Editorials

Widespread interest in health system reform

Thomas C. Meyer, MD, Medical Editor, Wisconsin Medical Journal

When it was decided last year to have an issue focused on “Affordable Care” I don’t believe any of us anticipated the response that has evolved. We find it sobering that there is the intense interest and concern about health system reform as is demonstrated in the pages of this issue. We decided to publish them in a compendium of ideas that could/should be considered in the upcoming debate.


Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Commentaries

Society must lead the way in reforming health care system

Mark K. Belknap, MD, President, Wisconsin Medical Society

A 50-year-old female convenience store manager from the Upper Peninsula of Michigan was recently referred to me from the emergency department (ED) for evaluation of heart failure. She had presented to the ED with progressively severe shortness of breath and leg edema. She had no health care insurance and had not seen a physician for several years. Following an episode of rheumatic fever as a teenager, she had a history of a murmur. An echocardiogram was performed, and it showed severe mitral stenosis and severe pulmonary hypertension. I referred her for cardiac catheterization, which confirmed the findings of the echocardiogram, and she underwent mitral valve replacement. Several aspects of this patient’s case are typical in patients without health insurance. Because she had no personal physician, she initially presented to the ED, where care is much more expensive. Her costs exceeded $60,000 and she has since applied for “compassionate care.” She presented at an advanced stage of her disease because she had not had regular ongoing health care. It is likely that she developed rheumatic fever and, subsequently, mitral valve disease because of lack of access to care for her initial episode of streptococcal pharyngitis. As a consequence of her need for mitral valve replacement, she will need lifelong anticoagulation with warfarin, with its attendant cost and risks. It is uncertain at this point how much of her pulmonary hypertension is reversible, and she may continue to suffer the morbidity of this condition because she did not receive care in a timely manner.



Author Affiliations: Doctor Belknap specializes in internal medicine in Ashland, Wis

Corresponding Author: Wisconsin Medical Soceity 330 E. Lakeside St Madison, WI 53715

Co-op Care: Using cooperative principals to add value to health care

Melissa Duffy and Bill Oemichen, Wisconsin Federation of Cooperatives

For more than a decade, studies and polls too numerous to mention have found that health care has been at the top of the list of concerns facing working families. This is especially true for Wisconsin farmers and other rural and urban small businesses that have suffered double-digit premium increases in each of the past several years.



Author Affiliations: Wisconsin Federation of Cooperatives is the statewide trade association representing the interests of more than 865 Wisconsin cooperatives owned by more than 2.9 million Wisconsin citizens. It was the primary advocate for a new law that allows for the cre

Corresponding Author: Wisconsin Federation of Cooperatives

The Wisconsin Health Security Act: A necessity for people, business, and the economy

Linda F. Farley, MD; Eugene S. Farley, MD, MPH

The problem: The rise of market-driven, investor-owned, for-profit health care has led to an increase in costs, and a decrease in access and benefits. The solution: The Wisconsin Health Security Act, a publicly funded not-for-profit health plan for Wisconsin.



Author Affiliations: Doctor Eugene Farley, Jr, is professor emeritus and former chair of the Department of Family Medicine, University of Wisconsin, Madison, Wis. Doctor Linda Farley is assistant professor emeritus, with the Department of Family Medicine, University of Wiscon

Corresponding Author: Please address correspondence to them at lfarley@wisc.edu or esfarley@wisc.edu.

Starting the health care debate in Congress

US Senator Russ Feingold

When I ask Wisconsinites what issues Congress should be working on, I often get the same answer: health care. I hear it everywhere I go, a desperate refrain from people deeply frustrated with our health care system, and increasingly angered by Congress’ inaction. There are an estimated 45 million Americans who are uninsured, and countless more who are underinsured.1 The skyrocketing costs of health care are crippling businesses, hurting families, and frustrating the medical community, and it’s time to do something about it.



Author Affiliations: Senate

Corresponding Author: Please address correspondence to: Senator Russ Feingold, 1600 Aspen Commons, Rm 100, Middleton, WI 53562; phone 608.828.1200; or 506 Hart Senate Office Building, Washington, DC 20510; phone 202.224.5323.

Should Wisconsin finance health care through a special tax and a voucher system?

Guenther P. Pohlmann, MD

Historical and Economic Perspective Burdening employers with most of the cost of health care is a distinctly American phenomenon. Wage freezes during World War II enticed industries to offer their employees full health insurance coverage as an incentive for employment and a reward for work performance. This benefit continued into the post-war years as well, prompted by the negotiation pressures of powerful labor unions and a general labor shortage.

Author Affiliations: Doctor Pohlmann is a retired internal medicine physician from Milwaukee

Corresponding Author: Please address correspondence to: Guenther P. Pohlmann, MD, 1459 East Bay Pont Rd, Milwaukee, WI, 53217; phone 414.352.4214; e-mail guentherp@aol.com.

The Wisconsin Health Care Plan: A practical, effective, and comprehensive response to our health care crisis

David Newby, President, Wisconsin State AFL-CIO

We are facing a catastrophic health care crisis in Wisconsin and in the United States as a whole. For those not yet eligible for Medicare, we have linked access to health care to employment. Yet nearly 46 million Americans do not have health insurance and the increases in health insurance premiums have risen to a point where soon neither employers nor employees will be able to afford it.



Author Affiliations: Wisconsin State AFL-CIO

Corresponding Author: Please address correspondence to: David Newby, phone 414.771.0700; e-mail dnewby@wisaflcio.org.

Affordable health care: A local solution

Judy Reed

Madison’s Mayor Dave Cieslewicz recently said that important initiatives in this country will only happen if they begin locally, and the 150 volunteers for Wisconsin Health Care for All Inc. (WHCFA) couldn’t agree more. WHCFA members have found a solution to America’s health care crisis. They’ve even figured out how to implement universal health care now, without having to spend years negotiating with state lawmakers.



Author Affiliations: Ms Reed is the Communications Director for Wisconsin Health Care for All Inc. She is the former director of the Program Information Office, Division of Continuing Studies, UW-Madison. She was a Dane County Supervisor from 1986-1992.

Corresponding Author: For more information, visit: www.wisconsinhealthcareforall.org.

Wisconsin Medical Society Health System Reform Plan

Paul Wertsch, MD

Health care premiums are skyrocketing. The number of uninsured continues to climb. States are in a fiscal crisis, struggling to plug huge deficits. Back in 2002, the Wisconsin Medical Society Board of Directors saw the enormous issues facing health care and voted to convene a Task Force on Health System Reform. The charge of the task force was to guide the Society’s role and positions in the debate on health care expenditures and system reform. The task force and its committees analyzed health care funding and ways to expand access to appropriate and high quality health care. The task force also addressed the ongoing issues of the uninsured and underinsured in Wisconsin and considered various cost-containment approaches. To ensure that the task force viewed health care system reform from a broad perspective, the Society invited participation from various other Wisconsin groups (see sidebar). I participated on the task force as the then-President Elect of the Society. The task force recommended a Health System Reform Plan (Plan), which was endorsed by the Society. Its three main goals are: 1. to attain universal health insurance coverage 2. to provide high quality health care 3. to control health care costs

Author Affiliations: Doctor Wertsch is a Past President of the Wisconsin Medical Society and a family physician in Madison, Wis.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

The New Wisconsin Idea: A prescription for health care system reform

Al Jacobs, Chief Executive Officer of the WEA Trust

It has been almost five years since I wrote Solving Wisconsin’s Health Care Cost Crisis: A Call to Action and three years since I developed The New Wisconsin Idea, a plan for health care system reform. Sadly, while we have made some progress since then, we continue to waste about 40% of our health care dollars due to what remains an incoherent, fragmented health care system that is heading pell mell toward collapse. The New Wisconsin Idea (NWI) is a prescription for reform that can turn Wisconsin’s health care system into the highest quality and most cost effective in the nation.



Author Affiliations: WEA Trust

Corresponding Author: Please address correspondence to: Al Jacobs, e-mail ajacobs@weatrust.com.

The health care conundrum: Providing access to the uninsured while balancing costs

Donald C. Logan, MD; Christy Mokrohisky, MBA

Who deserves access to health care? If we agree everyone deserves medical care, who bears the responsibility of paying for care for the uninsured and underinsured? In this article, we will address the financial impact that the uninsured have on the health care delivery system and outline the efforts of Dean Health System to offer quality care to the uninsured through innovative programs and community partnerships.



Author Affiliations: Authors are with Dean Health System. Doctor Logan is Chief Medical Officer, Ms Mokrohisky is Director of Community Advocacy & Partnerships

Corresponding Author: Christy Mokrohisky at 608.250.1471.

Affordable health care practiced here

Josephine Guenzel, RN, MSW; Peter Sigmann, MD

We present our experience in providing affordable primary care to the uninsured population of a rural Wisconsin county in the hope that it may be of interest to physicians in other parts of the state with similar needs.



Author Affiliations: Ms Guenzel is administrator and Doctor Sigmann is medical director of the Community Clinic of Door County, and a member of the Wisconsin Medical Journal Editorial Board

Corresponding Author: Please address correspondence to: Peter Sigmann, MD, CCDC, 1623 Rhode Island Ave, Sturgeon Bay, WI 54235.

Original Research

Emergency Department Visits in Wisconsin 1998-2002: Trends in Usage and Accuracy of Reported Data

James E. Svenson, MD, MS

Introduction: There is a paucity of data regarding the utilization of emergency departments (EDs) across Wisconsin. It is unknown if national trends in increased utilization are consistent within our state. Several years ago, mandatory reporting of ED visits to the Department of Health and Family Services was instituted and, if accurate, may provide a method for tracking ED usage.

Methods: We conducted a survey of existing EDs to study the trend in patient visits for the 5-year time period 1998-2003. Data reported in the surveyed departments were compared to those reported to the state database.

Results: On average, all EDs reported a consistent yearly increase in patient visits over the time period (an average overall increase of 10%). On average, this increase was larger for smaller hospitals. Growth was consistent over the time period, but the yearly rate steadily slowed down. Data reported to the state consistently underreported the actual census.

Conclusion: All sizes of EDs across Wisconsin continue to show increases in ED utilization. The growth rate is consistent but may be slowing. This has implications for planning for ED resources. Reported data have many discrepancies and need to be independently checked before they can be utilized in any research or planning.



Author Affiliations: Doctor Svenson is an associate professor in the Section of Emergency Medicine, University of Wisconsin, Madison, Wis

Corresponding Author: James Svenson, MD, MS, Associate Professor, Department of Medicine, University of Wisconsin, F8/175 Clinical Science Center, 600 Highland Ave, Madison, WI 53792; phone 608.265.5808; fax 608.262.2641; e-mail jes@medicine.wisc.edu.

Low Bone Mass Prevalence and Osteoporosis Risk Factor Assessment in African American Wisconsin Women

Srividya Kidambi, MD; Susan Partington, PhD; Neil Binkley, MD

Background: Post-menopausal osteoporosis is seen in all racial groups. With the increasing population and longevity of minority groups, osteoporosis is becoming an important health concern. Data regarding risk factors for, and prevalence of, low bone mass and awareness of osteoporosis risk in African American (AA) women are limited.

Objective: This article evaluates the risk factors for, and prevalence of, low bone mass in a population of urban AA women in Wisconsin and assesses this group’s perceived risk for osteoporosis.

Methods: One hundred fifty consecutive community-dwelling AA women >45 years old from Milwaukee, Wis were asked to complete a questionnaire based on currently accepted osteoporosis risk factors. Additionally, their perception of osteoporosis risk was assessed using a Likert scale. All subjects underwent quantitative calcaneal ultrasound. Results: Subject mean age was 54±7 years. Mean T- and Z-scores were 0.5 and 0.4, respectively. Applying World Health Organization criteria, osteopenia (bone mineral density T-score <-1.0) was present in 23.3% and osteoporosis (bone mineral density <-2.5) in 9.3%. Multivariate analysis of risk factors showed that lifetime incidence of at least 1 fracture, multiparity (>2 children), postmenopausal state, and current smoking were associated with lower calcaneal bone mass. Higher education and presence of diabetes were associated with a higher bone mass. Only 25% of the women surveyed thought they were at moderate to high risk for osteoporosis.

Conclusions: Low bone mass was present in 33% of these AA women despite their relative young age. Many AA women do not perceive osteoporosis as a health risk. It is necessary to develop strategies to educate AA women regarding osteoporosis risk.



Author Affiliations: Funding was provided by the Department of Medicine, University of Wisconsin Medical School, Milwaukee Clinical Campus, Milwaukee, Wis. Doctor Kidambi is with the Medical College of Wisconsin, Milwaukee, Wis. Dr Partington is with the University of Wiscons

Corresponding Author: Srividya Kidambi, MD, Department of Endocrinology, 9200 W Wisconsin Ave, Milwaukee, WI 53226; phone 414.456.6816; fax 414.456.6210; e-mail skidambi@mcw.edu.

The Increasing Incidence of End-Stage Renal Disease in Wisconsin from 1982-2003: An Analysis by Age, Race, and Primary Diagnosis

Kelly L. Stolzmann, BS; Jenny L. Camponeschi, MS; Patrick L. Remington, MD, MPH

Purpose: To examine the trends in the incidence of end-stage renal disease in Wisconsin from 1982 to 2003. Methods: De-identified incidence data for this study were supplied by the Renal Network of the Upper Midwest (Region 11). We examined trends in the incidence of end-stage renal disease by age, race, gender, and primary diagnosis from 1982 to 2003.

Results: The incidence of end-stage renal disease increased more than 3-fold from 1982 to 2003. This increase was especially striking in persons with diabetes and hypertension, as well as among those aged >75 years. The increase in the incidence of end-stage renal disease was also apparent among all racial groups and both genders.

Conclusions: The continued increase in the incidence of end-stage renal disease in Wisconsin may result from a number of factors, such as an unintended consequence of better chronic disease management, which may predispose older individuals to end-stage renal disease. Resources aimed at decreasing the incidence of end-stage renal disease are needed to prevent unnecessary health care costs and negative health outcomes, including loss of life.



Author Affiliations: This journal article was supported by Grant/Cooperative Agreement Number U32/CCU522717-03 from the Centers for Disease Control and Prevention, Division of Diabetes Translation. Ms Stolzmann is a graduate student in the Population Health Sciences Departmen

Corresponding Author: Kelly Stolzmann, University of Wisconsin Population Health Institute, 610 N Walnut St, WARF Building – 7th Fl, Madison, WI 53705; phone 608.265.8924; fax 608.262.6404; e-mail klstolzmann@wisc.edu.

Case Reports

A Challenging Patient, An Innovative Solution

Jaishree Hariharan, MD; Kathryn M. Denson, MD

This report of the management of a 28-year-old patient over 2 and a half years illustrates how interaction between psychosocial issues and physical symptoms complicates diagnosis and management. The case also highlights the challenges inherent in a large health care system with multiple health care professionals, clinics, and available resources. A “team model” approach is outlined as a useful strategy in such cases. Once problem areas are defined, a partnership agreement (contract) is recommended, which applies structure and limits to the physician-patient relationship. This contract calls for mutual trust, communication, and accountability while preventing excessive use of the health care system. Our patient and hospital system greatly benefited by this approach as evidenced by (1) a 60% decrease in medication costs, (2) markedly decreased ED visits and telephone calls, (3) successful treatment of depression and anxiety, and (4) a positive outcome on the patient’s health.

Author Affiliations: Authors are with the Medical College of Wisconsin, Milwaukee, Wis. Doctor Hariharan is an associate professor of medicine in the Division of General Internal Medicine. Doctor Denson is an assistant professor of medicine in Geriatric Medicine.

Corresponding Author: Jaishree Hariharan, MD, Assistant Professor, Division of General Internal Medicine, Medical College of Wisconsin, Froedtert East Clinic Building, Suite E4200, 9200 W Wisconsin Ave, Milwaukee, WI 53226; phone 414.456.6866; fax 414.456.6212; e-mail jharihar

Your Practice

Does celecoxib increase cardiovascular risk?

Brian J Mayer, MD; Randall Lamfers, MD; David A Feldstein MD

A 50-year-old woman with no coronary risk factors and a history of peptic ulcer disease is taking rofecoxib for osteoarthritis. She has tried acetaminophen and did not receive as much relief for her pain as she does with the rofecoxib. Since rofecoxib was voluntarily withdrawn from the market for increased cardiovascular events, she wants to know if her cardiovascular risk would be increased if she switched to celecoxib.



Author Affiliations: Authors are with the University of Wisconsin Hospital and Clinics. Doctor Mayer and Doctor Lamfers are both chief residents in Internal Medicine. Doctor Feldstein is an academic hospitalist. He is also an assistant professor in the Department of Medicine

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Index to Articles 2005

Wisconsin Medical Society

Index

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Your Profession

Taking the lead locally to address our urgent national problem

Philip M. Farell, MD, PhD

Most experts agree that the American health care system is in jeopardy and must be improved. Health care expenditures continue to rise—both as a percentage of the gross domestic product and on a per capita basis. At the same time, outcomes are not improving proportionally; in fact, the health of the population has leveled off while expenditures are still climbing.



Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Your Society

Resolution Deadline Date for 2006 Wisconsin Medical Society Annual Meeting

Wisconsin Medical Society

Resolution deadline

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Wisconsin Medical Society Strategic Plan 2006 - 2008

Wisconsin Medical Society

Strategic Plan

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

To Cure a Cold

Arthur J. Patek, AB, MD, Editor, Wisconsin Medical Journal

Consul-General Guenther, of Frankfort, Germany, reports a new cure for a cold. It consists of a mixture of cocaine, paranephrine, and water, applied on cotton to the nose. It arrests secretions, and cures the cold, usually, by several applications. Inasmuch as colds can lead to dangerous diseases, it is wise to prevent its protraction. In the case of children, Doctor Vohsen advises mothers to cut a small rubber tube obliquely and to insert the sharpened end into the nose; then, by means of a rubber ball, blow air into the tube. Thus the secretions in one side may be blown out through the other side. This eases the children and allows them to breathe freely. One can see at a glance how valuable such knowledge is. It can be used in all kinds of cases affecting the nose and throat.


Author Affiliations: Arthur J. Patek, AB, MD, Editor, Wisconsin Medical Journal

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Maidson, WI 53715

Are you protecting your most valuable asset?

Russ Heil, Principal Life Financial Representative

Your ability to work and earn a living is your most valuable asset. Most of your income is earned income. When you stop working, your income stops. When protecting your most valuable asset, you should ask yourself, “How long could I live on my savings if my income stopped this very second?” It’s shocking that people in the richest nation in the world are often within six weeks of personal bankruptcy.



Author Affiliations: Mr Heil is a Financial Representative of Principal Life Insurance Company. Principal Life is a member of the Principal Financial Group, Des Moines, IA 50392. Disability Income Insurance has limitations and exclusions

Corresponding Author: For costs and complete details of coverage, contact Wisconsin Medical Society Insurance and Financial Services, Inc., at 866.442.3810.

The 100,000 Lives Campaign

Jay A. Gold, MD, JD, MPH

Seven Wisconsin health care organizations have come together to form a “node” in the Institute for Healthcare Improvement’s 100,000 Lives Campaign.



Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract with the Centers for Medicare & Medicaid Services

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715