Happy Holidays

Health Reform

January 23, 2010

Rep. Mike Rogers

Michigan 8th Congressional District

Dear Rep. Rogers

I am writing you this letter in regards to the Republican party's role in health care reform, and the promise of revising or repealing the present healthcare reform initiative. As you know from my many previous communications, I have long been a limited government advocate. It has been, and continues to be, a personal  belief that individual liberty is paramount, and in the recent past we have lost our way. 

But today I write from  different perspectives. I am by training and practice an emergency physician since 1991, and most recently I have moved into an administrative role as the vice president and chief medical officer of a hospital in southeastern Michigan. I would like to share some perspectives from the front line as an emergency physician, as a hospital administrator concerned with budgets, and finally as a US citizen.

First, I would like to introduce a fictional, though very typical, patient in any emergency department across the country. Mike, a middle-aged unemployed man without health insurance arrives to the emergency department via an ambulance after dialing 911 with crushing chest pain. It becomes clear to the staff in the emergency department that Mike is suffering an acute myocardial infarction, otherwise known to nonmedical layperson, as a heart attack.

As you are assuredly aware, because most hospitals participate in federally funded insurance programs, such as Medicare and Medicaid, we operate under a myriad of federal regulations. These regulations are so numerous and detailed that we have in effect become a privatized extension of the federal government. One of these regulations, the Emergency Medical Treatment and Active Labor Act (EMTALA) directs us to treat and stabilize any patient presenting to the hospital requesting emergency medical treatment regardless of their ability to pay. This regulation grew out of the practice, that most would agree is ethically empty, of some hospitals refusing to offer timely medical care to patients without insurance, and redirecting them to public hospitals.

As a patient advocate and a physician treating Mike my path is the clearest;  though I may not be paid for the care that I direct, I am morally comfortable treating Mike like any other patient.

 As a hospital administrator, Mike's treatment is consistent with our not-for-profit mission but  I need to figure out how to pay for the inevitably expensive, technologically burdened, and potentially life-saving treatment that Mike will need, which I do by charging those with insurance enough to cover both the insured and the uninsured patients. This overcharging, or cost shifting, results in the often quoted inefficient and expensive costs of providing care in our nation's emergency departments.

As a citizen of the United States and a believer in small government I have another problem. Is providing treatment to Mike part of the original mission of our country? Our declaration of independence states that "We hold these truths to be self evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness." Is Mike's medical treatment, which very well may preserve his life, consistent with these unalienable rights? Specifically, the unalienable right to life? How does this integrate with my belief in small government?

Furthermore, is the' right to life' as purported by many across the political spectrum, and most often applied to abortion, applicable in this instance? Mike's immediate treatment may in fact save his life. 

These questions vex me, and lead me into moral, ethical, political, and philosophical conundrums that my education has not prepared me for. But I can assure you, from both an administrative and clinical perspective:  it 'feels right' to treat Mike like anyone else.

As you can see, I am conflicted between my personal  ethical belief in small government, and my moralistic compass as an emergency physician, hospital administrator, and US citizen. How to best weave these conflicting strands together?

So as you participate in the Republican Party's agenda to repeal the Obama health care reform initiative, I ask that you keep Mike and his heart attack in mind, and I look to your leadership on these issues. How should healthcare providers be reimbursed for care to those who cannot afford it? Is access to healthcare for all of our citizens part of the natural unalienable rights our founding fathers referred to? What does the' right to life' mean outside the abortion debate? Who is going to pay for Mike's medical care under the current Federal regulations? Do you want me to turn Mike away?

As always, I appreciate the ability to communicate my concerns to you as my elected representative. May God be with you as you weigh the alternatives.

Respectfully,

David P. Walters, DO, MHSA, FACEP

Associate Clinical Professor

Michigan State University College of Osteopathic Medicine

Vice President and Chief Medical Officer

Botsford Hospital

Farmington Hills, MI       

Executive Committee Meeting

I just came from our Executive Committee Meeting tonight, and I have to say that as a member of the committee for over 12 years, that the present group has embraced their job in a very positve manner. This had changed the committee from a ver angry and argumentative committee to a responsible and fun committee. A formerly staid committee has become engaged and involved. My thanks goes out to all of the members of the committee for a job well done!

Happy New Year

I hope all of you had a safe and a fun Holiday and New Year. Personally, though it was busy, it was one of my best crowned by ringing in the new year at home with Lori and our two children, Louis (17) and Claire (15). Lori and I will not have many more opportunities to so selfishly enjoy our childeren by ourselves.

I am looking forward to re-invigorating this blog, so stay tuned to regular posts here relevant to Botsford Hospital and our Medical Staff.

Cardiac CT Angiogram

Earlier this year we acquired a 128-slice CT scanner. One purpose of this scanner, among many, was to be able to perform Cardiac CT Angiograms (CCTA). Over the last six months we have perfected the process of CCTAs and are now offering the service to our referring physicians.

CCTAs are not an imaging study for everyone. In fact, standard cardiac angiograms are still the gold standard for diagnosing coronary artery disease. However, for a specific subset of patients it is a very good alternative for ruling out cardiac disease.

Specifically, CCTA is a good choice for the following outpatient groups:

1. Unexplained or atypical chest pain in a patient with low to intermediate likelihood of coronary artery disease based on age, gender and other risk factors.
2. Typical or atypical chest pain with normal or equivocal stress test and normal or equivocal ECG findings.

Radiation exposure should always be taken into account as a risk when ordering any x-ray study, including CCTA. (Radiation is measured in millisieverts, mSv). Because of the speed of our 128-slice CT, we have the ability to minimize the radiation exposure for patients undergoing a CCTA. We have successfully been able to perform the CCTA studies using less than 6 mSv (considered low risk for lifetime chance of malignancy). In comparison, we are all exposed to about 3 mSv annually from the natural radiation in our environment.

To achieve this low exposure to radiation, it is important to make sure the patient’s heart rate is low, and a dose of a medication to slow the heart rate down, such as a beta blocker, is usually recommended prior to the study. This will be done prior to the CT if the heart rate is higher than recommended.

Scheduling a CCTA is done through our Central Scheduling office at (248) 471-8100. The scheduler will advise the patient about the preparation for the test. If you have any further questions regarding a CCTA you should discuss this with a Cardiologist prior to recommending the study to your patients.

iGoogle

iGoogle

Comparative Effectivenss Analyasis

Rationing has turned into a politically charged word which immediatly causes visceral repulsion for most americans. Cost effective analysis is a tool by which we may choose to ration a particular treatment or procedure.

Who should make rationing decisions in the US is an issue that separates the left and the right in our country along legitimate philisophical differences.

Rationing at the cash register is what we are accostomed to in the US. Not everyione gets a Cadillac, but we are comfortable with that within reason. Problem is that the consumers (patients and physicians) are no were near the healthcare cash register.

Rationing through a central power structure makes many in the US suspicious, and hence one of the reasons the Democrats struggle.

Even though I am philosophically a believer in rationing through the market, the goverment is so far into healthcare already I do not see any way that we can feasably unwind it enough to even try a true market solution.

By the way,  Botsford now has a Davinci - Hey, we can't compete on price, so we have to compete with technology!

So here is the question: if you had to have a prostatectomy, would you choose to have it done using a Davinci, or the 'old fashion way' as an open procedure (assuming that you have good insurance and price is no object)? It is the question I had to ask myself as we contemplated the purchase of a Davinci. My honest answer: I personally would choose a robot because even though you are right in that there is no data regarding a cost effectiveness benefit, there is a huge benefit in recovery time; with an open prostatectomy recovery can be weeks, but with a Davinci it is usually days. Hey, I'm a wimp and I do not like pain. This is not measured in most cost effectiveness studies.

But, if I had to pay an extra $20,000 out of pocket...?

Progress Notes

Physician and Hospital Collaborative Program Development
We have been working collaboratively with the leadership of Olympia Medical Services, (Randy Bickle, D.O.; Tom Selznick, D.O.; and Mike Wayne, D.O.) to identify collaborative initiatives where the hospital and medical groups can mutually benefit. These meetings have been terrific and very productive, but we realized that many of you, our staff physicians for whom we work, might not know what we have accomplished. Therefore, I have highlighted some of the initiatives we have launched together and that you can draw on as well.

Web site Development: Using Botsford’s expertise in web design we have created a template Web site that we can modify to your specific practice. It can be very simple and be hosted on our Botsford Hospital Web site or (with added fees) it can be very elaborate and hosted by you. We have successfully launched several web pages for staff physicians and we are ready to offer the service for you on a first come, first serve basis. For a sample of what we can offer, please visit http://www.botsford.org/nfmc.

Office Staff Training Course: This year, we hosted three training courses for office staff personnel. I am sure that many of you have sent some of your employees. Each course had over 50 attendees. The topics focused on connecting with the patients and customer service. The feedback we have received from the staff has been nothing short of great. Look for more useful classes for your office staff in 2010!

Urgent Care/After-Hours Clinic: In partnership with the Emergency Medicine Group at Botsford Hospital, we have established an after-hours Urgent Care center for your patients to utilize. This is a cost effective alternative to the ER and provides a faxed report to your office the next morning and assurance that your patient will return to your practice. This collaborative clinic will also allow you to fulfill the Patient Centered Medical Home after hour requirement for incentive pay through third party payors. Please click here for more details: http://mwurgentcare.com.

Physician ID cards for patients: We have developed practice ID cards for patients to carry in their wallets. The card identifies the Primary Care Physician and the practice information. When they go to an ER or Urgent Care facility, the patient can present the card at the time of the visit, and (the hope is) your patient’s pertinent health information gets relayed back to you.

Here is a list of other services offered to Botsford Hospital Medical Staff physicians:

PCP referrals following ED visits (for Family Medicine physicians)
Medical supply and surgical supply discount pricing available through hospital Group Purchasing arrangement
Opportunity to utilize CEMTech for auto repair at a discount
Medical Staff Membership opportunity – application fee waived in 2009
Red Flag Compliance – documentation offered
Sharps disposal discount opportunity
Costco Membership discount opportunity
Senior Assessment program at Botsford Commons
Diabetes Education program in your office
Professional Liability Program at discount rates
EMR collaborative opportunities/strategies

For more information on any of these initiatives, please contact me (or Sonja Amos, Director, Medical Staff Services) at (248) 471-8222.


Best Dictator Award

In honor of Health Information and Technology Week (November 1-7, 2009), the Transcription Department would like to announce the winner of the newly created Best Dictator Award! This honor is being awarded to one Staff Physician and one Resident Physician who are considered outstanding when using the following criteria when dictating: Concern for accuracy of report, clear enunciation, accurate data input into dictation system regarding patient account numbers and report types, dictation done in a quiet area. This year, the Fall 2009 Best Dictator Award goes to Jeffrey Gerken, D.O., and Gasson Alaouie, D.O. Congratulations!
Honorary mention goes to Staff Physicians (in alphabetical order) Drs. Ajluni, Colen, Fleming, Jennings, Philip Kaplan, Linard, McMichael, Ruza, Sierra, Susser as well as Resident Physicians Drs. Hederman, Quan, Voshel, and Wheat.
The Health Information Services Transcription Department would like to remind all dictators to refrain from dictating on a cell phone to ensure privacy and accuracy of reports.

New Visitor Restrictions in Place Due to Flu
In response to the outbreak of influenza in this area, Botsford Hospital has implemented temporary visitor restrictions to protect, patients, visitors and hospital employees.

Effective October 24, the following visitor restrictions are in place:
Individuals with flu-like symptoms such as cough, fever, runny nose and sore throat will not be allowed to visit patients

Children ages 12 and under will not be permitted to visit patients

Only two visitors at a time will be allowed in a patient's room

"Our goal is to protect the health and safety of our patients," said Margaret Hasler, R.N., Botsford Hospital Vice President and Chief Nursing Officer. She also encouraged visitors to wash their hands upon entering the hospital and before and after a visit with a patient. Hasler emphasized that Botsford has not experienced a large number of H1N1 flu patients or an unusual number of seasonal flu cases.

Events

Symposium for Primary Care Medicine (formerly the Allen Zieger Lecture Series)
http://www.botsford.org/physicians/2009/Primary_Care.html
November 6 and 7, 2009
Novi Sheraton

4th Annual Botsford Autumn Gala
http://www.botsford.org/foundation/events/
Saturday, November 14, 2009
Ritz Carlton, Dearborn



New Medical Staff

Please welcome our new medical staff for the month of November.

Internal Medicine
Gassan Alaouie, D.O.

Neurology
Amish Patel, D.O.

Physician and Hospital Collaborative Program Development

We have been working collaboratively with the leadership of Olympia Medical Services, (Randy Bickle, DO, Tom Selznick, DO, and Mike Wayne, DO) to identify collaborative initiatives where the hospital and medical groups can mutually benefit. These meetings have been terrific and very productive, but we realized that many of you, our staff physicians for whom we work for, might not know the fruits of our labor. So I will highlight some of the initiatives we have launched together.

Website Development: Using Botsford’s expertise in web design we have created a template website that we can modify to your specific practice. It can be very simple and be hosted on our Botsford Hospital website or (with added fees) it can be very elaborate. We have successfully launched several web pages for staff physicians and we are ready to offer the service for you on a first come first serve basis. For a sample of what we can offer click here: http://www.botsford.org/nfmc/

Physician ID cards for patients: We have developed practice ID cards for patients to carry in their wallets. The card identifies the Primary Care Physician and the practice information. When they go to an ER or Urgent Care facility, the patient can present the card at the time of the visit, and (the hope is) your patient’s pertinent health information gets relayed back to you.

Office Staff Training Course: In 2009, we have hosted three training courses for the office staff personnel. I am sure that many have you sent some of your employees. Each course has had over 50 attendees. The topics focus on connecting with the patients and customer service. The feedback we have received form the staff has been nothing short of great. Look for more great classes for your office staff in 2010!

Urgent Care/After-hours Clinic: In partnership with the Farmington Emergency Medicine Associates at Botsford Hospital, we have established an after-hours Urgent Care center for your patients to utilize. This is a cost effective alternative to the ER, and provides a faxed report to your office the next morning and assurance that your patient will return to your practice. This collaborative clinic will also allow you to fulfill the Patient Centered Medical Home after hour requirement for incentive pay through Third party payors. Click here for more details: http://mwurgentcare.com/

Here is a list of other services offered to Botsford Hospital Medical Staff physicians:

-         PCP referrals following ED visits

-         Medical/Surgical supply pricing through hospital Group Purchasing Organization arrangement

-         Opportunity to utilize CEMTech for auto repair at a discount

-         Medical Staff Membership opportunity – application fee waived 09

-         Red Flag Compliance – documentation offered

-         Sharps disposal discount opportunity

-         Costco Membership discount opportunity

-         Senior Assessment program at Botsford Commons

-         Diabetes Education program in your office

-         Professional Liability Program at discount rates

-         EMR collaborative opportunities/strategies

For more Information on any of these initiatives, please contact me or Sonja Amos at (248) 471-8222.

You can all visit me on the Botsford Hospital Medical Staff Blog at the following link:  http://botsfordhospital.blogspot.com/

Distribution of Initial Delivery of H1N1 (Swine) Flu Vaccine

MEMO
TO: Employees of Botsford Hospital
FROM: David Walters, D.O., Vice President and Chief Medical Officer
        Gerald Blackburn, D.O., Director of Infection Control
        Janet Moody, R.N., Infection Control Coordinator
DATE: Tuesday, October 27, 2009
SUBJECT:  Distribution of Initial Delivery of H1N1 (Swine) Flu Vaccine

Our Inpatient Pharmacy has received its initial delivery of H1N1 (swine) flu vaccine. As you may have heard in the news, there is a shortage of this vaccine. Botsford Hospital received only a fraction of the amount that was ordered. Therefore, our available H1N1 vaccine serum will be offered on a priority basis to certain patient populations and certain caregiver populations beginning today.

Because children, pregnant women, and the immune suppressed are and increased risk, we have prioritized the distribution of the vaccine with this in mind.

Patients, patient care providers, including residents and attending physicians will be the first to be offered vaccine in descending order:

• OB Clinics pregnant patients and staff
• Botsford Pediatric patients and staff
• Emergency Department staff
• Postpartum patients
• Respiratory Care staff
• Child Care Center staff
• 3-North Oncology Unit staff

There is not enough vaccine to cover every patient care employee on the above units and departments. Managers of the above-named areas will determine which of their patient care employees will be offered this priority vaccination.

Updates will be forthcoming as more vaccine becomes available. Everyone needs to follow the advice below.
What to do if you get sick

• If you become ill with flu like symptoms (respiratory symptoms, sore throat, fevers, and muscle aches) you should stay home. Please be in contact with your unit/department manager since you should not come to work if you are contagious. The Centers for Disease Control and Prevention (CDC) recommends that you stay at home until you have been free of fever (100°F or 37.8°C), or signs of a fever, for at least 24 hours, without the use of fever-reducing medication.
• Contact your personal physician about the need for anti-viral treatment, and watch for signs that you need immediate medical attention. 

FW: Reminder ~ General Staff Meeting ~ Botsford Hospital

 

 

 

*****REMINDER*****

 

GENERAL STAFF MEETING

 

October 28, 2009

 

Community Room of the Zieger Education Center

Botsford Hospital

 

Breakfast at 7:00 a.m.

Business Meeting at 7:30 a.m.

 

 

“Trauma Case Presentation”

Robert Colen, D.O.

 

**Employee Health Services available for **

TB skin tests and Flu Shots

 

 

To avoid attendance issues please send a written excuse to Maral Meyers via fax at (248) 471-8837 or via email to mmeyers@botsford.org.  If you attend a General Staff meeting at another Osteopathic Hospital, please provide verification of your attendance.

 

 

 

2009 Botsford Autumn Gala- RESERVE YOUR SPACE TODAY

 

 

 

Join Us in Celebration- Tickets are Still Available

 

MUST BE RESERVED BY MONDAY, OCTOBER 26

Table Sponsor:  (10 tickets, full-page color ad, plaque and additional recognition)           $5,000

Four tickets plus a full-page color ad (plus additional recognition):               $3,000

Two tickets plus a full-page color ad:                                                  $2,000

 

RESERVE BY MONDAY, NOVEMBER 2, 2009

Individual tickets:                                                                                     $275pp    

 

Contact Marla Kaminsky at 248-442-5065 or mkaminsky@botsford.org.

H1N1 Treatment

This is an official

CDC Health Advisory

Recommendations for Early Empiric Antiviral Treatment in Persons with Suspected Influenza who are at Increased Risk of Developing Severe Disease

Summary Recommendations: When treatment of influenza is indicated in a patient with suspected influenza, health care providers should initiate empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation of influenza to begin treatment with antiviral drugs is not necessary.  Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative rapid influenza test result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests for 2009 H1N1 virus can range from 10% to 70%, indicating that false negative results occur frequently.

 

Welcome to the new Botsford Hospital Medical Administration weBlog site. We will be posting interesting information that our medical staff will find interesting and necessary to your practice at Botsford Hospital.

All important e-mails and letters will be posted here for you to read and comment on to increase the flow of information between Hospital administration and the medical staff.

We would appreciate your feedback as to the content we are sharing and its impact on your practice of medicine at Botsford and beyoond our hospital walls..