, a medical epidemiologist with the CDC, will discuss guidance on
CDC recommendations for screening and management of cases of the
2009 H1N1 flu. Raymond A. Strikas, MD, of the HHS’s National Vaccine
Program Office, will discuss logistics of vaccine supply and
delivery for providers. Litjen Tan, director of the AMA’s medicine
and public health department, will moderate the session.
Physicians can
visit
https://cc.readytalk.com/cc/schedule/display.do?udc=3nn2451lq34x
to register for this free webinar.
In addition, the
AMA Web site is updated as news breaks, so physicians should
bookmark it and check back often. Visit
http://www.ama-assn.org/ama/pub/physician-resources/medical-science/infectious-diseases/topics-interest/novel-influenza-a-h1n1.shtml
to view the AMA’s 2009 H1N1 flu Web page.
Also, physicians
can visit
http://www.ama-assn.org/ama/pub/physician-resources/medical-science/infectious-diseases/topics-interest/novel-influenza-a-h1n1/subscribe-updates.shtml
to sign up for e-mail updates, news and educational opportunities
from the AMA about the 2009 H1N1 flu and other national health
topics.
And AMA Immediate
Past President Nancy H. Nielsen, MD, PhD, wrote about preparing for
seasonal and H1N1 influenza in a column posted Sept. 10 on physician
blog KevinMD.com. Visit
http://www.kevinmd.com/blog/2009/09/ama-prepare-seasonal-h1n1-influenza.html
to view Dr. Nielsen’s column on KevinMD.com.
9. State pre-registration is key for physicians administering
H1N1 vaccine
In anticipation of the availability of the H1N1 vaccine, a
pre-registration process has been established that will allow
physicians and health care providers who are authorized to
administer vaccinations to pre-register for receipt of the H1N1
vaccine.
Visit
http://www.cdc.gov/h1n1flu/vaccination/statecontacts.htm
for state/jurisdiction contact information for providers interested
in supplying the H1N1 vaccine.
10. Free webinar
highlights motivational interviewing techniques for counseling
parents about secondhand smoke
The
AMA is offering a free online program at 9 a.m. CST on Sept. 29
designed to assist clinicians in talking about the health risks
associated with secondhand smoke.
Jonathan Winickoff, MD, chair of the American Academy of Pediatrics
Julius B. Richmond Center Tobacco Consortium and associate professor
of pediatrics at Harvard Medical School, will review basic
principles of motivational interviewing and practical advice on
overcoming barriers. The webinar, funded as a cooperative agreement
with the Environmental Protection Agency, will be archived and
available for future viewing on the AMA Web site for those unable to
participate in it live.
Space is limited.
Physicians can visit
http://eo2.commpartners.com/users/ama/session.php?id=3155
to learn more and register.
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AMA Weighs In On
Latest Reform Bill
Editor’s note:
The following is attributable to AMA President James Rohack, MD.
“The AMA applauds
Chairman Baucus and his colleagues for their hard work and important
contribution toward our mutual objective of comprehensive health
system reform. Expanding coverage through tax credits, insurance
market reforms that protect patients if they get sick or lose their
job, and offering more affordable choices through new health
insurance exchanges will significantly improve our health care
system.
“The AMA will
continue to work with Chairman Baucus and his colleagues to
strengthen this proposal. The AMA continues to call for permanent
repeal of the current Medicare physician payment formula that
threatens seniors’ access to care. The House has already recognized
the importance of this action by including it in pending
legislation.
“Without
permanent repeal of the current formula, physicians face cuts of 40
percent over the next few years that will erode access and choice
for America's seniors. A recent AARP poll found that 90 percent of
people 50 and over are concerned that the current Medicare physician
payment formula threatens their access to care.
“After further
review of the proposal, the AMA will continue ongoing discussions
with Chairman Baucus and other Finance Committee members regarding
policies of concern to physicians.”
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Capitol Check-Up
THURSDAY,
SEPTEMBER 24, 2009
MSMS CAPITOL
CHECK-UP
HEALTH CARE UNDER
the Dome
RADISSON HOTEL,
LANSING
REGISTRATION:
8:00 am
PROGRAM: 8:30 am
– 4:00 pm
$15 (Continental
Breakfast and Lunch included)
Be apprised of
up-to-the-minute information about the current state of affairs in
Lansing, the latest legislation being considered, and what impact
current and future legislation will have on the medical profession.
Featured topics to include: MDCH Update, National & State Health
Care Reform, Legislative Priorities, and Individual Market Reform.
Sponsored by:
American Physicians and MSMS Physicians Insurance Agency.
EASY TO REGISTER
ON-LINE at
www.msms.org/eo
CALL MSMS
REGISTRAR at (517) 336-5785
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St. John Hospital
CME
St. John Hospital
& Medical Center
Continuing
Medical Education Seminar
Overview of Geriatric Medicine
Wednesday, October 28, 2009 – 7:30 a.m. to 1 p.m.
For more
information, click here
or call (313) 343-3877
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