Showing posts with label Michigan. Show all posts
Showing posts with label Michigan. Show all posts

01 August 2012

Michigan Woman Dies From Flesh-Eating Bacteria

Story first reported from USA Today

FARMINGTON HILLS, Mich. -- Twelve days after doctors told a woman that she was finally clear of a life-threatening flesh-eating bacteria infection, she took a turn for the worse and died.

Crystal Spencer, 33, had spent a month in and out of three hospitals. Her husband had been visiting a rehabilitation hospital Sunday where she was about to be transferred when the hospital called and told him to return immediately.

A team of eight doctors worked for more than an hour to resuscitate his wife, amid alarms indicating she was near death three times. She died at 3:36 p.m. Sunday.

The family is raising money to conduct an autopsy to find out as much as they can about what happened. Results could take several weeks.

Until about a week ago when they learned that their application for Medicaid had been approved, the Spencers had limited health insurance. Now Jeff Spencer said he has thousands of dollars in medical debt from care not covered by insurance.

Crystal Spencer was a high school dropout and had been poor and underinsured or uninsured most of her life. She had adult-onset diabetes and weighed more than 300 pounds all of her adult life, factors that put her at higher risk of contracting the flesh-eating bacteria.

Her death from necrotizing fasciitis has drawn national attention to a rare disease many had never heard of and others knew only by its scary name: the flesh-eating bacteria.

Nationwide, the U.S. Centers for Disease Control and Prevention has reported 500 to 1,500 cases a year; 1 in 5 people dies from it. Many others have fingers, toes or limbs amputated because the bacteria eats away at underlying layers of tissue.

Many cases are misdiagnosed or found late, according to the National Necrotizing Fasciitis Foundation, a nonprofit founded by two women who survived the infection.

The foundation hopes to raise awareness about a problem that needs more education and hospital early intervention programs so symptoms can be caught and treated with antibiotics or the removal of dead skin and infected tissue, a procedure called debridement. Others need surgery, including extensive skin grafts.

Too often, patients get the wrong treatment because the infection is misdiagnosed, according to the foundation

Jeff Spencer said doctors at Huron Valley-Sinai in Commerce Township, Mich., originally had told him his wife had a urinary tract infection. At Botsford Hospital here, where she first sought care June 23 for what she thought was a boil on her upper right thigh, an emergency department physician lanced the protruding tissue and sent her home with a Motrin prescription, said Theresa Corwin of Farmington Hills, a close friend.

She and Spencer blame Botsford for not running blood tests to see whether white blood cell counts were elevated, a sign of infection.

They also wonder why a doctor there called the infected area on her leg an "abscess" -- an accumulation of pus and tissue triggered by an infection -- but gave them no warning that Crystal Spencer might be contagious. Corwin, who said she is certified in CPR and first aid, was given the job of cleaning the wound and changing the dressings four to five times a day when her friend got home.

On Monday, Botsford spokeswoman Margo Gorchow said it was unlikely that Crystal Spencer contracted necrotizing facitiitis there because the infection typically is not acquired in a hospital, and the woman had none of its symptoms when she came to the emergency department.

A spokeswoman for Huron Valley-Sinai declined comment both Monday and Tuesday, citing patient privacy laws.


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19 April 2012

Simple Test for Babies to Determine Heart Problems

Story first appeared in the Detroit Free Press.

It's a simple test, but it can make a life or death difference for newborns with a previously undiscovered heart defect. Pulse oximetry in infants -- a variation of the finger-clip test many Americans get to determine whether the heart is pumping blood effectively -- is being added in U.S. hospitals -- including a dozen in Michigan -- as a common newborn screening tool.

There's also a push here and in other states to pass laws, as Indiana and Maryland have, to require the test, according to a support group, PulseOx Advocacy, which tracks the issue on its website.

A lot of newborns can be discharged without knowing they have significant problems with the heart. Each year, between 4 and 10 out of every 1,000 children born in the United States will have a congenital heart defect. Of those, more than 1,500 won't live to have a first birthday, according to the American Heart Association.

Fortunately, detection tools have improved so much that many of the problems are found by fetal ultrasound tests during pregnancy or during exams by pediatricians after birth. For those that are not found prior to birth, pediatric pulse oximeters make the difference.

One baby of 14,017 tested at the University of Michigan between 2006 and 2010 was diagnosed through pulse oximetry testing with a heart problem that otherwise would have gone undetected.

U-M has routinely offered the newborn screening since 2003 because it saw a benefit to the tests and, as a teaching hospital, had pediatric cardiologists readily on staff. Michigan doctors are working with the Michigan Department of Community Health to create a statewide system so that babies born at hospitals without pediatric cardiologists get the right, immediate follow-up if they flunk a pulse oximetry test showing that their hearts don't pump oxygen effectively.

In a smaller community hospital, we need to make sure cardiologists are available to see patients.

Most of the 60 Michigan hospitals that deliver babies have fewer than 1,000 births a year and of those, half have fewer than 500 births -- places unlikely to have pediatric cardiologists on staff.

Michigan applied for a $300,000 federal grant to gather statistics about the screening and follow-up tests and treatment.

The project also will look at whether there are more inaccurate readings -- usually suggesting a problem that isn't there -- if the pulse oximetry test is performed after the first day of life, as is done in England without big problems.

2-minute test
Over the past few months -- and as recently as last week -- metro Detroit hospitals adding the test include Hutzel Hospital, Detroit; St. John Providence, Southfield, and St. Joseph Mercy Oakland, Pontiac, according to doctors and hospital spokespersons.

Others expect to start soon, including the Oakwood Healthcare system in Dearborn, St. Mary of Livonia and Beaumont Health System based in Royal Oak, spokespersons said.

Pulse oximetry is best at finding heart defects that result from poor oxygen circulation in the blood. It's usually performed 24 hours after a baby is born -- while most infants still are in the hospital. If the test picks up something suspicious, it often is repeated once or twice within the next few hours.

It's recommended that babies discharged before 24 hours after birth get the test within a few days at their pediatrician's office.

The tests take about two minutes. Sensors are attached with tape to a baby's hand and foot. St. John Hospital spent $16,900 to buy new motion-resistant machines for its labor and delivery unit.

Proponents hope to get the Michigan Lt. Governor to help push for mandatory testing. His then-15-month-old daughter underwent open-heart surgery last May for a congenital heart defect.

The Lt. Governor who has another child with autism, played a similar role recently in the passage of legislation to require insurance coverage for autism care.

For now, the Michigan Governor's office said it will review any legislative proposals and is working with hospitals to develop a coordinated system.

Push for a testing law

Several local groups, including Hearts of Hope, support a state testing law involving pediatric pulse oximeters.

A  Royal Oak woman's son, now 3 1/2, was born with a hole in his heart and a narrowing of a key valve and artery. The condition left him too weak to breastfeed. After he lost a pound of his birth weight and continued having nursing problems, she brought him to his pediatrician, who recommended he see a pediatric cardiologist.

When the diagnosis came, it was like the air shifted in the room.

He had heart surgery when he was just 9 months old. Today, he's doing fine, loves his gymnastics class and calls his younger brother his best friend. His long chest scar is nearly gone and he has stretched his follow-up appointments with a Beaumont pediatric cardiologist to every two years.


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05 April 2012

Michigan Abortion Providers Violate Safety Protocols

Story first appeared in the Detroit Free Press.

LANSING -- Abortion providers operate with minimal or no state oversight in Michigan, resulting in widespread violation of requirements for ensuring patient safety, the disposal of medical waste and patient privacy, according to a report by Right to Life of Michigan presented Thursday to a state Senate subcommittee.

Only four of 32 surgical abortion facilities in the state are currently licensed, the Right to Life's legislative director told the subcommittee. That lack of oversight results in widespread unsanitary conditions and serial violations of reporting requirements and result in rampant malpractice claims according to Detroit Medical Malpractice Lawyers.

In at least two instances in the last 10 years, the death of Michigan patients from abortion complications were not reported to the state, according to Right to Life, the state's leading anti-abortion lobby.

The director of the Bureau of Health Systems, which is responsible for the licensing and inspection of abortion clinics and a variety of other medical and psychiatric facilities, conceded the state provides relatively lax oversight. But many of the shortcomings pointed out in the report stem from the fact that so few clinics are licensed.  The agency doesn't have the authority to inspect an unlicensed facility.  But inspections even at the licensed facilities are infrequent, because of limited manpower. The licensing fees paid by the clinics are inadequate to support even a single full-time inspector.

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30 August 2011

DMC Invests In Itself For The Community

Story first appeared in the Detroit News. 

With more than half a year in the books with its new for-profit owner, Detroit Medical Center President and CEO Mike Duggan said patients and doctors are returning to the eight-hospital system, spurred by Vanguard Health System Inc.'s planned construction improvements.

Vanguard, which bought the DMC on Dec. 31 and promised to spend $500 million on construction, expansions and renovations and $350 million in routine capital during the next five years, said Thursday its shareholders lost $9.9 million during its fourth quarter.

The loss, compared with earning a $2.8 million profit a year ago, was driven largely by charges related to its June initial public stock offering. But patient service revenue soared 75 percent to $1.28 billion, largely attributable to the acquisition of the DMC.

Keith Pitts, Vanguard's vice chairman, said Detroit's seeing good volume in the marketplace, so they have been very happy with some of the volume trends there, and they will continue to work to improve the operations there over the next few years.

While Duggan isn't talking volume or revenue specifics — and neither are his Vanguard bosses in Nashville, Tenn. — Duggan said Vanguard ownership has boosted employee morale and hospitals have been busy.

Duggan said he has talked to doctors and patients all the time that have chosen to come back to DMC because of the momentum from Vanguard.

The DMC, which last year generated nearly $2.1 billion in revenue, now represents more than a third of revenues for Vanguard, which operates 26 hospitals in five states. With such a large exposure in Detroit, some analysts expect much of Vanguard's stock earnings will be all about Detroit during the next few years.

One anyalst said with over $2 billion in revenue solely in the Detroit market, they believe investors should get used to almost all focus on this one particular market, as the stock will likely live and die by the success of the transaction.

While some have questioned Vanguard's wisdom in buying the DMC, several analysts predict the DMC will continue to increase revenue, improve its margins and help Vanguard's stock price grow over the next several years.

But some, such as Citi research analyst Gary Taylor, have lowered outlooks on Vanguard's stock price from earlier this month in the wake of the stock market slide tied to concerns about the economy, Standard & Poor's downgrade of the U.S. credit rating and government talks of possible cuts to government reimbursement programs hospitals rely on.

The DMC and Vanguard hope to recapture some of the 30 percent-plus of Detroiters with commercial insurance who now head to suburban hospitals for surgeries and other services, analysts said. This insurance typically pays higher reimbursement than government programs.

Vanguard expects that infrastructure investment will improve physician recruitment, volume and payer mix, and new DMC facilities could directly contribute to revenue growth starting in 2013. Better facilities and more physician affiliations are expected to stem the outmigration of surgical volume from the city to the suburbs and to pull in some demand from the suburbs to the city.

A senior health care services analyst said Investing in the facilities will make them … to varying degrees more user-friendly, and if you can keep some of that care closer to where they live, it would be more convenient for the patients and (could generate) more patient revenue for Vanguard.

Gallucci, whose firm within the last year managed securities offerings for Vanguard, said if the DMC is successful on capitalizing on infrastructure investments, margins eventually will improve.
But Vicki Bryan, a senior high yield analyst for Gimme Credit, a research service on corporate bonds, doubts Vanguard's recent entry into Detroit and other markets will help revenue. She expects Vanguard will need to borrow more money to fund a projected cash flow shortfall.

She said the acquired assets are money losers and/or bankrupt operators, and this has resulted in even weaker operating margins and cash flow and massive capital expenditure obligations over the next five years.

Construction already is under way on some DMC building projects, and Duggan said the DMC is getting ready to contract out other projects. Vanguard officials are pleased about Detroit saying it's progressing as they hoped.


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08 November 2010

Technology a Blessing, a Curse for remote Island

Associated Press


Muggs Bass doesn't own a computer. She's pretty much dead set against e-mail. Anyone who calls her home on Michigan's remote Beaver Island should be prepared for a busy signal, if she's on her land-line phone. She has no cell.

"When you don't have it, you don't miss it. That's what I say," says the spunky 70-year-old grandmother, who's as comfortable telling jokes at the local pub as she is attending Mass each morning.

Technology isn't really her thing. So, it's a small miracle when Bass drives, once a month, to her island's rural health center to sit down in front of a wide-screen television. There, she and a handful of other islanders connect by video conference with a similar group in Charlevoix, Mich., a two-hour ferry ride to the south and east.

They chat. They laugh. They cry together.

All of them have, or have had, cancer, Bass included. Hers started with a lump in her breast and has since metastasized to her bones, making her cancer treatable, but incurable, her doctors tell her.

Her own grandmother died of the same disease and went off the island for occasional treatments, as Bass does every few weeks. But that grandmother could hardly have imagined a day when islanders talked openly about their cancer, face-to-face with people in a support group miles away.

It's just one of many ways technology is making this rugged place less remote than it once was and, some would say, more livable for more people.

It also gives islanders hope for new jobs that could attract residents to this island in northern Lake Michigan where the year-round population is about 650 people, give or take a few dozen.

"In the last few years, technology has sprung," says Joe Moore, a retired teacher who's known as one of the geeks on the island who helps keep computers running.

Not that the change has come quickly, or that technology always works perfectly.

That's just how it is on an island where a popular bumper sticker reads "Slow Down! This Ain't The Mainland." It's aimed at anyone who's in too big a hurry, including lead-footed tourists who kick up dust on the many dirt roads or who panic when cell phone service drops.

That's life on wired - or at least, semi-wired - Beaver Island.

___

So, where is Beaver Island, anyway?

Some Michiganders would show you by holding up their right hands, palms up, and pointing just above the tip of their ring fingers - in other words, just off the far northwest tip of the state's lower peninsula. But that's if even THEY know where it is.

While Michigan's Mackinac Island is well known, Beaver Island - much of its 54 square miles covered in lush hardwood forests, sand dunes or pristine inland lakes - is not.

That's partly because it is more difficult to get to, especially in the off season. Ferry service runs from Charlevoix, from April through mid-December. Quick flights in small propeller planes are available year-round, weather permitting. In winter, it's not unusual for islanders to be physically cut off from the mainland, unless an emergency sends the U.S. Coast Guard to their rescue.

So when high-speed Internet service became available to most of the island last spring, this was more than just a convenience. For many, it was a godsend - even if having the service simply meant being able to shop online for just about anything, to play an online game or to watch a newly released movie. For others, it meant being able to stay on the island longer because they had a more reliable connection to do work.

Either way, the outside world was even more readily available, at least virtually.

Schoolchildren on the island were ahead of this curve: The main public school knew how valuable it would be for them to be technologically savvy, especially when students headed to college. In the last decade, those students have been encouraged to take language and advanced-placement classes online. Some in high school also take college courses. They learn how to download and evaluate statistics using palmtop computers.

Connie Boyle, a teacher at the school, helped implement the technology program. She had a vested interest in it, partly because she and her husband decided to raise their daughter on the island after moving here from Chicago 25 years ago.

"We were worried - 'How do you bring up a kid on very tiny Beaver Island?'" Boyle says. An answer came when their daughter, now a freshman at Michigan State University, called recently about her computer class.

"Mom, I don't get it," she said. "I'm helping everybody here. We did all this in high school."

___

Today's state-of-the-art Beaver Island school is quite different from the one Muggs Bass attended. For her, books were the only real window to the mainland, especially in elementary school.

Like many who settled on Beaver Island, her great-grandparents and a grandmother had come from Ireland, to farm, fish and find a better life. Her own father was a dairy farmer. Born Mary Margaret but called "Muggs" as long as she can remember, Bass went to a small school across the field from the family farmhouse.

Until her school combined with another in the island's main town, St. James, she didn't even know some of her own cousins on the island. Other than a trip to the doctor when she was a young child, she didn't go to the mainland of Michigan - "across," as the islanders like to say - until she visited an aunt in Detroit when she was 12 years old.

"It was big and noisy," she recalls.

She didn't mind that her family didn't have a television until she was a teenager. For a long time, the closest thing she had to a technological device was the family radio, which she sat beside with her father to listen to boxing matches.

Her world was small in those days. That's how she liked it.

But after she graduated from high school, she left the island to find work and she ended up living in other parts of Michigan and then Illinois, where she met her husband. They then moved to northern Indiana, where they raised their son and his children from a previous marriage. Always, she longed to return to the island one day.

___

It's not the kind of life that appeals to just anyone.

Donna Kubic, a registered nurse who heads the island's rural health center, gets that. She tells the story of a young woman who came to the island to apply for a job at the health center. The woman had planned to stay for a week, but left after staying just one night in a lakeside cottage.

It was too dark out there with no street lights, she told Kubic. Too solitary.

This is, indeed, a place where one doesn't take modern convenience for granted. There is one grocery store, a couple of gas stations, a handful of restaurants and bars but no movie theater. There is no full-time doctor on the island, though two visit from the mainland twice a month. Critical patients are airlifted off the island, by the Coast Guard if weather shuts down other options.

As recently as two years ago, if someone needed an X-ray, the films had to be flown to the Charlevoix hospital so a radiologist there could read them. Depending on weather, it could take days.

Kubic knew there was a better way. She persuaded the hospital to help her apply for a grant that recently helped her purchase digital X-ray equipment for the health center. Now images can be transmitted in a matter of minutes.

Next came video conferencing, connecting the island's nurse practitioner and physician's assistant to the mainland hospital's emergency room. It's the same technology that allows Bass and the other islanders to take part in the "Circle of Strength" cancer support group.

"Without it, we'd be out here, in the lake, without a lot of support," Kubic says. Eventually, she hopes that primary care doctors and specialists - even mental health care providers - will be more willing to offer their services to islanders (though so far, she says, they've been reluctant).

"I think it's just education, saying the technology is there, getting the docs used to it," she says.

___

When Muggs Bass moved back to the island 12 years ago, she had no idea that she'd soon be dealing with a serious health issue.

A year after she'd been there, she traveled to the mainland for her annual mammogram, which revealed cancerous tissue. She had surgery to remove a breast.

"Then I went along fine for 10 years," she says, until she got a cough she couldn't shake. One morning, she got up and said to her husband, "I need to go across, to the doctor."

Her lung was filling with fluid. The cancer had spread to her bones.

So for the past 18 months, she has traveled to the mainland every six weeks for an infusion of a drug that keeps her bones from fracturing, and also takes a daily pill to slow the cancer's growth. The goal is to extend her life as much as possible.

"I'm going to hold to this until I reach something else," Bass recently told her support group. "And then I'll have to make another decision."

The group in Charlevoix includes an 80-year-old woman with lung and colon cancer, as well as younger mothers who've survived breast cancer and those who are in the thick of the battle. They talk about infections and drainage tubes, mammograms and mastectomies. They somehow manage to find humor in topics such as constipation.

One of the moms, introduced to the Beaver Island group through video conference, thanked Bass for sending her a card and a prayer.

"I read it every day," the woman, who has 11- and 16-year-old children, told Bass. "I'm in it for the long term fight. I'm prayin' hard, too."

"That's what you do," Bass said, as she grabbed a tissue to dab her eyes.

Diane Gorkiewicz, who began the Charlevoix "Circle of Strength" six years ago, marvels at the intimacy that has developed so quickly between her group and the islanders.

"The only thing you're missing are all the hugs and stuff," Gorkiewicz told the islanders during a recent video conference.

"And the food," Bass said, teasing the Charlevoix group that they need to share the treats they bring to their meetings.

___

Joe and Phyllis Moore understand the dynamic.

Earlier this year, the longtime islanders were able to "attend" their youngest granddaughter's first birthday party via Skype. Guests at the party in Washington state sat at a computer to introduce themselves. The Moores saw the cake. They gave real-time wishes to the birthday girl.

"Just thinking about it, it almost brings tears to my eyes," Joe Moore says.

It's not ideal, but the best they can do - better than they could've hoped for, really. The hard reality is that the cost of getting off the island can be prohibitive.

Most islanders have to "wear many hats" just to get by, Moore says. In addition to his computer work, he's one of the island medics and also runs a local website that provides video footage of township meetings, as well as the school's soccer and volleyball games.

Phyllis Moore is now the assistant librarian, but when she moved back to the island after college, she and Joe ran a vacation lodge while he did his student teaching.

"Like most graduates, I was going to get off this rock and never look back," says Phyllis Moore, now 62. "And look where I am now."

Many young people who live here say technology - social networking and their cell phones included - make life on the island better for them, too. But in the end, they face the same dilemma as everyone else: How do you make a living here? And what if there's really no place for the kind of work you want to do?

Brontae Cole, a 17-year-old high school senior, will be heading to college next year and wants to become a homicide detective.

"There's one cop here, two in the summer if we get lucky," Cole says. She grins. "And not a lot of dead people."

Jewell Gillespie-Cushman, a 14-year-old freshman, also wonders where he'll land. His late grandfather, an island icon for whom he was named, was born on Beaver Island and lived here his entire life. Gillespie-Cushman isn't sure he could do the same, even with more contact with the outside world than his grandpa had.

"I'm still debating whether to stay here, or move over there," he says.

___

Like Muggs Bass, though, a growing number of people want to find a way ONTO Beaver Island - many of them among the thousands who visit each summer and would like to make it home. For many of them, technology is the key.

Jeff Stone and his wife, Sarah Rohner, were able to start spending more time on the island in 2006, when a satellite-based service began offering an Internet connection that was about two-thirds as fast as the newest service, and much faster than the sluggish dial-up service that had been the only option.

The satellite option enabled Stone to quit his real estate job in the Chicago area to start a website design business that he and his wife run from the island much of the year, though not without some initial glitches.

He recalls how snow from a huge storm covered their satellite dish, cutting off their Internet service just as they were about to launch their site.

"We ended up going out in the back yard and throwing snow balls at the dish," he says. That knocked off enough snow to get the Internet working, and they were back in business. But it's not always that easy, or quick.

Laurel Vietzen, a college professor, also from the Chicago area, who now spends several months a year on the island, remembers a violent summer thunderstorm two years ago that left much of the island without Internet and phones. "We had a daughter at the University of Iowa and we were hearing about terrible flooding in Iowa City," she says. "It was three days before we could reach her!"

Now that Internet service on the island is more reliable, many islanders say cell phone service is the big hurdle. One mobile provider's service works well here, though only on the upper third of the island - and outages happen more frequently than most would like.

Even those who reap the benefits of technology feel torn, though. They worry that it infringes on one of the very things they love about the island - its inherent, blissful peacefulness.

Technology is, at once, their blessing and their curse.

On a summer night, it's not unusual to see more than a dozen people sitting outside the library's memorial garden, on picnic tables and in their cars, tapping into the free wireless that's left on 24 hours a day.

At the same time, islanders and summer residents alike regularly complain about all the people who now walk around the main streets of St. James, staring at a smart phone screen or iPad instead of their beautiful surroundings.

"The technology is wonderful, but ... ," Phyllis Moore says. She raises her eyebrows, noting how, on a nice day, she isn't opposed to kicking kids out of the library after they reach their 30-minute time limit on the computers there.

Meanwhile, it used to be the joke that, by St. Patrick's Day, anyone who lived here year round couldn't stand the sight of anyone else. In many ways, communicating with the outside world helps with that, but not always.

"I don't think it's eliminated cabin fever or getting at each other's throats," Joe Moore says, chuckling. "Sometimes, I think it makes it worse because they can communicate more and get on each others' nerves even more."

___

Muggs Bass knows about the squabbles and the way a rumor can take on a life of its own, computer or no computer. She wasn't too happy, for instance, when she heard that some islanders were calling her cancer "inoperable." She didn't like the sound of it - wished they'd just ask her directly.

But that was nothing, she says, compared with the support she's gotten from her tiny island community.

"We joke. We kid. We take care of each other," she says. "I can't imagine living anyplace else."

When she got her latest diagnosis, islanders organized a "50/50 raffle" for her, where the winner is supposed to take half the donations. Instead, the winner gave his portion to Bass, a common outcome on Beaver Island. All up, she received nearly $9,000 to help with flights to the mainland and other expenses related to her illness.

"You talk about emotional," Bass says, tearing up again.

She recalls sitting down after that to pray and, as she might say, have a chat with God.

"I thanked Him, and thanked Him, and thanked Him. I was so grateful that I was able to come back and live here, and for holding me up at this time in my life," she says.

The support group and her new friends on the mainland are part of that.

For her, technology - at least her little slice of it - has allowed the best of both worlds.

10 April 2010

Michigan Lawmakers Push for Further Health Care Reforms

mLive

 
On the heels of the national health care overhaul, a bipartisan group of lawmakers in the Michigan House and Senate have introduced a package of four bills to address access to individual health insurance in Michigan, including some new rules on how insurance carriers may treat individuals who have pre-existing conditions.

Sen. Tom George, R-Texas Township, the lead sponsor of the Senate bills, says the proposals are designed to increase access to insurance coverage for the uninsured, help stabilize Blue Cross Blue Shield of Michigan and improve the health of state residents.

George, a practicing anesthesiologist who is running for governor, said the bills have strong bipartisan support and he hopes they can be passed this year.

While many of the proposals overlap the federal health-care law, George said the state legislation is necessary because “we don’t know if the federal bill could be changed or repealed. It’s also being phased in over several years, and we have issues we need to address now.”

Some of the proposals in the state bills include:

    * Requiring any Michigan health insurance provider to cover individuals’ pre-existing conditions after six months rather than 12 months.
    
    * Preventing a carrier from limiting or excluding coverage because of a pre-existing condition for those moving from group coverage to individual coverage.

    * Prohibiting insurance companies from canceling policies for reasons other than non-payment.


It also would overhaul the state’s health-insurance market for individuals. Currently, Blue Cross Blue Shield is the market of last resort for people who cannot obtain insurance through an employer or government program. But George says that individual market is an “unfriendly market” right now, and there are 1.3 million Michigan residents who are uninsured.

Under the proposal, Blue Cross would lose its tax exemption status and have to pay $90 million to $100 million annual tax assessment, which would be used to help subsidize premiums for those pursuing individual insurance.

In a statement, Blue Cross called the bills a “step forward” but said they need to be modified.

“Blue Cross believes that these bills need some changes to reflect provisions of federal health care reform and ensure fair taxation and regulation among insurance carriers,” said Mark Cook, vice president for governmental affairs.

George said one of the biggest differences between the federal legislation and his proposals is an emphasis on healthy behaviors. He said the bills would allow insurance carriers to take into account whether insurance clients smoke or are overweight when pricing premiums.

“There would be a reward for taking care of ourselves, which is absent now,” George said.

01 April 2010

County Set to Waive Taxes in DMC Sale

The Detroit News


The Wayne County Commission is expected to approve a proposal today to waive taxes at the Detroit Medical Center to allow its sale to a for-profit company from Nashville, Tenn.

The deal cleared a hurdle Wednesday when the commission voted 12-1 to move it to the full board. The proposal creates a 100-acre Renaissance Zone that forgoes most taxes for 12 years and phases them in for another three.

The zone is expected to allow Vanguard Health Systems to compete with nonprofit medical facilities.

"It sends a message to any business that wants to invest in Detroit that you've got a county commission that's pro-business," said Mike Duggan, CEO of the DMC. "It's a good day for Detroit."

The Detroit City Council also has to approve the zone, but no date for that action has been set. The county committed its last zone -- a state-sanctioned development tool -- to the medical center campus, which hasn't generated taxes because the DMC is nonprofit.

Under the deal, Vanguard would pay off the bonds and assume liability for any other DMC liabilities, totaling $417 million. It is also expected to invest $850 million, including $500 million for a new tower for Children's Hospital of Michigan.

"The message this is going to send nationally and internationally is that this multibillion-dollar company firmly believes in investing in Detroit," said Turkia Mullin, assistant Wayne County executive and chief development officer.

"We recognize this is a historic day for Wayne County and a historic investment."

Commissioner Bernard Parker, D-Detroit, objected, saying Detroit should have scrutinized the zone first. Commissioner Laura Cox, R-Livonia, whose husband, Attorney General Mike Cox once worked for Duggan, abstained.

But most commissioners were enthusiastic about the plan.

"Our citizens in Detroit deserve the best," said Commissioner Keith Williams, D-Detroit.

"We're on the right track of preserving health care and preserving the tax base in Detroit."

22 March 2010

Need for Elder Care Services Ready to Explode

Gaylord Herald Times
LANSING — At a press conference in Lansing on Tuesday, the Aging Services of Michigan will release its 2010 Annual Long Term Care report, “A Decade in Review,” focusing on long-term elder care issues.

The association is issuing a call for action on the state level to change public policies that are detrimental to the care of seniors, family caregivers and nonprofit care providers.
According to the Aging Services of Michigan, which represents nonprofit organizations providing community and home-based services for the elderly, there will be an explosion in the need for such services in the coming years.

Among the issues reported in the review is the estimation that Alzheimer’s disease will affect 180,000 Michigan elders in 2010, with an additional 200,000 people affected by from some form of dementia. The number of adults 65 and older will represent 20 percent of the population by 2030; the number of adults 85 and older, the fastest growing age group in the nation, will double by 2050. Michigan is not prepared for the increase in the aging population.

“Michigan’s long-term care system is under assault and has been for a long time,” said David Herbel, president and CEO of Aging Services of Michigan. “The need for Michigan senior care is increasing, while funding and state support is eroding.”

Women have traditionally been the caregivers of aging relatives, but economic factors over the last few decades have forced more and more women into the workforce as a necessity for family survival. The decreased funding and increasing need  for care providers as the aging population grows will put an additional burden on middle class families already struggling.

The report was initially released in the first of a series of regional meetings with Aging Services of Michigan’s nonprofit member organizations. It was held at the Otsego Memorial Hospital (OMH) in Gaylord March 4. OMH’s McReynolds Hall skilled nursing facility, which provides short and long-term care, is a member.

For a copy of the 2010 Annual Long Term Care Report, visit the Aging Services of Michigan’s Web site at www.AgingMI.org.

17 March 2010

As Patients Flock to Medicaid, Doctors Drop Them

NY Times
With Medicaid Cuts, Doctors and Patients Drop Out

 Rebecca and Jeoffrey Curtis searched for care for their son. In the process, they felt like “second-class citizens,” Ms. Curtis said.


FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.


New doctors, with their mountains of medical school debt, are fleeing Michigan because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.



In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work and without a Michigan health insurance company for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.

“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.

“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.

Michigan Medicare and Medicaid enrollees in the state's midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”