New generation of doctors prefer stability over autonomy

By Becky Johnson • Staff writer

---

In an effort to boost recruitment of doctors to the region, hospitals across Western North Carolina are following in the footsteps of a national trend to employ physicians in-house.

 

Historically, doctors set up independent, private practices.

But doctors are increasingly being squeezed by rising overhead and lower reimbursements for Medicare and Medicaid patients. As a result, doctors are gravitating toward a new model of being employed directly by hospitals. The hospitals keep the revenue generated from the patients, while providing a steady salary to the doctors.

“It allows them to do what they were trained for, the clinical work, and let someone else handle the administrative side,” said Tim Hubbs, CEO of Angel Medical Center in Franklin.

Whether it’s disciplining chronically late employees, shopping malpractice rates or billing insurance companies, “It is nice to say ‘Hey, can you all just handle that?’” Hubbs said.

Sylva-based WestCare is leading the hospitals west of Asheville in the number of physicians employed in-house. WestCare employs 19 physicians across six practices. Angel Medical Center employs 13, while Haywood Regional Medical Center employs five.

WestCare CEO Mark Leonard said the trend reflects a generational preference among younger doctors. He cited a recent survey of medical school grads at Duke University where 74 percent said they would rather be employed upon graduating than go into their own private practice.

“This really reflects a generational shift on the part of new physicians entering into medicine,” Leonard said. “It was incumbent on us to shift and embrace this new way of doing business.”

Leonard said he understands why the new model is attractive to today’s younger doctors, citing the long shifts doctors pull simply to care for their patients.

“When you put on top of that being a business owner and doing the taxes and the personnel issues, that causes the hours to stack up,” Leonard said. “These new physicians coming out say, ‘I just went to medical school and I want to emphasize the clinical side of medicine.”

Haywood CEO Mike Poore added that young doctors aren’t eager to follow the rigorous on-call schedule that had their older peers chained to beepers most of their lives. They want a steady salary and more free time.

Balancing autonomy

The only downfall of the model is a potential loss of autonomy. Doctors can suddenly find themselves answering to a hospital CEO, unlike a private practice model where they answer to no one but their patients.

All three hospital CEOs interviewed for this story said they recognize the concern.

“When I go to my personal physician, I don’t want to be thinking that there is a suit in another room influencing how he is going to care for me, my wife or my children,” Leonard said. “I want his decision to be based on what’s in my best interest as a patient.”

At WestCare, Leonard said he has laid the foundation of trust between physicians and administration and a collaborative decision-making model, which should in turn allay such fears.

“I am not a physician. I did not go to medical school. I am going to rely on and trust the physician’s judgment when it comes to clinical decision-making,” Leonard said.

Hubbs also pledged a hands-off management style when it comes to medical care.

“If a physician says I think we need a CAT scan on this, we are not going to second guess that,” Leonard said.

For Dr. Bruce Lobitz, an ER doctor who joined a team of hospital-employed doctors in the Angel emergency room this year, the possibility of hospital administration intruding on his care of patients was a top concern.

“That was one of my hesitations,” Lobitz said, who has found it not to be the case, however. “Here, there is very little of that.”

While it might give some physicians pause, the positves seem to outweigh the negatives.

“There is some trepidation in the loss of autonomy,” said Dr. Charles Trenthem. “But if you look at the trends nationally, this is what’s happening.”

While the nonprofit hospitals in the mountains have a community minded philosophy, larger for-profit hospitals could take advantage of the employment model.

“They do have a profit model, and they do push the providers at all levels to see that one extra patient, to generate that one extra charge,” said Dr. David Farley, an internist at Angel Medical. “I have not seen that be an issue here.”

Hubbs said there are external controls to ensure hospitals don’t prod physicians to order more costly tests than a patient really needs just to boost revenue. The insurance companies or Medicare who get stuck with the bill would notice an outlier ordering gobs of tests, Hubbs said.

There is one upside for patients: fewer bills. Anyone faced with a hospital stay braces for a litany of separate bills trickling in for lab tests, X-rays, various specialists and the hospital itself. Poore said bundled payments — where the bill for doctors is included with the bill from the hospital — is a model that shows promise.

Hospitals employing a critical mass of in-house doctors will often house them in a joint practice, even if they aren’t in the same specialty. It allows for integrated patient care, providing quick access to charts and reducing the chances of two doctors ordering the same test.

“Really it is kind of a data flow issue that is so clumsy in medicine right now,” Farley said. “If you’re housed in the same unit, you can walk down the hall and say ‘What did you think of Mrs. So-and-so this morning? Should I be concerned about this?’ You don’t have that when you are all scattered around in separate pods around town.”

Making the transition

While urban hospitals have launched a large-scale transition toward employing doctors, rural hospitals are using the model primarily to lure new recruits or to stabilize a faltering practice in a specialty the hospital can’t afford to lose within its medical community, said Dr. David Farley, an internist at Angel Medical.

“In this town, most of the employed physicians are the new recruits,” Farley said. “The existing doctors have remained solo, but I don’t think you can predict that will continue.”

Farley said the new model could be enticing to physicians at different points in their career, like a physician nearing retirement who wants to go part-time and no longer wants to deal with the hassle of managing a private practice.

As the new model develops, the result is a hybrid of traditional private practices and hospital-employed physicians within the community, Leonard said. Leonard largely follows the preferences of the doctor being recruited. If there is an existing private practice in the community the doctor wants to join, the hospital simply plays matchmaker.

When a doctor joins an existing practice, they are often expected to make an upfront investment.

“They buy in to do their fair share,” Poore said.

In Haywood County, both models exist within the same orthopedics office. Western Carolina Orthopedic Specialists has three doctors, two of whom own the private practice, while a third, Dr. Gerald King, is an employee of the hospital.

The hospital pays Western Carolina Orthopedic Specialists a management fee to covers King’s share of overhead, from office space to secretarial staff. The hospital also pays Kings salary.

In exchange, the hospital gets 100 percent of the revenue generated from King’s patients. It also benefits from having an orthopedist in the county who will bring business through the doors of the hospital. The hospital was suffering from a chronic orthopedist shortage that led patients unable to get appointments locally to take their business outside the county.

Haywood Regional Medical Center recently bought out Haywood Women’s Medical Center, the only Ob-Gyn practice in the county. The hospital now owns the practice and the doctors are employees of the hospital.

It was one of the first moves toward hospital-employed physicians in Haywood. The Ob-Gyn practice was a good starting place for several reasons, Poore said.

For one, doctors who deliver babies have some of the highest overhead.

“The malpractice is unbelievably high,” Poore said.

But the service is so crucial, no well-rounded hospital could afford to be without it.

“Our goals was to keep a viable Ob-Gyn practice in Haywood County,” Poore said.

Buying out an existing practice is more complicated than setting up the arrangement from the get-go with new hires. The process took six months and required outside consultants to help arrive at a fair purchase price.

Getting squeezed

The new model is particularly attractive to doctors in a climate of decreasing reimbursement rates for Medicare and Medicaid patients. Doctors take a bigger hit in rural areas, where a higher percentage of patients are likely to be on Medicare or Medicaid. It makes the offer of employment — and the steady salary that goes with it despite the poverty level of patients — an even more important recruiting tool in rural areas, according to Dr. Charles Trenthem, an anesthesiologist and chief of staff at Angel Medical Center.

“If we weren’t employing physicians and subsidizing their practices, the health care in Western North Carolina would suffer,” Trenthem said.

Angel Medical recently got a special “critical access” designation for its hospital that gets it a higher reimbursement rate from Medicare and Medicaid. Physicians employed by the hospital also enjoy the higher reimbursement rate, since billing is done by the hospital itself.

The issue is particularly acute in emergency room settings, where doctors are likely to see a higher number of patients without insurance who have no means to pay their bills.

While ER doctors theoretically treat patients without regard for whether they can pay, it can influence doctors on a subconscious level, said Dr. Bruce Lobitz, an ER doctor at Angel. But as a hospital-employed physician with a steady salary regardless, it makes it easier for doctors to ignore a patient’s ability to pay when providing care.

“I don’t care about the patient’s payer status. The hospital takes care of all that,” Lobitz said.

The hospital is left to absorb the hit, which can be a problem for rural hospitals already operating on a paper-thin margin, Trenthem said. The model also saddles hospitals with the upfront investment of setting up a new doctor and shouldering the risk if patient revenue falls short.

“Costs are being shifted to these smaller hospitals,” Trenthem said.

But given the trend, they had no choice but step up to the plate and adopt the model.

“The days of a physician going out and hanging a shingle are kind of over now,” Trenthem said.

via Smokey Mountain News

Health: Senate has much work ahead

By a thin margin of 220-to-215, the House of Representatives passed their version of health care reform legislation on Saturday. The flawed bill now faces Senate action, and without some substantial revisions is unlikely to pass.

Mississippi’s House delegation split over the bill with only 2nd District U.S. Rep. Bennie Thompson, D-Bolton, voting in favor of the bill. Democrats 1st District U.S. Rep. Travis Childers of Booneville and 4th District U.S. Rep. Gene Taylor of Bay St. Louis joined Republican 3rd District U.S. Rep. Gregg Harper of Pearl in voting against the legislation.

Both of Mississippi’s Republican senators – Thad Cochran and Roger Wicker – have said they can’t support the current Senate proposals contained in the Senate Finance Committee bill. That leaves Democrats scrambling in the Senate for support from Democratic moderates who reject the so-called “public option” and other measures contained in the House version.

That said, the public option – in states like Mississippi where private health insurance competition is relatively weak – is one that has the potential if structured correctly to help bring down health care costs for consumers and for taxpayers.

Key components of the House version of the bill that will almost certainly invite the scorn of the Senate include the failure to tax “Cadillac” insurance plans. The House bowed to pressure from labor unions on that facet of the bill. The House bill is also under fire for a significant lack of cost control and a lack of medical malpractice tort reform – both of which are critical to holding down the cost of expanding public health care.

The need to reform this nation’s health care system is one that isn’t argued by either of the two major political parties. But the methods by which the system is reformed and who bears the brunt of the financial burden for those reform are both contentious issues.

The House version of health care reform did address the issue of government-funded abortions. Removing that powder keg from the debate was a positive contribution and removes a stumbling block from Senate consideration.

The House also included strong mandates for industry to provide access to health care plans. But the Senate has much work to do. Final public health care reform legislation needs a stronger tax policy to support it than the House employed.

The Senate also needs to strengthen costs controls and beef up medical malpractice tort reforms if the legislation is to have a chance to pass.

via ClarionLedger.com

Maryland Court of Appeals to hear med-mal cap case



Hearing an appeal of a multimillion-dollar verdict, Maryland’s highest court last week considered if a trial judge engaged in “mischief” or correctly read the statute in ruling that the state’s cap on medical-malpractice awards for pain and suffering applies only to lawsuits first submitted to voluntary arbitration.

James L. Shea, representing a dermatology practice found liable in a Bethesda lawyer’s death, called the lower court’s ruling “totally at odds” with the General Assembly’s intent in passing the 2004 law. The legislature intended that the new cap limit doctors’ legal exposure and insurance premiums, thereby keeping health care costs down, Shea told the Court of Appeals.

But attorney Patrick A. Malone, representing the dead man’s family, said Montgomery County Circuit Judge John W. Debelius III’s ruling tracked the words of the 2004 Maryland Patient’s Access to Quality Health Care Act.

During Thursday’s session, Court of Appeals judges seemed to see merit in both lawyers’ arguments. Several judges said the legislature presumably intended the cap to apply to all malpractice cases but that the actual text of the law could indicate a more limited application.

When legislative intent conflicts with statutory language, courts should favor the law’s words, said Judge Joseph F. Murphy Jr.

“The question is not did they intend to do it, but did they do it,” Murphy said.

Shea, urging the court to focus on intent, said the General Assembly’s debates leading to the cap statute included “not one whisper” about exempting cases that have not been arbitrated.

Debelius engaged in “mischief reading” of the law to find that exception, said Shea, of Venable LLP in Baltimore.

But Malone said the law clearly delineates between cases that go first to arbitration, in which the cap applies, and those that go directly to trial, which are not subject to the cap. When the law is clear, judges should not try to determine the legislature’s intent, he added.

“The legislature knows how to write statutes,” said Malone, of Patrick Malone & Associates PC in Washington, D.C.

The high court did not indicate when it will decide the case, Norman A. Lockshin, M.D., P.A. v. Semsker, No. 78, September Term 2009.

via The Daily Record, Maryland

Court won’t hear case with conflict question

 

WASHINGTON — The Supreme Court will not review an $18 million verdict won by a lawyer who served as a co-chairman of the trial judge’s re-election committee.

The court on Monday turned down a hospital’s appeal in a case involving an infant who was seriously injured when a nurse hit his head on a night stand and then did not report the incident or seek treatment.

Brittany and Brandon Shinn successfully sued after their infant son, Nathan, suffered multiple skull fractures and a hematoma in the incident at Oklahoma Children’s Hospital.

Nathan Shinn died on December 14, 2006, shortly after the jury verdict against HCA Health Services of Oklahoma, doing business as Children’s Hospital at the University of Oklahoma Medical Center.

During the trial, HCA demanded that Oklahoma County District Judge Barbara Swinton recuse herself because Gerald Durbin, the Shinns’ lawyer, served as a co-chairman of the trial judge’s re-election committee.

Swinton was running unopposed. She said at trial that Durbin was only a formal co-chair and her husband was the person really running her re-election committee. She rejected the request to step aside, saying since she was running unopposed, there was no re-election campaign.

HCA unsuccessfully appealed Swinton’s decision to preside during the trial, but did not make the issue part of its state court appeal after the $18 million verdict was handed down.

HCA said the Supreme Court should review the case, considering the court said in June that elected judges must step aside from cases when large campaign contributions from interested parties create the appearance of bias. Durbin contributed $1,000 to her campaign, but got $719.77 refunded because she was unopposed.

But the Shinns said the court should not get involved since HCA did not make the recusal question part of its state appeals.

The case is HCA Health Services of Oklahoma v. Shinn, 09-311.

Copyright © 2009 The Associated Press. All rights reserved.

via AP

Trial lawyers could win bonanza in health care reform

 

By David Frum, CNN ContributorNovember 9, 2009 6:38 a.m. EST

The political equivalent: “Amateurs talk ideology — professionals talk interest groups.”

Small but sophisticated interest groups use big political battles to gain special advantages. Health care reform is, of course, the biggest battle of them all, with trillions of dollars at stake.

On Saturday night with the House vote in favor of the health reform bill, the trial lawyers sliced themselves a nice little piece of that bonanza.

It’s Section 2531 of the bill — to be precise Section 2531(4)b — and it provides as follows:

The new health bill will empower the Secretary of Health and Human Services to make grants to states that reform their medical malpractice systems. There are just two conditions: Those reforms must not “limit attorneys’ fees or impose caps on damages.”

Which is like saying that we’re going to encourage you to develop a personal weight loss plan that includes neither exercise nor changes in diet.

Here’s how Section 2531 works. Over the past decade and a half, states have reacted to abusive lawsuits by imposing various restrictions on personal injury awards.

In California, pain and suffering damages cannot exceed $250,000. Attorneys may collect no more than 15 percent of malpractice awards over $600,000.

The impact of these kinds of reforms can be dramatic. After Texas capped pain and suffering damages at $750,000 in 2003, the number of malpractice lawsuits dropped abruptly. Lawsuits in Harris County (Houston and environs) plunged by 50 percent.

Fewer lawsuits meant lower malpractice premiums. Texas’ largest malpractice insurance carrier cut costs to doctors by 17 percent. Lower insurance premiums attracted more medical professionals to the state. In the 1990s, Texas ranked low in the nation in the number of doctors per person. In the four years after 2003, the number of doctors in the state jumped by 18 percent.

“It was hard to believe at first, we thought it was a spike,” the executive director of the states’ medical board told the New York Times.

Texas’ experience is dramatic, but consistent, with other reforming states. States with damage caps gain more doctors than uncapped states — and the difference is greatest in the most underserved counties within capped states. Capped states have 5.5 percent more OB-GYNs per person in their rural counties than do states without caps.

But the money saved by insurers, doctors and their customers is money subtracted from the pockets of trial lawyers — and those lawyers carry real clout in the Democratic Congress.

The trial lawyers’ national PAC, the American Association for Justice, was the second-biggest source of PAC dollars for Democratic candidates in the 2006 election year: almost $2.6 million. That same year, Iowa’s trial lawyers elected a former president of their association to Congress. Had the National Enquirer been less inquiring, a former trial lawyer named John Edwards might well be serving as attorney general right now.

Huey Long once summed up the professional politicians’ credo:

“Those who support me early will have my close attention when I win office. Those who support me late will have my attention when I win office. And those who oppose me –” and here he’d wink — “they’ll get good government.”

We all know what Long meant by “close attention,” and his old party apparently still lives by his rules. On Saturday, House Democrats have delivered some very “close attention” to their friends in the trial bar. The question is: who will stand up for good government for the rest of us?

Two U.S. Senators who are MD’s, talk about Healthcare Reform and about health problems affecting Americans.

Can tort reform save health care?

By Paul Dailing and Susan Frick Carlman

After 28 years, Roop Shivpuri couldn’t afford to be a doctor any more.

At the end of her medical career, Shivpuri, now the president of the Kane County Medical Society, was paying $135,000 a year for malpractice insurance for her Elgin practice.

Dr. Roop Shivpuri retired from her ob/gyn practice two years ago because of rising malpractice insurance premiums. She now serves as president of the Kane County Medical Society.

The ob/gyn calculated that, based on the amount she was making versus the amount she was paying for malpractice insurance, she was basically doing the first six months of each pregnancy for free.

“I was drawing from my savings for several months before I thought, ‘What am I doing? This makes no sense,’” she said.

She opted for an early retirement, dissolving her practice two years ago this month.

Although Illinois is one of a handful of states that have set a cap on malpractice awards, Shivpuri, now 63, is among those who see more extensive malpractice reform as key in the overhaul of the nation’s health care system.

Without these reforms, even the public option proposed by President Obama would just be adding another insurance company to the mix, she said.

While most jokes about lawyers imply greed, corruption and the professional courtesy of sharks, doctor jokes generally go no further than to say they all play golf.

But the junction of the legal and medical professions comes in malpractice law, a field where both professions feel they’re the victim.

Howard Peters, senior vice president for government relations for the Naperville-based Illinois Hospital Association, said excess liability is responsible for $100 billion in health care costs every year. This is because physicians and other health care workers feel they must go to great lengths to guard against “unfair lawsuits.”

“We strongly believe that if you want to reform health care and you want to squeeze costs out of the health care system, you’re going to have to do comprehensive liability reform,” said Peters.

St. Charles attorney Peter Flowers is president of the Illinois Trial Lawyers Association. He believes malpractice reform is a giant red herring in the debate.

“I refuse to call this reform. There is no reform in this. It’s limiting the rights of people who have been injured,” he said, citing a Congressional Budget Office report that malpractice costs make up one-half of 1 percent of health care costs.

Would it matter?

One-half of 1 percent seems like a small figure.

However, one-half of 1 percent for the health care industry still amounts to $11 billion. And that number is for this year alone.

In an Oct. 9 letter to Sen. Orrin Hatch, R-Utah, CBO Director Douglas Elmendorf wrote that a tort reform package including caps on noneconomic damages and time limits for how long after an accident someone can find an injury would have long-reaching effects over time.

“Combining the effects on both mandatory spending and revenues, a tort reform package of the sort described earlier in this letter would reduce federal budget deficits by roughly $54 billion over the next 10 years,” Elmendorf wrote.

And for the doctors, it would result in a 10 percent reduction in malpractice premiums, Elmendorf wrote.

Shivpuri said caps on pain-and-suffering damages are only part of the equation.

“According to (the Kane County Medical Society), that sensible malpractice reform should be expert witness qualifications, there should be nonbinding arbitration and we need to have health courts, specialized health courts, but only a physician who has practiced medicine can determine if malpractice has occurred,” Shivpuri said, adding blame and damages are currently determined by juries.

“We are judged by a plumber maybe, we are judged by an office employee and they do not know what the practice of medicine is all about,” she said.

The Medical Rights and Reform Bill — sponsored by U.S. Rep. Mark Kirk, R-Northbrook, and cosponsored by Rep. Judy Biggert, R-Hinsdale, and 18 other House Republicans, and otherwise known as HR 2516 — includes a suggestion to “encourage states to adopt ‘alternative to litigation’ reforms such as early disclosure and compensation, administrative determination of compensation and specialized health care courts.”

The proposal also calls on doctors to consider practice guidelines supported by clinical evidence as a way of reducing defensive medical practices, and includes “stabilized compensation” for those who are injured in the course of receiving treatment.

Flowers said many doctors seem to forget that Illinois has had malpractice caps since the 2005 Medical Malpractice Act. And premiums are still high.

“That’s all something we’ve learned since 2005 is not the case. Premiums did not get reduced in Illinois other than slightly. And that was when the Illinois Department of Insurance reduced them,” Flowers said.

But the costs to the medical profession are mounting, with an increasing number of the most experienced doctors looking at getting out of the field, Shivpuri said.

“One-third of the U.S. physicians are my age group, and a lot of them are retiring prematurely,” Shivpuri said.

Scott McKibbin doesn’t dismiss a connection between the suits and the costs. The Naperville health care consultant helped set public policy during the state’s tort reform effort in 2005.

Defensive medicine drives up costs substantially, McKibbin said, and the expense is compounded when screenings and other costly procedures are repeated by different providers. Placing test results on discs that can be shared among medical facilities readily eliminates those added outlays and reduces patients’ inconvenience and discomfort, he said, though it’s not routinely done.

Shivpuri said doctors will continue to practice defensive medicine, ordering every unnecessary test and adding billions in medical costs until limits are set on malpractice suits.

“When a patient comes to see me, I will always have in the back of my mind that this is a patient who can sue me,” she said.

Also complicating the task of bringing down costs are cases in which doctors follow established medical protocols, but something beyond their control goes wrong — and the case ends up in court.

“Sure, somebody needs to have a forum to address some of these true medical errors or mistakes, but if you’re talking about an outcome that the doctor really didn’t have anything to do with … this is clearly one of the reasons why the United States has one of the most expensive health care systems in the world,” McKibbin said.

As for Shivpuri, she did not recommend medicine when her two children, now adults, came to her for career advice.

“I told my son, if you can’t beat them, join them,” she said. “He’s an attorney.”

via The Geneva Sun

Medical Research Spurt Offers Promise Of New Cures

The WALL STREET JOURNAL
By Anya Martin
November 5, 2009

As the first grants from $10 billion in federal stimulus to health research flow in, researchers believe they may see a renaissance in their profession that inspires a new generation of scientists and speeds up the race for many cures for years to come.

Nearly half of the new National Institutes of Health money – $4.35 billion – has been allocated to 12,770 projects in all 50 states. The grants already cross myriad health categories from treatments for well-known diseases that affect millions such as breast cancer, heart disease and diabetes to obscure disorders that normally have trouble attracting funding.

At a time when private and foundation funds were sparse due to the downturn, the announcement of the new federal dollars spurred a frenzy of activity at research universities across the nation.

“There was a big bang when people heard this money was coming and it was coming fast,” said Marcia L. Smith, associate vice chancellor in the Office of Research Administration at the University of California, Los Angeles. “Folks worked around the clock not just in the central office here, but in departments across campus.”

Normally UCLA submits about 325 research proposals per month to NIH, the National Science Foundation and other federal agencies, but in March, April and May 2009, the monthly rate spiked to 525, she said. By October, the tremendous effort had scored more than 200 NIH grants, totaling over $67 million and positioned the university to improve its research capabilities in a wide range of disease areas including cancer, HIV/AIDS and Parkinson’s disease while also benefiting the southern California economy.

“In particular, during this terrible (state) budget crisis in California, we’ve had to furlough faculty and staff,” she added. “That’s a hard way to retain faculty. These funds help us fill in these gaps.”

Federal funding has a greater potential for facilitating better health outcomes in the future than if the dollars came from private sources or foundations, said Arthur W. Toga, director of the UCLA Laboratory of Neuro Imaging (LONI), who recently received news that NIH had accepted his department’s proposal for funds to purchase a $1.9 million supercomputer.

“Let’s face it, the United States is a global leader in science and we only have that to lose if we don’t pay attention it,” he added. “These types of investments are very important to demonstrate a national commitment to scientific discoveries.”

The cutting-edge new technology funded by LONI’s NIH grant will significantly advance UCLA researchers’ ability to map the structure of the human brain and cross-reference MRI, CT and other scans. Those results, in turn, have the potential to inspire and spur scientists in institutions across the nation to devise and develop dynamic new treatments to prevent, slow and heal mental disorders such as Alzheimer’s disease, schizophrenia and Parkinson’s disease, Dr. Toga said.

“The only way you can get a handle on the progression of these diseases is to be able to mathematically combine and better understand the characteristics and biomarkers of their various stages,” he added. “These really are such complex problems for which you must have very sophisticated tools.”

Providing Hope

Those who suffer from less-familiar diseases may also see benefits.

Emory University School of Medicine in Atlanta, for example, received a $590,247 grant to finance Phase II human clinical trials for a promising new therapy that could benefit approximately 8 million Americans with peripheral arterial disease. Some have no symptoms, but for others just walking a short distance can be so painful that they cannot remain on the job and can eventually face loss of limbs and life-threatening complications.

Put simply, the severe discomfort comes from blockage and hardening of the arteries so that blood required for mobility cannot flow freely to the legs. Currently, the only treatments are to control risk factors such as stopping smoking, reducing cholesterol and blood pressure levels or controlling diabetes, as well as drugs such as Trental to treat leg pain and surgeries to restore the blood supply or bypass blockage, said Dr. Arshed A. Quyyumi, a cardiologist who leads the Emory team.

In the NIH-funded study, patients will be injected with a cytokine, which stimulates the bone marrow to release progenitor cells, which have the ability to mature into different tissues. The hope is that these naturally occurring cells will grow new blood vessels or repair damaged ones, Dr. Quyyumi said.

“(People with PAD) are a group of individuals at a dead end; there is no good therapy but amputating their legs when the disease is advanced,” he added. “If this is found to be a good modality of treatment, it will be hugely persuasive to get Phase III funding from NIH or industry. Even if it doesn’t, it could also stimulate more research into better cytokines. It moves the field forward.”

Stimulating Innovative Ideas

Another plus to the NIH grants is that one program objective specifically is to fund high quality research projects that explore new ideas as opposed to concepts that have been tested in the past, said Jordan Cohen, interim vice president for research and economic development at the University of Iowa in Iowa City. Iowa also rallied its researchers to acquire 128 NIH grants totaling $51.7 million as of Sept. 30, he added.

“It all combined to really energize everybody to start writing and put their best ideas down in a very short amount of time, but at the end of the day, what was most impressive for us was that a lot of individual faculty members applied for funding in new areas for them,” Cohen said. “The energy was going towards new ideas even if they don’t always get funded.”

One of the greatest benefits of the new monies is the potential to recharge morale and launch careers for science students and entry-level researchers who have been disheartened not only by stagnated private and foundation grant sources in the downturn but also by a long-term NIH funding deficit, he added.

Congress doubled NIH’s annual budget between 1998 and 2003, but NIH funding was flat at about $30 billion per year from 2003-08. Add inflation, and purchasing power actually dropped by 13%, according to Broken Promises, a 2007 analysis of the effect of NIH funding by scientists at eight of the nation’s most prominent research universities.

When the stimulus money is added in, it raises the overall outlay for both 2009 and 2010 by nearly 17% to approximately $35 billion each.

Indeed, the stimulus grants could not have come at a better time for Dr. Philip M. Polgreen, who was promoted to assistant professor of internal medicine at Iowa in 2006.

“When trying to develop an independent research program or start new collaborations, it’s always difficult when you’re starting out,” Dr. Polgreen said. “You’re competing with people who have track records, but it’s easier to get your first grant from NIH.”

For example, 6,311 NIH awards are specifically targeted to support Summer Research Experiences For Students And Science Educators, with every state guaranteed to receive this funding.

Polgreen attracted national attention for helping to develop the Iowa Influenza Prediction Market, where people could buy and sell shares which predicted annual flu activity.

Now an NIH grant is allowing him to repurpose used pagers to electronically track the movements and social networks of hospital staff with the goal of identifying patterns of infection spread in institutional settings.

“If we better understand the interactions between patients and physicians, nurses, respiratory therapists and there’s a vaccine shortage, we can make the tough decisions about who to vaccinate in a hospital setting,” Dr. Polgreen said. “It’s important for everyone to wash their hands, but maybe it’s even more important for some people.”

(Anya Martin is a freelance writer based in Decatur, Ga. She can be reached at 415-439-6400; AskNewswires@dowjones.com)

 

via Wall Street Journal

Medical Malpractice Cases Drop Off

Tuesday, November 3, 2009 at 01:42 PM

As some states continue adopting laws refining the requirements of a medical malpractice lawsuit, the number of payments made by physicians for malpractice claims dropped to the lowest level in recent years.

According to figures by the National Practitioner Data Bank, the number of these payments fell to 11,037 last year, which is the lowest number since the organization began tracking data in 1990, the Commercial Appeal reports.

In some states, as in Tennessee, new laws require plaintiffs to certify that they’ve conferred with an expert before filing suit. The law, passed in 2008, evidently affected courtroom trends as the number of medical malpractice cases in the state dropped by 65 percent between October 2008 and May 2009.

Mississippi legislation passed in 2004 set a $500,000 cap on the amount of money plaintiffs can receive for non-economic damages.

Furthermore, as research director for the consumer-advocacy group Public Citizen, Taylor Lincoln, told the news source, “I think it’s become harder to get lawyers to take malpractice cases. Only the most clear-cut and the most egregious cases, in terms of the potential financial recovery, can be pursued.”

In 1999 the Institute of Medicine reported that medical malpractice contributed to as many as 98,000 deaths in the U.S. each year.

via Avvo

Keane Insurance moving to Kirkwood

Current progress on the new Keane Insurance building

By Tim Bryant

St. Louis Post-Dispatch

Work is underway in downtown Kirkwood on the $6 million, two-story headquarters for The Keane Insurance Group, which will move from its current location in Sunset Hills. Contegra Construction Co., of Edwardsville, is putting up the 21,000-square-foot building designed by Archimages Inc. When completed next spring, the building at 135 West Adams Street will be faced in red brick with limestone and plaster accents and ribbons of amber-tinted glass. Nearly 60 people will work in the new headquarters, which also will house KIG Healthcare Solutions Inc., a Keane affiliate that markets electronic medical records.

via St Louis Post Dispatch