E-DMN - September 28, 2009

September 28, 2009

Legislators: Reject Medicaid Cuts, Physician Tax!
Don't Be Fooled By 'Medical Society' Communiqués
Editor's Column: An Exaggeration, Not Quite
Responses To Editor's Column
Domestic Violence Awareness Month Features Variety Of Events
Children's Holiday Party Contributors 2009
'Strengthening The Nation'
Overview Of Geriatric Medicine At St. John

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Legislators: Reject Medicaid Cuts, Physician Tax!

The following is a letter to legislators from George Shade Jr., MD, WCMSSM President

September 28, 2009

Michigan Legislators

State Capitol Building

Lansing, Michigan

Re: Medicaid Cuts and Physician Tax

Dear Legislators:

The physicians of Wayne County express their deep concern for the proposed legislation to cut Medicaid reimbursements by as much as eight percent as well as the proposal to generate a new source of revenue to fund the state Medicaid system by imposing a so called “Physician’s Tax.” Both of these measures have previously come before the legislative body and as physicians we find them to be no more palatable today than when first introduced. The physicians of Wayne County have historically served a disproportionate share of both uninsured and under-insured citizens of the state of Michigan in an effort to make sure that high quality health care remained accessible to all. This has often included significant pro bono services to individual patients, and many times entire families. The doctors of Wayne County have consistently proven themselves to be committed partners actively involved in improving the quality of life in the Great State of Michigan!

Over the past two decades, we have seen a progressive erosion in payments to physicians while the regulatory demands, the overhead costs of providing care and the acuity of medical illness in the state of Michigan have escalated. We have stayed despite the fact that Michigan has consistently had one of the lowest reimbursement rates of all 50 states in the Union. We have consistently shouldered these burdens but now find ourselves at the breaking point. Our young, Michigan-educated physicians upon graduation no longer choose to practice in Michigan. Our highly trained, experienced doctors are either leaving Michigan, changing their scope of practice or retiring earlier than originally anticipated. I have witnessed some of our most outstanding physicians, servicing areas of critical need, simply shut the doors to their offices and stop practicing medicine because the costs of remaining in business were greater than the income derived from all of their compassionate care. I have witnessed major health care systems and state medical schools struggle to recruit high quality, out-of-state candidates to fill high-need specialties and faculty positions at their respective institutions.

The doctors of Wayne County know firsthand the seriousness of the economic crisis in the state of Michigan. The Detroit area has been devastated by a recession/depression that has lingered in this area for the last eight years. However; there is no QAAP for physicians as there is for hospitals. The “Safety Net” is unraveling. The draconian measurers currently before you for consideration will have a dire, lasting impact on access to healthcare and the quality of healthcare in our state.

As the United States of America goes through some of the most serious and emotionally charged debates on healthcare reform ever witnessed in this country; all eyes will be turned toward Michigan. What you do as a legislative body in the next two to three days will be seen by all as an example of exactly what happens when government takes a more active role in the delivery of healthcare. The legislation passed in Michigan must not be seen as the government action that helped derail meaningful healthcare reform in America.

Sincerely yours,

George H. Shade Jr., M.D.

President, Wayne County Medical Society of Southeast Michigan

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Don't Be Fooled By 'Medical Society' Communiqués

The following is a letter from MSMS President Richard Smith, MD, to all Southeast Michigan physicians.

September 22, 2009

Dear Doctor

This special letter is to update you about several issues of interest to members of the Michigan State Medical Society in Southeast Michigan and to make you aware of one particular concern.

The concern is that two organizations in Southeast Michigan recently applied to the state of Michigan to use "Michigan Medical Society" as an assumed name, or "doing business as" (DBA). One organization's application in July was later withdrawn and a second organization's application in August was then accepted by the state.

I want to make it clear that if you receive any communication from a "Michigan Medical Society" it is NOT from the Michigan State Medical Society. Any use of a name so similar to that of your professional association will cause confusion among MSMS members. MSMS legal counsel is reviewing options to resolve this situation. Please contact me through the MSMS Executive Office at (517) 336-5742 or jcrum@msms.org if you receive any communication from a "Michigan Medical Society" and we will work to clarify any confusion.

MSMS Connect, the single sign-on web portal free to MSMS members, is progressing with many more applications becoming available soon. Through collaboration with the AMA, more than 20 additional practice-related products and services will be available later this fall, including a free e-prescribing application. Physician practices will be able to ease into the adoption of evolving health information technology at whatever level they want and need. Please watch upcoming issues of Medigram and your weekly e-mail updates from me for more details.

Regarding federal health care reform, I urge you to go to www.msms.org/reform to see the letter the MSMS Board of Directors sent to Congress in July regarding our concerns about pending health care reform legislation.

To summarize the MSMS position, while supporting a number of issues including extending coverage to all Americans and eliminating pre-existing condition clauses, we expressed serious concerns about long-term funding and effects of a public option, about the need to include significant tort reform, and the need to ensure that physician participation in any program remains voluntary, among others.

The last issue requiring some clarification is the creation of the Beaumont Physician Organization that was announced this summer. As a recognized statewide leader in PO operations, Medical Advantage Group (MAG) was approached to provide management services by the physicians who created this organization. MAG provides similar services to 54 other physician organizations across Michigan.

MAG is owned one-third by physician stockholders, one-third by American Physicians, and one-third by MSMS. As a private corporation, MAG has its own board of directors and is not answerable to or controlled by the MSMS Board of Directors. The mission of MAG is to help physicians run a professionally appropriate physician organization. MAG focuses on data and information analysis, integration of clinical tools (i.e., registries and e-prescribing), support of medical management activities, assistance in health plan negotiations, and administrative support.

I hope this letter has been helpful in clarifying these issues. Please contact me through the MSMS Executive Office if you have questions, comments, or concerns.

Sincerely,

Richard E. Smith, MD

President

P.S. MSMS is fighting legislation that was introduced at the end of last week to impose a 4% physician tax on the gross receipts of your practice. Please go to the MSMS Action Center today at www.msms.org/action to send an e-mail to your state legislators opposing this unfair tax. We will be successful only by standing together with one united voice.

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Editor's Column: An Exaggeration, Not Quite

By JOSEPH WEISS, MD
(Editor's Note: As with all Editor's Columns and In My Opinion columns appearing in the Detroit Medical News, the following views are those of the author, not necessarily those of the Wayne County Medical Society of Southeast Michigan, its members or its staff. Its publication here does not constitute an endorsement.)

American medical schools should be watching the health reform battle on Capitol Hill. If the reform effort fails, medical schools may want to take another look at their curriculums. The schools will need to change what they teach to fit the services patients will be able to afford.

There are locations in Afghanistan where there is no electricity or running water and where double-digit inflation exists. Medical students may want to take an externship in such places to gain experience for a future practice of primary care in Birmingham or Bloomfield Hills if health reform fails.

I recently saw a patient who was laid off from Avis Ford and lost his health insurance. All he could afford for health care was the cash in his pocket. He had a chance to earn some money doing carpentry work, but developed marked pain in his foot. If he couldn’t walk, he couldn’t work.

History brought out that he had a similar attack in his foot three weeks ago, but as he wasn’t working, he just suffered out the pain and the attack cleared. Now it was back again. Examination revealed tenderness and swelling in the right great toe. I aspirated and injected the joint, scanned the fluid under the office microscope and identified gout crystals. The aspiration established that he had gout and the injection resolved the attack so he could work the next day.

I looked in the Wal-Mart $4 formulary, and found that a 30-day supply of allopurinol 300 mg was on the list. I gave him a prescription, told him to fill it in two weeks. I would have liked to obtain a CBC, ALT, AST, GFR and uric acid. As he had no insurance, I settled for a serum uric acid, since I needed that information to follow the efficacy of allopurinol. Quest Labs would charge him $32 for that test. For the visit and procedure I charged him $40. As he had $75 in his pocket, he was able to pay his visit and lab study and still have enough change for a cup of coffee.

Of course, the pay-for-performance panelists would be outraged, and the standard of care consultants appalled. He had no x-ray to r/o fracture, no laboratory studies to assess his bone marrow, liver or kidneys in case of allopurinol toxicity.

When a patient can’t afford the cost of care, expediency trumps excellence. Pay-for-performance becomes a perk of boutique medicine, physicians no longer need Epocrates, but carry a printout with the latest $4 K-Mart formulary. Instead of physicians coming from third-world counties to be taught American medicine, American physicians travel outbound to learn the third-world way.

Another advantage for American physicians studying abroad will be learning how to mend ragged white coats, and reuse syringes and needles by autoclaving them. Such strategies may be useful as American doctors returning to the States will likely face a third-world-like income.

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Responses To Editor's Column

ALLAN DOBZYNIAK, MD, commented:

Given (Dr. Wiess’) exaggerated description, I really doubt there will be any medical students anyway. Those that were would likely be dolts and untrainable anyway. If the country continues to languish in this degree of economic downturn, having enough money to pay for health care will be only one of a myriad of even more serious problems. Your description of overseas medicine seems like that of many socialized systems. I say let us get the free market economy going, not continue to divert precious capital to the valueless expansion of government, fit health care into it proper place as a positive part of a vibrant and expanding economy and reward the medical profession for the value it contributes. Certainly, a prosperous country needs the social conscience to care for the truly needy. There are free market solutions for even this specific issue.

SUSAN ADELMAN, MD, commented:

Pretty good, if somewhat overstated. While I doubt that we will become a third-world nation as a result of health reform, I am sure that we will have substantial cut-backs. The ways in which (Dr. Weiss) modified his care and testing program for the needy patient are spot-on.

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Domestic Violence Awareness Month Features Variety Of Events

The following is a listing of events for Domestic Violence Awareness Month, with contact information when available.

Purple Light Campaign (Oct. 1-Oct. 31)
Spreading the word about Abuse Free Homes. For a donation, participants receive a Purple Light Bulb to place in their homes or businesses to express their support of abuse-free homes, businesses and communities. For requests and donations, call Looking For My Sister at (313) 861-3221.

Clothesline Project (Oct. 1-Oct. 31)
Takes place in Shelby Township. For more information, call Turning Point at (586) 463-4430.

Takes place in Shelby Township. For more information, call Turning Point at (586) 463-4430.

Candlelight Vigil (Oct. 1)
Hosted by Serenity Services, in conjunction with several Detroit-based domestic violence agencies. Annual candlelight vigil, “Telling Our Story from Victim to Survivor,” at Wayne State University, Student Center Building, 6 p.m.-8 p.m. More than 100 survivors, community members and leaders will attend. Free.

ACCESS 4^th Annual Banquet, “SAFETY NOW” (Oct. 2)
6:30-9:30 p.m., at the Bint Jebail Cultural Club. Keynote Speaker: Carolyn Clifford, Anchor, Action News WXYZ. Ticket Donation: $35. Table Sponsorship: $500. Featuring silent auction. Contact Joanna Ladki at (313) 216-2226 or jladki@accesscommunity.org

No More Abuse: A Community Response to Domestic Violence (Oct. 3)
Hosted by Looking For My Sister, in partnership with Wayne County Community College District, Downtown Campus & Wayne County Prosecutors Office. 10 a.m.-2 p.m. Event features vendor space (prices on request), general session and eight workshops. Information available at LFMS, (313) 861-3221

A CHOCOLATE AFFAIR and GARDEN LUNCHEON (Oct. 4)
2 p.m.-5 p.m., The Inn at St. John’s, 44045 Five Mile Rd., Plymouth. Benefit for First Step, Wayne County Shelter for Domestic Violence. Events hosted by the Ladies Ancient Order of Hibernians, Elizabeth Fagan Division. Luncheon Tickets $25, advanced sales only. Chocolate Affair tickets $25, combined ticket $45. For tickets, call Barb (734) 453-1459 or Kittie (248) 449-6570.

Speakers’ Panel at Macomb Community College (Oct. 6)
In partnership with Turning Point’s Prevention Education, South Campus, Noon- 1 p.m. and Center Campus, Oct. 13, from 7 p.m.-8 p.m. Featuring a discussion on Domestic Violence and Dating Violence.

Detroit PD vs. Canton PD, POLICE CHARITY SOCCER GAME (Oct. 10)
1 p.m.-4 p.m., at High Velocity Sports, 46245 Michigan Avenue, Canton. Playscapes, prizes, face painting, and photos with Ignition Players. All proceeds to benefit First Step and YWCA Interim House Domestic Violence Shelters. Contact Sgt. Deanna Wilson at (313) 237-2579.

YWCA of Metropolitan Detroit INTERIM HOUSE 30^th Anniversary Gala (Oct. 16)
6 p.m., Charles H. Wright Museum of African American History, 315 Warren Ave., Detroit. Advance ticket purchase: $60. Carolyn Clifford, Anchor, WXYZ News is Mistress of Ceremonies. Gala features live entertainment provided by Ortheia Barnes, food, cash bar, recognition and awards, museum gallery tour, silent/live auction, complimentary valet parking. For tickets, contact YWCA Interim House: (313) 862-3580 or (313) 861-5300.

Cruise for a Cause (Oct. 17)
Hosted by Looking For My Sister, Celebrating Five Years of Service to Wayne County. Event aboard Ovation Yacht, with Infinity Ovation Yacht Charters. 6 p.m. board, 6:30 dinner cruise. Featuring live Detroit entertainment, open bar, strolling dinner, silent auction and presentations. Ticket price: $150, on sale now. Call: (313) 861-3221, Ext. 12 for more information.

Macomb County Prevention Summit (Oct. 23)
Sponsored by Macomb Community Domestic Violence Council and Turning Point and Beaumont Hospitals, with administrative support from MISD. MISD Building, 8:30 a.m.-3:30 p.m. For more information, contact Turning Point at (586) 463-4430.

A Charity Fashion Show to benefit Turning Point (Oct. 23)
At San Marino in Troy, 6 p.m., hosted by Channel 4’s Karen Drew. Contact Turning Point at (586) 463-4430.

TRUNK OR TREAT Family Night (Oct. 24)
Noon-3 p.m. at the County Parking structure (Main St., Mt. Clemens). For more information, call Turning Point at (586) 463-4430.

Interfaith Prayer Luncheon for Serenity Services (Oct. 24)
Annual Prayer Luncheon “Transforming Lives Through Love, Hope and Healing. Farina Banquet Center, Berkley. 11 a.m.-2 p.m. Tickets are $40. Call office to buy tickets or visit www.serenity-services.org

SAFE (Sisters Acquiring Financial Empowerment) HEALTH & WEALTH EXPO (Oct. 24)
10 a.m.-4 p.m., Northwest Activities Center, 18100 Meyers Rd., Detroit. Click on www.SafeHealthWealth.com or call free Expo Hotline: (888) 757-6880 to reserve FREE community resource table.

DMC Sinai-Grace Safety Fair (Oct. 26)
Hosted by Serenity Services, in conjunction with the Sinai-Grace Domestic Violence Awareness Committee. Join us for a community information fair focusing on various areas of safety, including domestic violence. Sinai-Grace Main Hallway, 9a.m.

Domestic Violence For Health Care Providers, Part II (Oct. 29)
In conjunction with WSU School of Medicine, DMC and Wayne County Medical Society of Southeast Michigan. Please join us for an educational conference about caring for domestic violence survivors. Kresge Eye Institute Auditorium, 7:30 a.m.-2 p.m. Register by calling (313) 745-3030. CEUs offered. Free.

I AM WOMAN EXPO (Oct. 31)
Wayne State University, Community Arts Auditorium, Detroit, 9 a.m.-4:30 p.m. Featuring Tony Gaskins, Jr. and an all male panel discussion: A Male’s Perspective on Love and Life. Free health screenings and makeovers, prizes, free continental breakfast and lunch. Free registration. www.iamwomanexpo.org

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Children's Holiday Party Contributors 2009

The following is a list of contributors (since our last e-edition) 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

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

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'Strengthening The Nation'

Participate in strengthening the nation’s response to public health emergencies

Third National Congress on Health System Readiness

"Disaster Medicine and Public Health Preparedness in the 21st Century"

Dec. 1–3, Washington, D.C.

Join leading experts this December to review current research and science related to disasters and public health emergencies worldwide, and to establish the essential elements of a comprehensive disaster response health system. The congress will also include a special session examining the H1N1 influenza pandemic.

Community and government leaders and stakeholders from the fields of medicine, nursing, public health, emergency medical services and emergency management will convene in the nation's capitol to:

• Integrate lessons from recent public health emergencies—such as pandemic flu, terrorist attacks and natural disasters—into clinical and public health practice

• Advance health systems to prepare for, respond to and recover from disasters and other public health emergencies appropriately

• Develop a distinct educational framework for all health professionals to ascribe to in catastrophic events

Receive a free one-year online subscription to Disaster Medicine and Public Health Preparedness with registration.

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Overview Of Geriatric Medicine At St. John

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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