ReachMD XM 157 now presents this week's top stories from
the pages of American Medical News, the nation's leading newspaper for
physicians. American Medical News is published by the American Medical
Welcome to American Medical News on ReachMD XM 157. I am
Dr. Mark Chyna and I am Sue Berg on this week's program states struggle to maintain
Medicaid physician pay increases. A study documents burnouts and suicidal
thoughts among medical students and military tours of duty take a toll on
doctors and their practices.
Now, with the top story from American Medical News, here
is Dr. Mark Chyna.
More than half the states have raised Medicaid physician
rates for the fiscal year 2009, according to a survey of Medicaid directors,
but some other states have cut physician pay or are strongly considering cuts
because of dwindling tax revenues and the economic crisis. States face more
than 50 billion dollars in total deficits going into fiscal 2009, which started
in July in most states. Dr. Vernon Smith coauthored of the survey report and
is a Principal for Health Management Associates.
Well no state likes to cut Medicaid benefits, Medicaid
eligibility, or Medicaid payment rates. It just doesn't help the Medicaid
program to accomplish the goals, which they have set up for themselves and so I
think the first thing that needs to be set is that states do not willingly go
to cut provider rates, but having said that, we're on the threshold of a very
difficult economic time.
Increased Medicaid spending and enrollment are adding to the
strain. State directors say their relationship with Medicaid has deteriorated
as the Bush administration has worked to limit federal spending increases.
Democrats and Congress tried to adopt a temporary increase in the Medicaid
matching rate, but the economic crisis has deferred any such action until Bush
Both presidential candidates have said that they would
overturn president's Bush band on federal funding for embryonic stem cell
research, but some experts says Senator John McCain has sent mixed signals.
Bioethicist, R. Alta Charo is Co-Chair of the National Academies Human
Embryonic Stem Cell Research Advisory Committee.
R. ALTA CHARO:
His answers have been deliberately ambiguous. First, in
many cases he refers to stem cell research without specifying embryonic, adult,
or induced pluripotent stem cell research and so listeners can presume what
they wish about whether his support extends to all three or only to the
non-embryonic forms. In addition, he has suggested on several occasions that
the question of embryonic stem cell research in particular will soon, as he
puts it, become academic as if the advent of induced pluripotent stem cell
research has made embryonic forms unnecessary.
The stem cell battle is also being waged at the state
level. A Michigan ballot initiative seeks to repeal a law that would find or
even imprison researchers, who create new embryonic stem cell lines. Arkansas,
North Dakota, South Dakota, and Louisiana have restrictions similar to
Michigan's. David Doyle is a spokesman for Michigan Citizens Against
Unrestricted Science and Experimentation. He says the state's ballot
initiative goes too far.
Embryonic stem cell research is ongoing in Michigan today.
It's conducted at the University of Michigan Human Embryonic Stem Cell Research
Center. It is one of the largest Human Embryonic Stem Cell Research Centers in
the country and what this proposal would do is put a unique exemption in our
constitution. It says the state legislature would never be able to pass any
laws that prevent, restrict, obstruct, or discourage or offer disincentives for
anybody involved in this research or therapies or cures and what that means is
10 years from now or 20 years now anybody involved in this at the private level
or the public level could not be regulated in any way, shape or form, by the
state of Michigan.
Research developments have shifted the debate. Late last
year scientists successfully reprogramed adult skin cells to behave like
embryonic stem cells. It is not yet clear whether those cells can substitute
for embryonic stem cells and research.
From this week's Government and Medicine section, an Illinois
Appeals Court has shut down the governor's plan to expand health coverage for
low income parents. The ruling could jeopardize coverage for enrollees in the
family care program. The program covers low income parents whose children are
eligible for the State Children's Health Insurance Program or SCHIP. Governor,
Rod Blagojevich had directed the Illinois Department of Healthcare and Family
Services to enroll family care participants in Medicaid. Attorneys filed a
lawsuit on behalf of taxpayers. The court ruled that Blagojevich did not have
the authority to make the change without legislative approval. The governor is
considering an appeal to the state's supreme court. Other states are trying to
broaden access for the uninsured by expanding existing private and public
programs. Another legal battle is being fought over a 2007, Bush
administration directive that tried to limit eligibility for SCHIP programs.
At least 5 states sued the administration saying it did not have the authority
to act without public input.
Massachusetts will pour more than 20 billion dollars into
its landmark Commonwealth Connector Health System to keep it running through
2011. Jennifer Kritz is a spokeswoman for the Massachusetts Executive Office
of Health and Human Services.
Well as you know, Massachusetts has reached an agreement in
principle with the Federal Government to renew our healthcare reform waiver,
which will help the state to continue to expand access to affordable quality
care through our historic healthcare reform law and this is a 3-year 21.2
billion dollar agreement that represents an even stronger commitment to the
principles of healthcare reform than the states' current waiver and over the
past number of years, in less than 2 years, healthcare reform in Massachusetts
has made a significant difference for people without insurance; nearly 440,000
adults and children are newly insured and those are remarkable achievements.
From the American Medical News professional issue section,
the MacArthur Foundation has chosen 25 people as this year MacArthur fellows
including 4 physicians and a medical historian. Each MacArthur grantee will
receive a half million dollars over the next 5 years with no strings attached.
One of the new fellows Dr. Regina Benjamin is a family physician in Alabama.
She founded the Bayou La Batre Rural Health Clinic in 1990.
I am really not sure what I am going to do with it. It was
such a surprise to get it and it is such an honor, I am being kind of taken
away with that. The money is given over a 5-year period; if it were given in a
lump sum, I know exactly what I would do with it. I will finish completing our
clinic, which was basically destroyed by Hurricane Katrina. We rebuilt it and
then it was burned down, so we are in the process of rebuilding the clinic and
we kind of ran out of money so I would use it for that, but since the MacArthur
money, is given over 5 years, we can't wait 5 years for the clinic so I am sure
I will use much of it for the general operations and ongoing operations of the
clinic, as that's the hardest thing to come by anyway.
In this week's business section, military tours of duty are
taking a toll on doctors going to war zones and on their partners in
practices. Dr. Stephen Ulrich is a state surgeon for the Ohio National Guard.
He has been called away 3 times to serve his country, the latest was to review
medical records of soldiers who would be helping with relief duties during
Hurricane Gustav. He has also served as a flight surgeon in Iraq. Dr. Ulrich
and his partners have to sit down and work out a plan each time before he
It is kind of an involving process that we generally go
through. Fortunately, the National Guard has a planned rotation ability so
that we know ahead that we are being deployed, serving in the military with our
new 90-day Boots on the Ground policy, which is not really new now because we
have been doing it for a number of years. It does give us the flexibility of
knowing at least 3 months or so ahead of time if you have a particular
obligation. The challenge for us this time around was that, for my own
particular reasons, I chose to do a 6-month rotation. We were very fortunate
in that we were able to recruit a Locum Tenens doctor, who had practiced with
us previously at the last minute. We had anticipated having an additional
doctor in the practice to join us in my absence, but at the last minute she
chose to do urgent care instead of primary care and that presented a further
challenge for us. Many deployed physicians suffer financial hardships during
their time overseas, some lose patience and some have lost their practices.
Many physicians also lose their office based health insurance coverage.
Physicians who are being deployed are responsible for arranging care for their
patients and assuring access to patients records. Doctors also are required to
keep up with their continuing medical education hours.
This week in Health and Science, chronic stress associated
with paperwork and juggling job and family may be an one reason police officers
have an elevated risk for cardiovascular disease. Dr. Sandra Ramey is an
Assistant Professor of Nursing at the University of Iowa College of Nursing.
She says that police officers have twice the prevalence of cardiovascular
disease as the general population.
The way that stress impacts police officer's health is in
several ways. My research has shown that the primary way that affects their
health is by increasing the prevalence of several risk factors for
cardiovascular disease specifically cholesterol, hypertension, and being
They were also 3 times as likely to have high blood
pressure, high cholesterol, and diabetes. Other researchers are looking for
the biological mechanism that might trigger these health affects in police
officers. One hypothesis is at the bodies inflammatory response is higher in
people under chronic stress.
You have been listening to this week's top stories from
American Medical News. For these and other stories and for information on how
to join the AMA or subscribe to American Medical News, visit AMED news online
at its web site www-dot-amed-news-dot-com (www.amednews.com).
American Medical News is published by the American Medical Association, the
AMA, Helping Doctors Help Patients.