SCMS BULLETIN - June/July 2018 by SCMS Bulletin

The

Bulletin Saginaw County Medical Society

June/July 2018 | Volume 76 | No 8

SCMS Efforts on Suicide Awareness Training Directly Result in New AMA Policy p. 16-17

safeTALK Suicide Alertness Training Saturday, November 10, 2018 p.18

Save the Date: Shawn C. Shea, MD Nationally Known Suicidologist Monday, October 15, 2018 p. 22

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The

Bulletin Saginaw County Medical Society

contents 9

Save the Date! Opioid Crisis and Pain Management Saturday, October 6, 2018

SAGINAW COUNTY MEDICAL SOCIETY 2018-2019 OFFICERS AND DIRECTORS

16-17 President Julia M. Walter, MD President-Elect Zubeda S. Khan, MD Past President Virginia R. Dedicatoria, MD

17-18

Secretary Caroline G.M. Scott, MD Treasurer Mohammad Yahya Khan, MD Board of Directors

Mildred S. Willy, MD Anthony M. Zacharek, MD Jorge M. Plasencia, MD

21 22 22

SCMS Efforts on Suicide Awareness Training Directly Result in New AMA Policy safeTALK Suicide Alertness Training on Saturday, November 10, 2018

23 24

Primary Care – Why Address Suicide Prevention?

KeepSafe Connections How Can You Help? Save the Date! Shawn C. Shea, MD Nationally Known Suicidologist Monday, October 15, 2018 Ten Facts About Physician Suicide and Mental Health Walk for Hope Sunday, August 12, 2018

A Comprehensive Approach To Suicide Prevention

Kala K. Ramasamy, MD Tiffany K. Kim, MD Mark G. Greenwell, MD Bulletin Editor Louis L. Constan, MD Retiree Representative Rustico B. Ortiz, MD Resident Representative Mary J. McKuen, MD MSMS Delegates Elvira M. Dawis, MD Zubeda S. Khan, MD Julia M. Walter, MD Virginia R. Dedicatoria, MD Mildred J. Willy, MD Anthony M. Zacharek, MD Jorge M. Plasencia, MD Christopher J. Allen, MD

4 4 5 5 6 8 9 10 11

12 14 25 27

President’s Letter Attention Retired Members Save the Dates 2018-19 SCMS Meetings Caduceus Meeting for Recovering Health Professionals From the Editor August Birthdays Application for Membership ACEP Turns Up Criticism of Anthem’s Emergency Care Policy ACS CME Dropped for MOC Participants

St. Mary’s of Michigan | Ascension CMU College of Medicine | CMU Health Covenant HealthCare MSMS Saves Michigan Physicians $2,000,000+

Pictorial Directory Advertising Information

Pictorial Directory Advertising Contract

30 31 32 32

MSMS Advertiser Index Key Providers Calendar of Events

MSMS Alternate Delegates Caroline G.M. Scott, MD Waheed Akbar, MD Mohammad Yahya Khan, MD Danielle C. Duncan, MD Steven J. Vance, MD Amandeep S. Dhaliwal, MD Miriam T. Schteingart, MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS District 8 Director Thomas J. Veverka, MD EXECUTIVE DIRECTOR Joan M. Cramer ADMINISTRATIVE ASSISTANT Keri Benkert

The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

ON THE COVER: Barb Smith of Barb Smith SUICIDE RESOURCE & Response Network EDITOR Louis L. Constan, MD

PUBLISHER Saginaw County Medical Society

EXECUTIVE DIRECTOR Joan M. Cramer

350 St. Andrews Rd., Suite 242, Saginaw, Michigan 48638-5988. Hours: Tuesday, Wednesday, Thursday 8:30 AM - 3:30 PM. Web: SaginawCountyMS.com

DESIGNER Lori Krygier

Telephone: (989) 790-3590. Fax: (989) 790-3640 E-Mail: jmcramer@sbcglobal.net

All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events). The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals. The Bulletin is mailed free of charge to SCMS members as part of their membership. Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.

The Bulletin | June/July 2018 3

PRESIDENT’S LETTER

Fair Coverage? By Julia M. Walter, MD

n an effort to cut medical care costs, some new policies have been put into place. Some insurance agencies have enacted policies that place the coverage of an entire emergency room visit on the patient if the visit is determined to be non-emergent based on the diagnosis after evaluation. Six states (Georgia, Indiana, Missouri, Kentucky, Ohio and New Hampshire with Texas currently on hold) have enacted these changes to insurance coverage. The plans use a list of diagnoses considered emergent. If the diagnosis is not on the list, the claim is subject to “prudent layperson review of the medical record.” If the visit is not considered emergent, then the physician is reimbursed a screening fee of about $16.

On the surface, these policies appear prudent in helping to lower the cost of medical care. Emergency room visits are expensive. There are other less expensive avenues of obtaining care such as telehealth, independent provider clinics and urgent care walk-in clinics. In the past, some of the services only provided in the ER can now be provided in an urgent walk-in clinic. Most concerning is that diagnosis after evaluation, rather than symptoms prior to evaluation, are being used to determine what constitutes emergent needs. This requires that patients act as medical professionals to make a medical judgement, a diagnosis, without the training or information to make those decisions. So who is correct? The answer is not simple and probably differs from

patient to patient. Fortunately, Michigan has not been affected by these policies, but could face the changes in the future if this becomes a national trend. I welcome your comments and thoughts on this subject. Note: See ACEP Turns up Criticism of Anthem’s Emergency Care Policy with New Video Campaign on page10.

“This requires that patients act as medical professionals to make a medical judgement, a diagnoses, without the training or information to make those decisions.”

Julia M. Walter, MD

ATTENTION RETIRED MEMBERS! Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw. Those attending are responsible for their own lunch, and the informal gathering lasts about an hour. Join your retired colleagues whenever you like! If you have any questions, please contact Joan Cramer at the SCMS office at 790-3590 or by email at jmcramer@sbcglobal.net.

The Bulletin | June/July 2018

There are no Membership Meetings in July or August Tuesday, September 18, 2018 Membership Meeting - ETHICS Mark your calendar now for our Tuesday, September 18, 2018, Membership Meeting joint with the Saginaw County Osteopathic Society at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Jason Wasserman, PhD, Associate Professor of Biomedical Sciences at Oakland University William Beaumont School of Medicine will present a program on “Why Preventative Medicine is Failing: Understanding the Human Nature Behind Social Determinants of Health.” Dr. Wasserman joined the Oakland University William Beaumont School of Medicine faculty in July 2013. He directs the Medical Humanities and Clinical Bioethics courses for M1 students, as well as, serving on the Admissions, Curriculum and Student Research committees among others.

Tuesday, October 16, 2018, Membership Meeting Mark your calendar now for our Tuesday, October 16, 2018, Membership Meeting hosted at and by HealthSource Saginaw. The social starts at 6:30 p.m., followed by dinner, meeting and a Candidates’ Forum for the November election at 7 p.m.

Tuesday, January 15, 2019, Membership Meeting Mark your calendar now for our Tuesday, January 15, 2019, Membership Meeting joint with the Saginaw County Dental Society at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Henry Reyna will present a program on “Surviving Acts of Violence.” Reyna was a law enforcement officer in Saginaw County for 32 years until his retirement in 2015. Additionally, he was also an instructor at the police academy for over 20 years, teaching recruits and in-service officers in the areas of defensive tactics, edge weapon defense, hand guns and the use of rifles. Henry owns a security consulting business, and has been providing his services to several local prominent businesses. He is a certified Crime Prevention Specialist, and has participated in multiple advanced crime prevention training programs around the country.

Tuesday, April 16, 2019, Membership Meeting Mark your calendar now for our Tuesday, April 16, 2019, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Topic: TED Talks (tentative) – Do you have a topic you would like us to consider? Please contact Joan Cramer at jmcramer@sbcglobal.net with your idea and details.

Caduceus Meeting for Recovering Health Care Professionals Tuesday Nights at 7 p.m. | Zion Lutheran Church | 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs. Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists. We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members. The Bulletin | June/July 2018 5

FROM THE EDITOR

Only the Lonely By Louis L. Constan, MD

lthough some may find it laughable how teenagers will pine so intensely for lost love as depicted in Roy Orbeson’s classic song, “Only the Lonely,” it is no joke that loneliness can be a painful experience. It can also be a health hazard, according to research quoted recently by former Surgeon General, Vivek Murthy MD, because it leads to serious health problems such as heart disease, depression, anxiety and dementia. Seen any of these problems in your practice lately? In fact, according to Dr. Murthy, loneliness afflicts 40 percent of the U.S. population and causes a drop in life expectancy equivalent to smoking 15 cigarettes a day! Human beings, as we know, are not meant to be lonely. We are meant to live in groups. For thousands of generations, our survival as a species has depended upon cooperation between individuals within a group setting. Cooperation is how we protected ourselves from predators and found meaning in our lives. Very important! When people find themselves alone, levels of stress hormones increase and stay increased we know what happens then. And yet, being alone is what more and more of us spend more and more of our

time doing. Alienization in our society has been progressing for many decades. Extended families no longer live together. Both spouses work, and the children are in child care with strangers. Break times and lunch times at work are getting shorter and shorter in pursuit of greater productivity. More and more people, but less and less community. Even when we are together in a group, we often are separated because the other individuals are preoccupied with their tasks (work, to-do lists, texting, listening to music, etc.). This has led to what another popular song, this one by Simon and Garfunkel called “The Sounds of Silence,” where people are “speaking without listening.” Does any of this resonate with you? The fact that loneliness leads to serious problems should not be a surprise. It is reflected in our very language. Indeed, synonyms for “lonely” include: Solitary, dejected, sad, isolated, lifeless, empty, abandoned, forlorn, hopeless and desolate. These words scream illness. Our pining teenager doesn’t seem so laughable now, does he? He’s a poster boy for modern society, and he needs help. But help from whom? Not the pharmaceutical companies; not likely

they can come up with a pill. Not the government; they’re preoccupied with other issues. Not insurance companies; a diagnosis code for nearly half of humanity? Guess who’s left? The ones who’ve been treating these people all along, but who’ve perhaps failed to fully appreciate the depth of their problems. Perhaps it’s time we did so. Our patients would benefit, and we, I believe, would benefit as well. Consider the following patient: Her formal diagnosis is heart disease. True enough. But an underlying diagnosis is stress caused by lack of social connections - loneliness. She lives alone, her spouse has died, her children live in California and most of her old friends are in nursing homes. She calls the office for an appointment, but won’t get off the phone, chatting away about anything and everything, keeping your receptionist away from doing “productive” work for you. When you see her, you have trouble getting her to describe her symptoms, as she keeps rambling on about non-medical events in her life. She does this with everyone in your office. She slows down your whole day. Some doctors might find such a patient an annoyance, but if they continued on page 7

You cannot avoid the fact that patients will look to you and your staff for social connections. They are both physically and mentally more intimate with you than with practically anyone else in their lives. It is Louis L. Constan, MD

The Bulletin | June/July 2018

natural they will look to you as an extended family member and source of support.

continued from page 6

listen carefully, they will find a patient who is screaming, like the teenager above, for help, and no one is listening. She is lonely, and wants to make social connections – desperately - with everyone in her doctor’s office. Sure, she has heart disease, but a contributing cause is loneliness, and she is trying to tell you that. If you could do something about her loneliness, you would both improve the efficiency of your office and improve the life expectancy of your patient. Or rather 40 percent of your patients. A worthy goal at that! You cannot avoid the fact that patients will look to you and your staff for social connections. They are both physically and mentally more intimate with you than with practically anyone else in their lives. It is natural they will look to you as an extended family member and source of support. The only question is what you are going to do with the influence that comes with that status. I suggest the following:

• One “history” question should always be something along the lines of, “What do you do with your free time?” If it does not appear the patient engages in activities that connect with other people, then red flags should go up that this person could be lonely. • Another history question should be, “Who lives in your household?” Same idea as above. • Keep a list of volunteer organizations to hand out to those who seem disconnected. United Way has one. The hospitals are always looking for volunteers. Places of worship and faith-based initiatives such as Salvation Army and Habitat for Humanity as well. Volunteering is an excellent way to bring lonely people together. 1 2

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The Bulletin | June/July 2018 7

AUGUST BIRTHDAYS Salisu A. Aikoye MD Michael J. Argyle MD Ronald C. Barry MD M. Arshad Bashir MD Sussan M. Bays MD Ronald H. Bradley DO Michael J. Dense DC Michael L. Fiore MD Karensa L. Franklin MD Mark J. Heinzelmann MD Perlita P. Ilem MD Ankita A. Kapoor MD Sharanjit K. Khaira MD Harold B. Lenhart MD Ruth M. Licht DO Miles P. Light MD Robyn M. Lorenzo DO Amita Kakarla Maganti MD Steve Min DO Charles E. Mueller MD Gopi K. Nallani MD Sujal G. Patel MD Priya M. Punnoose MD

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APPLICATION FOR MEMBERSHIP Below is an Application for Membership that may be recommended for acceptance at the Tuesday, September 18, 2018, Board Meeting. Please contact Joan Cramer at jmcramer@sbcglobal.net or 790-3590 if you have any questions or would like more information on the applicant. Wendy S. Biggs, MD (CMU College of Medicine-Director, Comprehensive Community Clerkship) Specialty: Family Medicine, Board Certified 1994 Medical School: Baylor College of Medicine, Houston, TX, 1990 Residency: Baylor College of Medicine, Family Medicine, 3/90-7/93 Prior Practice: Dexter Village Family Physicians, Dexter, MI, 1993-98; Chelsea Community Hospital, Chelsea, MI, Interim Chief, Family Medicine Inpatient Service, 1/99-12/99 and Vice Chief of Medicine 1/00-12/01; Midland Family Medicine Residency Faculty, Midland, MI 1/02-12/10; American Academy of Family Physicians, Deputy Director, Medical Education Division, Leawood, KS, 1/11-5/13; and University of Kansas Family Medicine Residency Faculty, Kansas City, KS, 5/13-12/17 Sponsors: Doctors Delicia J. Pruitt and Steven J. Vance

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The Bulletin | June/July 2018 9

ACEP Turns up Criticism of Anthem’s Emergency Care Policy with New Video Campaign If Anthem Blue Cross Blue Shield decides your visit to the ER was not an emergency, based largely on their undisclosed list of diagnoses, they’ll leave patients with the entire bill. The American College of Emergency Physicians (ACEP) recently released two new videos to point out the dangers of the insurance giant’s controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients. To view the videos, go to www.FairCoverage.org. “Countless symptoms can either be something minor or something life-threatening,” said Paul Kivela, MD, MBA, FACEP. “We can’t possibly expect people with no medical expertise to know the difference between the two before they even leave their house. Anthem is forcing them to play doctor and threatening them financially if they go to the ER.” The videos focus on two scenarios that the Anthem policy could lead to. The first shows a man with stomach pain looking up possible causes on the internet. His wife advises him to go to the ER, but he refuses, saying “if it ends up being just a

10 The Bulletin | June/July 2018

“These videos demonstrate what millions of people go through every day trying to determine what is an emergency and what is not and hoping they make the right choice.” – Paul Kivela, MD, MBA, FACEP hernia or really bad stomach pain, our Anthem insurance won’t cover us.” The second video depicts a man in a gym with chest pain. A concerned employee offers to take him to the ER but he refuses, saying “if it turns out to just be injured ribs, Anthem could deny my claim and send me the ER bill.” “These videos demonstrate what millions of people go through every day trying to determine what is an emergency and what is not and hoping they make the right choice,” said Dr. Kivela. “Anthem’s policy is unlawful. The ‘prudent layperson standard’ is federal law that requires health insurance companies to cover emergency visits based on the patient’s symptoms, not the final diagnoses. No insurance policy is affordable if it abandons you in an emergency.” Currently, Anthem has rolled out this policy in six states: Georgia, Kentucky, Indiana, Missouri, New Hampshire and Ohio. Unless stopped, this could go into effect in more Anthem states, as well as, additional health insurance companies possibly following with policies of their own. Emergency physicians are urging the public to contact state and federal legislators and regulators and demand that they ensure that the prudent layperson standard not be violated. Health plans must provide fair payment for emergency services or emergency patients will suffer. Go to www.FairCoverage. org and learn more.

ACS CME Dropped for MOC Participants The American College of Surgeons Committee on Trauma (ACS-COT) recently revised the criteria for trauma CME for trauma centers. Effective immediately, certified physicians from any ABMS Member Board with a MOC program that includes sufficient trauma content will not need to acquire trauma CME credits. ABEM and every major EM organization submitted the trauma content of ABEM’s MOC Program and it was found to meet this standard, so ABEM-certified physicians participating in MOC no longer need to fulfill the ACS-COT trauma center verification trauma-related CME requirement. ABEM will continue to seek opportunities like this to add value to your certification. Please send any questions you may have to moc@abem.org.

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St. Mary’s Oncology Research Programs Receive Additional Grant

As a result of the St. Mary’s of Michigan’s Seton Cancer Institute’s extraordinary efforts related to its clinical trial patient accruals from August 1, 2017, through May 1, 2018, it is receiving an additional $25,000 lump sum payment from the Michigan Cancer Research Consortium (MCRC) for the second year in a row. To receive this added payment, a MCRC component hospital had to achieve at least 25 equivalent credits by May 1. St. Mary’s Seton Cancer Institute exceeded the goal and reached 36.2 equivalent credits. This program works with patients to participate in studies designed to determine ways to best prevent, detect, diagnose and treat cancer. The knowledge gained through clinical trials is at the core of advances in cancer care for patients. Kathi Smith-Nowlin, Director of Seton Cancer Institute, expressed many thanks to the St. Mary’s principal investigators within the MCRC including: Ernie Balcueva, MD; Asma Taj, MD; Elayne Arterbery, MD; Tushar Shah, MD; John Bartnik, MD; and Bei Liu, MD, for identifying patients who could potentially benefit from cancer clinical trials. In addition, St. Mary’s Oncology Research department played a significant role. Special thanks and appreciation to Clinical Research Specialists Lori Srebinski, LPN, and Stacey Lopez, LPN.

St. Mary’s Launches Online Scheduling Advertising Campaign St. Mary’s of Michigan unveiled its new online scheduling advertising campaign aimed at increasing access to compassionate, personalized care. The comprehensive campaign, which is part of Ascension’s national consumer 12 The Bulletin | June/July 2018

marketing strategy, educates the public on the ease and convenience of scheduling care online. Online scheduling allows for last-minute appointments, decreases appointment cancellations and offers same-day scheduling, which research shows patients prefer. It also streamlines the appointment-making process, allowing patients to go online using their computer or mobile device and schedule appointments for themselves and their family anytime, anywhere. “Most of us use technology daily to simplify our lives, and the process of getting the care we need, when and where we need it should be no different. Online scheduling allows consumers to view available appointments at their preferred location, and select a time that fits their busy schedules,” said Sheri Leaman-Case, Vice President of Operations at St. Mary’s of Michigan. “As we work to improve access to compassionate, personalized care, we must also ensure we are letting consumers know about the new and innovative ways in which we are making the healthcare delivery process easier for them.” The advertising campaign includes television, radio, billboards and direct mail, in addition to comprehensive online engagement and public relations campaigns. St. Mary’s of Michigan launched online scheduling for new and existing patients in April for primary care, urgent care and emergency care. Plans to expand online scheduling capabilities to include specialty care and diagnostic and imaging services are underway. Patients can schedule an appointment, at GetAscensionCareMidMI.com .

Did You Know – St. Mary’s Offers Open MRI St. Mary’s of Michigan offers a completely open MRI at their main campus for those with claustrophobia or fear of small spaces or for large patients. Our open MRI is designed to provide the utmost in patient comfort as it allows for hand holding to support loved ones and with minimal noise. To schedule a patient in our open MRI, please call (989) 9078222. Correction: In the May 2018 Bulletin, it was stated “St. Mary’s of Michigan has named Timothy R. Hackett, MD, as their trauma program medical director.” Per St. Mary’s, the article should have stated Dr. Hackett was named interim trauma program medical director.

St. Joseph

Lung C a ncer Scr eening Progr a m

Take charge of your lung health A lung screening could save your life!

Is it covered by insurance?

If you’re a long-time smoker age 55 to 80, you’re at a higher risk for developing lung cancer. National studies have shown a low-dose CT (computed tomography) lung screening can diagnose early stage lung cancer, when it can be more effectively treated. An early diagnosis could save your life.

• Medicare covers an annual low-dose CT lung cancer screening for beneficiaries who meet the criteria.

Why is a lung cancer screening important? • Can detect cancer long before symptoms are present • Identifies the cancer’s stage to help your doctor decide the best course of treatment. • Early diagnosis can reduce the risk of death by up to 20%

• Most private insurances now cover all or a majority of the screening cost. A self-pay option is also available.

What are the benefits of going to St. Mary’s of Michigan and St. Joseph Health System? • Education about the benefits and risks of a lung cancer screening to help you make an informed decision.

• Noninvasive, painless and only takes a few minutes.

• Low-dose computed tomography with expert radiological interpretation.

Who should get a lung screening?

• Interdisciplinary lung nodule review by physicians for every positive screening result.

High-risk category 1: • Age 55-80 years (77 with Medicare)

• A thorough follow-up report and recommendation is sent to your primary care physician.

• Asymptomatic (no signs or symptoms of lung cancer)

• Immediate access to experts in the treatment of lung cancer.

• Smoked at least 30 pack years (1 pack a day for 30 years OR 2 packs a day for 15 years, etc.)

• Patient Navigator to coordinate care, answer questions and provide support.

• Currently smoking or have quit smoking within the last 15 years

Where do I go for my screening?

High-risk category 2a:

St. Mary’s of Michigan & St. Joseph Health System offer two convenient locations:

Age 50 or older with a 20+ pack year history AND one additional risk factor (family history of lung cancer, emphysema, pulmonary fibrosis or exposure to certain carcinogenic substances).

• Located inside St. Mary’s of Michigan Towne Centre 4599 Towne Centre Road, Saginaw • Located inside St. Joseph Health System 200 Hemlock, Tawas City

Call now to learn about your options and to schedule your The Bulletin | June/July 2018 lung cancer screening. 1-866-246-4673

College of

Medicine Central Michigan University’s College of Medicine was granted full accreditation by the Liaison Committee on Medical Education in June, completing the charge by the CMU Board of Trustees in 2009 to address a burgeoning shortage of physicians across the state and beyond. “This accreditation marks a historic day for Central Michigan University and affirms the quality of CMU’s College of Medicine,” President George E. Ross said. “It reflects the enormous impact CMU has on patients and families throughout Michigan and beyond by preparing physicians who are dedicated to rural and urban medically underserved communities.” The opening of the College of Medicine was the top priority for Ross when he was appointed president in 2010. “We are proud to have earned full LCME accreditation,” said Dr. George Kikano, Dean of the College of Medicine. “It is a testament to the collaborative work of students, faculty, staff and CMU leadership to develop the people, processes and infrastructure that deliver a high-quality medical education. We also are grateful to our clinical affiliates and volunteer teaching physicians throughout the region.”

“This marks a significant and final milestone on our journey to be recognized with full accreditation,” Kikano said. “Now we will build on our strong foundation to enhance research, further develop strategic clinical affiliations throughout Michigan and continue to establish programs that will improve the communities we serve.” Full LCME accreditation complements previous accreditation of the College of Medicine’s seven residency programs in partnership with Saginaw’s Covenant HealthCare and St. Mary’s of Michigan and accreditation of the College’s professional development programs.

Medical School Expands CMU’s Leadership in Health Care, Support of Michigan Communities When discussions about a medical school began, CMU already had other strong, successful health care programs that helped position CMU to create a successful medical school. “Now, we are not only producing excellent physical therapists and physician assistants. Today, CMU also is producing excellent physicians,” said former trustee Sid Smith, who was a driving force behind creation of the College of Medicine. continued on page 15

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The Bulletin | June/July 2018

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continued from page 14

The need for CMU doctors is great. Primary care physicians in Michigan meet only 63 percent of the need, according to a study by the Michigan Department of Public Health, and 51 of Michigan’s 83 counties are designated health professional shortage areas. Statistics also show how CMU’s College of Medicine is helping to offset the physician shortage, especially - and significantly - in Michigan: • The College of Medicine received 7,300 applications for the 104 spots in its sixth class beginning in August. • Eighty percent of the College of Medicine’s students are Michigan residents; 13 percent come from rural and urban medically underserved areas. • CMU’s unique curriculum places third-year students for six months in community-based clinical experiences working side by side with physicians across the state and in Ohio. • Residency placement for CMU’s two College of Medicine graduating classes stands at 100 percent. This year, 75 percent chose to follow the college mission and serve families as primary care providers. More than half are in residency programs in Michigan. Bill Weideman, chair of CMU’s Board of Trustees, puts the accreditation in historical perspective. “CMU was founded 125 years ago to meet the need for classroom teachers educated in reaching and leading students. Likewise, the Board of Trustees voted in 2009 to step forward and take action in addressing Michigan’s burgeoning shortage of doctors. “It’s unbelievably rewarding for Central Michigan University’s College of Medicine to be fully accredited and to watch each class of physicians cement a passion for serving patients who otherwise might travel long distances or wait days to see a doctor. At CMU, we take seriously our role in addressing the needs of the state, our businesses and our residents.”

Saginaw County Medical Society Foundation Funds Awards for 3rd Annual Research Symposium The 3rd Annual CMU College of Medicine and CMU Medical Education Partners Research Symposium took place on April 11, 2018, showcasing the research accomplishments of over 65 abstracts from faculty, residents, fellows and students. Awards were sponsored by the Saginaw County Medical Society Foundation and given for the best oral presentations and best poster presentations. Below are the winners:

(l-r): Eleanor Smith – Award for Poster Presentation in the category Basic and Translational Science; Lisa Weisenberger – Honorable mention for her oral presentation in the category Clinical Science; Aaron Sifuentes – Award for Oral Presentation with Monte Scott (4th from left) and Zach Fattal (6th from left) in the category Basic and Translational Sciences; Merna Abdou – Award for Oral Presentation with George Matar (8th from left) in the category Clinical Science; and Marcello Caso – Award for Poster Presentation in the category Clinical Science. *Not pictured - Sharanjit Khaira - Award for Poster Presentation in the category Case Reports.

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SCMS Efforts on Suicide Awareness Training Directly Result in New AMA Policy

he SCMS is pleased to announce a Resolution on Suicide Awareness Training for health care professionals was unanimously approved by the MSMS House of Delegates (HOD) in April. The Resolution was proposed by Joan M. Cramer, SCMS Executive Director; authored by then fourth-year Central Michigan University College of Medicine (CMU) students Joshua David Donkin, Taylor Boehler-Gaudard and Kathleen Duemling, and introduced by Anthony M. Zacharek MD in response to the high number of suicides in Saginaw County, Michigan and nationwide, including the suicide of the 26-year-old lifelong friend of Cramer’s son on September 30, 2017. Testimony at the MSMS HOD was given by Elizabeth Godfrey, then CMU M-2 student. To combat the growing suicide epidemic in this country, and as a direct result of SCMS efforts, the AMA unanimously adopted a new policy to increase awareness and physician training on suicide. MSMS Delegates to the AMA presented Cramer’s Resolution to the AMA for consideration and approval at the AMA’s Annual Meeting in Chicago June 9-13, 2018. “With an increasing number of people committing suicide in the U.S., we must do everything we can to help increase

Below: Dr. Elvira Dawis, Kim Kosberg and Barb Smith Right: Ben and Keri Benkert

awareness about the risk factors for suicide,” AMA President, Barbara L. McAneny MD, said in a statement. Suicide rates in the U.S. have risen nearly 30 percent since 1999, according to recently released data from the Centers for Disease Control and Prevention (CDC). Suicide was the 10th leading cause of death in the U.S. in 2015, and is the second leading cause of death of people aged 15-24. In 2015, Michigan had a suicide rate of 14.2 per 100,000 people, and more potential years of life are lost to suicide than to any other single cause except heart disease and cancer. In 2012, the Surgeon General and Institute of Medicine called for healthcare systems around the nation to aid in reducing the number of yearly suicides stating, “Clinical preventive services, including suicide assessment and preventive screening by primary care and other health care providers, are crucial to assessing suicide risk and connecting individuals at risk for suicide to available clinical services and other sources of care.” Sixty-four percent of people who attempt suicide have visited a physician in the month prior to their suicide attempt, and 38 percent of those who attempt suicide visit a physician in the week before. Community-based suicide

prevention programs have been shown to be a cost-effective way to lower costs to the healthcare system from averted suicide attempts and decrease the number of suicides in communities with prevention programs. The Henry Ford Health System started a ZEROSuicide initiative in 2001 to cut the suicide rate among its patients, and demonstrated an 80 percent reduction in suicide among the Henry Ford Medical Group HMO membership that has been maintained for a decade since the implementation of this program. For more information on how you or your organization can be trained in Suicide Awareness, please contact Barb Smith SUICIDE RESOURCE & Response Network at (989) 781-5260

National Suicide Prevention Lifeline - We all play a role in suicide prevention. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. 1-800-273-8255 Text 741741. “It’s OK to Ask4Help!”

SCMS Offers safeTALK Suicide Alertness Training Earlier this year, the SCMS offered safeTALK Suicide Alertness Training to physician members, medical students, healthcare professionals and others interested in the training. A second safeTALK training is scheduled for Saturday, November 10, 2018, with registration from 8-8:30 a.m., and training from 8:30 a.m.-12 noon at CMU College of Medicine in Saginaw. See page 18 for further information and to register.

Top Left to Right: Drs. Julia Walter and Rama Mulpuri, safeTALK Group Left: Drs. Harold Lenhart and Radha Cherukuri

safeTALK Suicide Alertness Training Saturday, November 10, 2018 Registration 8-8:30 a.m.Training 8:30 a.m.-12 p.m. CMU College of Medicine1632 Stone StreetRoom 1008Saginaw, MI 48602 SPACE IS LIMITED TO 30 PARTICIPANTS Open to SCMS members, residents, medical students, health care professionals and anyone interested in becoming trained in suicide alertness. Additional sessions may be scheduled in the future based on need/interest. REGISTER ONLINE AT https://www.surveymonkey.com/r/safeTALK111018 Deadline for registration is October 31, 2018 At the request of our members following the October 2017 Membership Meeting, the Saginaw County Medical Society is hosting another FREE Suicide Alertness Training, safeTALK, to expand on the ZEROSuicide overview presented by Barb Smith SUICIDE RESOURCE & Response Network (formerly known as Survivors of Suicide). safeTALK is a half-day alertness training that prepares anyone 15 or older, regardless of prior experience or training, to become a suicide-alert helper. Most people with thoughts of suicide don’t truly want to die, but are struggling with the pain in their lives. Through their words and actions, they invite help to stay alive. safeTALK-trained helpers can recognize these invitations and take action by connecting them with life-saving intervention resources. Learning goals and objectives Over the course of their training, safeTALK participants will learn to:  Notice and respond to situations where suicide thoughts might be present  Recognize that invitations for help are often overlooked  Move beyond the common tendency to miss, dismiss and avoid suicide  Apply the TALK steps: Tell, Ask, Listen, and KeepSafe  Know community resources and how to connect someone with thoughts of suicide to them for further help Up to 45% of individuals who die by suicide have visited their primary care physician within a month of their death; additional research suggests that up to 67% of those who attempt suicide receive medical attention as a result of their attempt. Given these statistics, primary care has enormous potential to prevent suicides and connect people to needed specialty care - especially when they collaborate or formally partner with behavioral healthcare providers. Jerry Reed, PhD, MSW, Director, Suicide Prevention Resource Center Funded by a generous grant from the Dow Chemical Company Foundation Donor Advised Fund

Central Michigan University College of Medicine Office of Continuing Medical Education is accredited to provide continuing medical education for physicians. CMU College of Medicine Office of Continuing Medical Education designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Questions? Contact Joan Cramer at the SCMS at 790-3590 or jmcramer@sbcglobal.net 6/29/18 2:15PM

18 The Bulletin | June/July 2018

Primary Care – Why Address Suicide Prevention? Primary care is the setting in which Americans receive most of their health and behavioral health care. Frequent contacts and long-standing relationships between primary care providers (PCPs) and their patients make primary care an ideal setting for suicide prevention.

Why Address Suicide Prevention? • People who die by suicide are more likely to have seen a PCP in the previous month before their death than any other health care provider.1 • For a patient at risk for suicide, a visit with the PCP may be the only chance to access needed care. • National health care improvement efforts (e.g., patientcentered medical homes) are providing new ways to integrate suicide prevention into primary care.

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How Primary Care Providers Can Take Action The best way to prevent suicide is to use a comprehensive approach that includes these key components: • Establish protocols for screening, assessment, intervention and referral. • Train all staff in suicide care practices and protocols, including safety planning and lethal means counseling. • Create agreements with specific behavioral health practices that will take referrals. • Ensure continuity of care by transmitting patient health information to emergency care and behavioral health care providers to create seamless care transitions and follow up with at-risk patients by phone between visits. • Provide information on the National Suicide Prevention Lifeline crisis line and services. Reference 1. Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., ... Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29(6), 870–877.

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A Comprehensive Approach to Suicide Prevention Suicide Prevention Resource Center Strategies, Programs and Practices to Consider Effective suicide prevention is comprehensive: It requires a combination of efforts that work together to address different aspects of the problem. The model above shows nine strategies that form a comprehensive approach to suicide prevention and mental health promotion. Each strategy is a broad goal that can be advanced through an array of possible activities (i.e., programs, policies, practices and services). This model of a comprehensive approach was adapted from a model developed for campuses by Suicide Prevention Resource Center (SPRC) and the Jed Foundation , drawing on the U.S. Air Force Suicide Prevention Program. Identify and Assist Persons at Risk Many people in distress don’t seek help or support on their own. Identifying people at risk for suicide can help you reach those in the greatest need and connect them to care and support. Examples of activities in this strategy include gatekeeper training, suicide screening and teaching warning signs. Increase Help-Seeking By teaching people to recognize when they need support and helping them to find it - you can enable them to reduce their suicide risk. Self-help tools and outreach campaigns are examples of ways to lower an individual’s barriers to obtaining help, such as not knowing what services exist or believing that help won’t be effective. Other interventions might address the social and structural environment by, for example, fostering peer norms that support help-seeking or making services more convenient and culturally appropriate.

Ensure Access to Effective Mental Health and Suicide Care and Treatment A key element of suicide prevention is ensuring that individuals with suicide risk have timely access to evidencebased treatments, suicide prevention interventions and coordinated systems of care. Suicide prevention interventions, such as safety planning and evidence-based treatments and therapies delivered by trained providers, can lead to significant improvement and recovery. SPRC encourages health and behavioral health care systems to adopt the Zero Suicide framework for integrating these approaches into their systems. Reducing financial, cultural and logistical barriers to care is another important strategy for ensuring access to effective mental health and suicide care treatment. Support Safe Care Transitions and Create Organizational Linkages You can reduce patients’ suicide risk by ensuring that they have an uninterrupted transition of care, and by facilitating the exchange of information among the various individuals and organizations that contribute to their care. Individuals at risk for suicide and their support networks (e.g., families) must also be part of the communication process. Tools and practices that support continuity of care include formal referral protocols, interagency agreements, crosstraining, follow-up contacts, rapid referrals and patient and family education. Respond Effectively to Individuals in Crisis Individuals in your school, organization or community who are experiencing severe emotional distress may need a range of services. A full continuum of care includes not only hotlines and helplines but also mobile crisis teams, walk-in crisis clinics, hospital-based psychiatric emergency services and peersupport programs. Crisis services directly address suicide risk by providing evaluation, stabilization and referrals to ongoing care. Provide for Immediate and Long-Term Postvention A postvention plan is a set of protocols to help your organization or community respond effectively and compassionately to a suicide death. Immediate responses focus on supporting those affected by the suicide death and reducing risk to other vulnerable individuals. Postvention efforts should also include intermediate and long-term support for people bereaved by suicide. Reduce Access to Means of Suicide One important way to reduce the risk of death by suicide is to prevent individuals in suicidal crisis from obtaining and using lethal methods of self-harm. Examples of actions to continued on page 22

20 The Bulletin | June/July 2018

KeepSafe Connections KeepSafe Connections are Able, Approachable and Available to help with suicide. They know how to do suicide first aid (trained in suicide intervention). Different kinds of helpers in your community may have this training, but some may not. The following are those trained as KeepSafe Connections (there may be additional resources in your community not listed). Crisis (Distress) Center 1-800-273-TALK (8255) Suicide Prevention Center 1-800-273-TALK (8255), Text 741741 Teen Line Text 741741 Rape/Sexual Assault Center Underground Railroad 989-399-0007 Child & Family Services of Saginaw 989-790-7500

Pine Rest Christian Mental Health Services (Grand Rapids) Inpatient/Hospitalization for immediate help 1-800-678-5500 Counseling/Outpatient Services 1-866-852-4001 Michigan Medicine (UM) Department of Psychiatry (Ann Arbor) If you are having a Psychiatric Emergency, call 734-936-5900 or 911 To make an appointment, call 734-764-0231 or 1-800-525-5188 Henry Ford Health System (Detroit and surrounding areas): Call 1-800-422-1183 for same day assessment for 24-hour residential treatment facility. For adult patients in crisis, Henry Ford offers 24/7 emergency evaluations at Henry Ford Macomb Hospital’s Mt. Clemens campus (215 North Ave., Mount Clemens, MI 48043) as an alternative to an emergency room visit. Medical Clinic Great Lakes Bay Health Centers 989-755-3619

Domestic Violence Hotline Underground Railroad 989-399-0007

AIDS Information & Testing Sites Saginaw County Department of Public Health 989-758-3800

Sexual Abuse Hotline Underground Railroad 1-888-399-8385 or 989-755-0411

Children’s Services HealthSource Saginaw 989-790-7742

Child Abuse Hotline CAN Council Great Lakes Bay Region 989-752-7226 Michigan Department of Health & Human Services 1-855-444-3911 Police/Emergency Medical Services 911 Mental Health Crisis & Outreach Clinic Saginaw County Community Mental Health Authority 989-792-9732 or 1-800-233-0022 Emergency Shelters City Rescue Mission (Saginaw) 989-752-6051 Good Samaritan (Bay City) 989-893-5973 Michigan Coalition Against Homelessness 1-800-274-3583

Katherine Arkell, LMSW RPT-S, Family Therapist (Saginaw) 479-685-7830 Child & Family Services of Saginaw 989-790-7500 Children’s Grief Center of the Great Lakes Bay Region (Midland) 989-495-9335 Parent Training Child & Family Services of Saginaw 989-790-7500 Self Help Groups Barb Smith SUICIDE RESOURCE & Response Network 989-781-5260 Children’s Grief Center of the Great Lakes Bay Region (Midland) 989-495-9335 Substance Abuse Counseling DOT Caring Centers 989-790-3366 Saginaw Odyssey House 989-754-8598

Youth Shelter Innerlink 989-753-3431

Alcoholics Anonymous Saginaw Valley Alcoholics Anonymous 989-776-1241

Psychiatric Clinics HealthSource Saginaw Behavioral Medicine Center (Saginaw) Call 911 or go to nearest Emergency Department

Legal Assistance - Victim/Witness Assistance MDHHS 517-373-7373; Victims only may call 877-251-7373

The Bulletin | June/July 2018 21

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reduce access to lethal means include educating the families of those in crisis about safely storing medications and firearms, distributing gun safety locks, changing medication packaging and installing barriers on bridges. Enhance Life Skills and Resilience By helping people build life skills, such as critical thinking, stress management and coping, you can prepare them to safely address challenges such as economic stress, divorce, physical illness and aging. Resilience - the ability to cope with adversity and adapt to change - is a protective factor against suicide risk. While it has some overlap with life skills, resilience also encompasses other attributes such as optimism, positive self-concept and the ability to remain hopeful. Skills training, mobile apps and self-help materials are examples of ways to increase life skills and build resilience. Promote Social Connectedness and Support Supportive relationships and community connectedness can help protect individuals against suicide despite the presence of risk factors in their lives. You can enhance connectedness through social programs for specific population groups (such as older adults or LGBT youth), and through other activities that reduce isolation, promote a sense of belonging and foster emotionally supportive relationships.

How Can You Help? Do you want to raise awareness, volunteer or participate in an upcoming event? Contact Barb Smith at barb.smith@suicideresourceandresponse.net or 989-781-5260 and schedule a training or educational event or get more information. Barb Smith Suicide Resource & Response Network is supported solely by donations and grants. To make a donation, please make your check payable to Barb Smith SR&RN and mail to: Barb Smith Suicide Resource and Response Network PO Box 6712, Saginaw, MI 48608-6712 The organization is a 501(c)(3) nonprofit, and your donation is tax deductible (EIN 38-3400293). 22

The Bulletin | June/July 2018

Save the Date Shawn C. Shea, MD

“Suicide Prevention through Sound Suicide Assessment” College of

Medicine Date: Monday, October 15, 2018 Time: Two Sessions, 8 a.m.–12 p.m., and 1-5 p.m. Location: Horizons Conference Center (tentative) Speaker: Shawn C. Shea MD Topic: Suicide Prevention through Sound Suicide Assessment Invited: Medical students, residents, physicians and all health care personnel including nurses, social workers, physician assistants, nurse practitioners, EMT’s, etc. Cost: No cost for medical students. Cost to be determined for all others as plans are finalized. Registration: Electronic link to be made available as plans are finalized. Dean George E. Kikano MD, CMU College of Medicine and Barb Smith of Barb Smith SUICIDE RESOURCE & Response Network invite you to a suicide prevention workshop presented by Shawn C. Shea MD, an internationally acclaimed workshop leader and innovator in the fields of suicide prevention, building resiliency, clinical interviewing and improving medication adherence having given over 850 presentations worldwide. He is the creator of the highly acclaimed interviewing strategy for uncovering suicidal ideation and intent – the Chronological Assessment of Suicide Events (the CASE Approach). His other clinical interviewing innovations, including facilic supervision, macrotraining and the Medication Interest Model (MIM) have been adopted around the world. Dr. Shea is the Director of the Training Institute for Suicide Assessment and Clinical Interviewing (www.suicideassessment.com), a training and consultation service providing workshops, consultations and quality assurance design in mental health assessments. He is also in private practice. Funded in part by a generous grant from Dow Chemical Foundation

TEN FACTS ABOUT PHYSICIAN SUICIDE AND MENTAL HEALTH 1. Suicide is generally caused by the convergence of multiple risk factors, the most common being untreated or inadequately managed mental health conditions. 2. An estimated 300 physicians die by suicide in the U.S. per year.1 3. In cases where physicians died by suicide, depression is found to be a significant risk factor leading to their death at approximately the same rate as among non-physician suicide deaths; but physicians who took their lives were less likely to be receiving mental health treatment compared with non-physicians who took their lives.2 4. The suicide rate among male physicians is 1.41x higher than the general male population. And among female physicians the relative risk is even more pronounced — 2.27x greater than the general female population.3 5. Suicide is the second leading cause of death in the 24-34 age range (accidents are the first).4 6. The prevalence of depression among residents is higher than in similarly aged individuals in the general U.S. population — 28 percent of residents experience a major depressive episode during training versus the general population rate of 7-8 percent.5 7. Among physicians, risk for suicide increases when mental health conditions go unaddressed and when self-medication occurs as a way to address anxiety, insomnia, or other distressing symptoms. Although selfmedicating may reduce some symptoms, the underlying health problem is not effectively treated and this can lead to a tragic outcome. 8. In one prospective study, 23 percent of interns had suicidal thoughts, but among those interns who completed four sessions of web-based Cognitive Behavior Therapy nearly 50 percent fewer had suicidal ideation.6 9. Drivers of burnout include work load, work inefficiency, lack of autonomy and meaning in work, and work-home conflict. 10. Unaddressed mental health conditions are, in the long run, more likely to negatively impact one’s professional reputation and practice than reaching out for help early.

SOURCES 1. Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.A., Mann, J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M. M. (2003). Confronting Depression and Suicide in Physicians. JAMA, 289(23), 3161. doi:10.1001/jama.289.23.3161 2. Gold, K. J., Sen, A., & Schwenk, T. L. (2013). Details on suicide among US physicians: Data from the National Violent Death Reporting System. General Hospital Psychiatry, 35(1), 45-49. doi:10.1016/j. genhosppsych.2012.08.005 3. Schernhammer, E. S., & Colditz, G. A. (2004). Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry AJP, 161(12), 2295-2302. doi:10.1176/appi.ajp.161.12.2295 4. CDC National Center for Injury Prevention and Control. (2015). 10 Leading Causes of Death by Age Group, United States - 2014 Retrieved from http://www.cdc.gov/injury/images/lc-charts/ leading_causes_of_death_age_group_2014_1050w760h.gif 5. Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Angelantonio, E. D., & Sen, S. (2015). Prevalence of Depression and Depressive Symptoms among Resident Physicians. JAMA, 314(22), 2373. doi:10.1001/jama.2015.15845 6. Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns. JAMA Psychiatry, 72(12), 1192. doi:10.1001/jamapsychiatry.2015.1880

afsp.org The Bulletin | June/July 2018 23

HOSTED BY

WALK FOR HOPE 2018 EVENT AGENDA 8:30 AM - Registration/Check in Browse resource tables, art activities and special area for youth. Live entertainment with Robert Reeves & friends 10:00 AM - Welcome & Guest Speakers 10:30 AM - 5K walk/run Untimed and family friendly. Non-walkers and children are welcome. Please join us for special activities, raffles, and much more. Closing Ceremonies to follow run/walk near Hach. Only registered services dogs allowed for the safety of participants and your pets In the event of rain, the walk will take place on the indoor track at the Hach Student Center.

Depression & Suicide Awareness 5K Walk/Run Sunday, August 12, 2018 Northwood University | Hach Center 4000 Whiting Dr. | Midland, MI 48640 PRE-REGISTRATION

give.classy.org/walkforhope18 Deadline to register online is August 10th Online registration is easy and lets you connect with your friends and family to support your efforts. Onsite registration and donations â&#x20AC;&#x2039;accepted however pre-registration is appreciated. Registration is free and all profits will be used in the Great Lakes Bay Region to work towards ZERO SUICIDE.

OTHER WAYS TO PRE-REGISTER: Contact Barb Smith Phone: 989-781-5260 Email: sosbarb@gmail.com Mail Sponsor Form to: PO Box 6712 Saginaw MI 48608

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ORDER DEADLINE: Sunday July 22nd, 2018 (11:59pm EDT) Online Orders will be handed out at event Limited T-shirts available for sale onsite

The Bulletin | June/July 2018

The Bulletin | June/July 2018 23

28 The Bulletin | May 2018 www.facebook.com/BarbSmithSRRN | Barb.smith@suicideresourceandresponse.net | give.classy.org/walkforhope18

Covenant Featured on Forbes List of Best Mid-Size Employers Covenant HealthCare was included in Forbes Magazine’s 2018 ranking of top midsize companies, selected from a sample of U.S. employees working for companies with at least 1,000–5,000 employees. Covenant ranked #1 in healthcare in Michigan, #5 in Michigan overall and #192 nationally. Forbes created the Best Employers award to recognize companies that have made a distinct effort to create a positive and highly functional work environment. As we continue to reach and exceed national benchmarks in areas such as employee engagement, fiscal responsibility and overall quality control, Covenant acknowledges the secret to success is a dedicated workforce. We thank more than 4,500 team members who keep patients at the center of everything we do through their hard work and extraordinary efforts.

Do You Know Covenant Center for the Heart? You know Covenant by heart, but did you know Covenant Center for the Heart offers: • Highly experienced, board-certified cardiovascular specialists and cardiothoracic surgeons. • The first, most comprehensive Structural Heart Disease Program in the region. • The latest technology for diagnostic testing and treatment.

• The only pediatric cardiologist in the region. • Advanced cardiac procedures, like Transcatheter Aortic Valve Replacement (TAVR) and Watchman. With the #1 ranking in Michigan for Medical Excellence in Interventional Coronary Care (*CareChex), it’s no secret that Covenant is working very hard to keep extraordinary cardiac care close to home. That’s why we’ve been the region’s most preferred hospital for cardiac care for over a decade.

Covenant Offers Yoga Classes Tailored to Patients with Cancer “This yoga class is one of a kind. We have all had cancer. When one of us has upcoming tests, a setback or health worries, we have our own little tribe behind us providing support whenever needed. We are never alone in our journey. I don’t know what I would do without this class and my fellow survivors!” says cancer survivor Terri Puckett of Midland. Covenant HealthCare received a $5,110.81 grant from the Saginaw Community Foundation Senior Citizen Enrichment Fund in April 2017 to begin providing cost-effective yoga classes for cancer patients. Using the funding, the Covenant Physical Medicine & Rehabilitation professionals began offering yoga classes. More than eight people participated in the first session. Now, one year later, the program has impacted more than 55 participants. “The beauty of the class is that it is for all skill levels, and we can provide many variations of alternate poses depending on what the patient is needing,” states Morgan Auernhammer, B.S., SCCE, Health & Fitness Administrator and Oncology Exercise Program Leader with Covenant HealthCare. “The goal of the program is to unite our patients’ bodies, minds and breathing to strengthen, reduce stress and energize their lives. It’s amazing to be able to help patients make that connection within themselves and establish camaraderie with one another.” Yoga classes meet twice a week for eight weeks in Frankenmuth and Saginaw. Thanks to the Saginaw Community Foundation, the cost is just $35 for 16 classes. This program is part of the Covenant Cancer Care Center and Physical Medicine and Rehabilitation’s commitment to delivering programs that support the full continuum of care for cancer patients and their families. Services range from prevention and education to diagnosis to treatment and continued on page 26

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rehabilitation, with support for the clinical, physical, emotional and spiritual needs. To learn more about the cancer care exercise classes or register, please call 989.583.5242.

Former St. Luke’s President, Louis E. Zeile, Remembered Former St. Luke’s Hospital president, Louis E. Zeile, who led what is now Covenant HealthCare, through a period of tremendous growth, has died. Zeile passed away on Thursday, May 31 at the Cartwright Hospice Residence at the age of 96. According to hospital archives, Zeile joined then-St. Luke’s as Assistant Administrator in 1956 until he succeeded Walter R. Doud as CEO/President in 1975. In total, he dedicated 30 years of service to the hospital before retiring in 1986. During that time, Zeile is credited with overseeing seven hospital additions to what is now the Cooper campus, including the lecture theater, built as part of the 1971 expansion. He also hired a young administrator who would eventually become his successor, Spencer T. Maidlow. In a 1986 Township Times profile, Zeile was described by friends as “compassionate, concerned, Christian and concise.” He was also known as an “innovator, whose skills in quiet

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The Bulletin | June/July 2018

diplomacy and tact often concealed a sharp mind and unique farsightedness.” Zeile received his Bachelor of Arts degree from Valparaiso University, and received a Master of Social Work from the University of Michigan. He was awarded an honorary doctorate from Valparaiso University in 1987. He was an active member and elder at Peace Lutheran Church. Most of all, he enjoyed spending time with his family. Zeile was born on June 17, 1921, in Saginaw to the late Hilda (Moser) and Rev. Andrew Zeile. On June 27, 1951, Lou married Janice Marie Kolterman in St. Paul, Minnesota. Lou and Jan were blessed with 65 years of marriage before Jan passed away on April 19, 2017. Surviving are five children and their spouses: Kathi and John Behm (Milwaukee, WI), Kim and Karen Zeile (Clarkston), Karin and Robert Mauro (Denver, CO), Karl and Dian Zeile (Westlake Village, CA) and Kurt and Lisa Zeile (Lake Orion); twenty grandchildren; fourteen great grandchildren; his dear cousin, Victor Roekle, as well as, many nieces and nephews. A sixth child, Kevin J. Zeile, passed away in December 1977. Private family entombment services took place on Saturday, June 2, 2018, as well as, a memorial service on Friday, June 15. Those planning an expression of sympathy may wish to consider the Covenant HealthCare Foundation, Valley Lutheran High School or Peace Lutheran Church.

We are the region’s most experienced diabetes management team. Our program is certified by the American Association of Diabetes Educators (AADE) through the Michigan Department Health and Human Service (MDHHS). We are certified to provide education for patients of all ages and diabetes diagnoses, including pregnant women. Put your trust in the region’s most experienced diabetes management team . . . your PatientCentered Medical Home partner. We also have a Diabetes Prevention Program to help prevent or delay Type 2 diabetes. To refer a patient or for more information call 989.583.5193

JOIN THE MOVEMENT! JOIN THE MOVEMENT! Join the SCMS/MSMS by clicking HERE Join the SCMS/MSMS by clicking HEREHERE. or join through MSMS directly by clicking or join through MSMS directly by clicking HERE. When the Michigan State Medical Society (MSMS) learned Blue Cross Blue Shield of When the Michigan State Medical Society (MSMS) learned Blue Cross Blue Shield of Michigan Michigan (BCBSM) was going to pay evaluation and management (E&M) services billed (BCBSM) was going to 80 paypercent, evaluation andtook management with modifier 25 at MSMS action. (E&M) services billed with modifier 25 at 80 percent, MSMS took action. During several conversations with BCBSM, MSMS provided tangible evidence proving thereseveral was noconversations overlap in services when an E&Mprovided is billed with officeevidence procedures. As there a During with BCBSM, MSMS tangible proving BCBSM canceledwhen the implementation the office policy,procedures. restoring it back to 100BCBSM percent wasresult, no overlap in services an E&M is billedofwith As a result, and saving Michigan physicians more than $2 million. canceled the implementation of the policy, restoring it back to 100 percent and saving Michigan physicians more than $2 million. "This is a tangible benefit for MSMS members," said MSMS President Betty S. Chu, MD, MBA. "Withoutbenefit MSMS for at the table representing physicians, “This is a tangible MSMS members,” said Michigan MSMS President Bettywe S. would've Chu, MD,lost MBA. more than $2 million in care services. I strongly urge all Michigan physicians to jointhan “Without MSMS at the table representing Michigan physicians, we would’ve lost more MSMS in because we needI strongly them to be our tell our story and us."because we $2 million care services. urge allvoice, Michigan physicians tosupport join MSMS need them to be our voice, tell our story and support us.” MSMS and the Saginaw County Medical Society have been advocating on behalf of physicians and their patients for more than 150 years and 116 years, respectively. MSMS and the Saginaw County Medical Society have been advocating on behalf of physicians Become a member today, and help affect change in the practice of medicine. and their patients for more than 150 years and 116 years, respectively. Become a member today, and help affect change in the practice of medicine.

The Bulletin | June/July 2018 27

2018-2019 Saginaw County Medical Society Physician Directory

Attention all Physicians, Group Practices and Medical Partners

The 2018-2019 Physician Directory is produced by the Saginaw County Medical Society

To reserve a page for your company or physician, please call Joan Cramer at 989.790.3590 or email jmcramer@sbcglobal.net Space and Copy Deadline is Monday, August 13, at 5 p.m. Previous year’s “Premium Position” advertisers have first right to those positions until Monday, July 30 at 5 p.m. To submit fully finished ads, please provide press quality pdf files with all fonts embedded. All ads submitted should be 300 dpi at 100% for best printing. All files should be CMYK color. If you need your ad designed, please provide ad copy in Word or Text format and art and logos as jpeg or eps files.

Promote your company, office and/or group practice with an advertisement in the 2018-2019 Saginaw County Medical Society Physician Directory. Join the many other medical suppliers and vendors and take advantage of this unique opportunity to promote your practice, group or medical company in this widely used, easy reference resource. There will be two separate versions of this conveniently sized Directory distributed in the Fall of 2018. The Private Physician version will be distributed to members’ offices, and the Public Directory will be marketed and delivered directly into the hands of the public at the Annual Health Fair, events and expos throughout the year. A limited number of additional copies will be available at the Saginaw County Medical Society office and available electronically for download at www.SaginawCountyMS.com under the Pictorial Membership Directory tab. Premium Positions Outside Back Cover Inside Front Cover Inside Back Cover Pages 3, 4, 5 and 7 Center Spread

Full Color Actual Size $1,800 6.25” wide x 9.62” high $1,700 6.25” wide x 9.62” high $1,700 6.25” wide x 9.62” high $1,700 6.25” wide x 9.62” high $2,900 2 center pages – 13” wide x 9.62” high

Randomly Placed Full Page Half Page Quarter Page

$1,600 $ 905 $ 490

6.25” wide x 9.62” high 6.25” wide x 4.75” high OR 3” wide x 9.625” high 6.25” wide x 2.37” high OR 3” wide x 4.75” high

Price includes both Physician and Public versions. All ad design services are at no additional cost.

The Bulletin | June/July 2018

2018-2019 Saginaw County Medical Society Advertising Contract Name of Advertiser ___________________________________________________________________ Address ______________________________ City ___________ State _____ Zip __________________ Contact Name____________________________________ Phone (_____) _______________________ Email ____________________________________

Date Completed/Signed ___/___/____________

Signature of Authorized Representative ___________________________________________________ Please Check Ad Desired Full Color *Premium Positions n Outside Back Cover $1,800 n Inside Front Cover $1,700 n Inside Back Cover $1,700 n Pages 3, 4, 5 and 7 $1,700 n Page desired ____ (if available) n Center Spread $2,900 Randomly Placed n Full Page n Half Page n Quarter Page

$1,600 $ 905 $ 490

Actual Size 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 2 center pages – 13” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 4.75” high OR 3” wide x 9.625” high 6.25” wide x 2.37” high OR 3” wide x 4.75” high

*Current “Premium” advertisers have right of first refusal of current space until Monday, July 30, 2018, at 5 p.m. Space and copy deadlines for all ads is Monday, August 13, 2018. The above agrees to place and pay for the advertisement(s) listed above in the 2018-2019 edition of the Saginaw County Medical Society Physician Directory (includes both Private and Public versions). The total price for the advertisement(s) is listed next to the ad dimensions. Publication date is scheduled for October 2018. All billing statements will be sent to advertisers immediately following receipt of this Advertising Contract, and the total is due and payable by September 1, 2018, or 20 days after receipt of the invoice, whichever is later. Please return this Advertising Contract to Joan Cramer at jmcramer@sbcglobal.net, or mail to: Saginaw County Medical Society | 350 St. Andrews Road, Suite 242 Saginaw, MI 48638-5988 | Office (989) 790-3590 | Fax (989) 790-3640 | Mobile (989) 284-8884 The Public Directory will be distributed at the 2019 Health Fair on Saturday, March 16, 2019, by mail and throughout the year at events and physician offices/medical facilities. The Private Directory will be distributed in October to physicians, group practices and the hospitals. Advertisers will receive both Directories which will also be available for download at www.SaginawCountyMS.com on the home page and under the Pictorial Membership Directory tab. Published by the Saginaw County Medical Society The Bulletin | June/July 2018 29

MSMS.org Relaunch On June 14, a refreshed MSMS.org launched. While there remain a few minor details to iron out, the launch was a relatively smooth one. Here are some highlights: 1. The home page now features quick links to MSMS.org’s most visited areas: Member resources, latest news and events. 2. While the Health Law Library launched last year, this section has seen the most drastic area of improvement. We’ve taken almost 50 years of content which was produced as a book, updated it to the most current laws and presented it in an online format. MSMS members get access for FREE. Non-members and even nonphysicians (we’ve had previous requests from attorneys) can purchase a specific subject for as little as $250. This is seen as a potential revenue stream, starting with a sponsorship from our Legal Counsel’s firm, Kerr Russell. A joint marketing plan is currently being finalized in conjunction with Kerr Russell, targeting both Michigan physicians and attorneys. 3. Doctor Mukkamala brought to our attention an Unclaimed property search so we took the liberty of launching our own. Michigan physicians may not realize the amount of money the State has that’s rightfully theirs. MSMS.org has simplified the search to find any unclaimed property. After we get through some of the final details, there will be several messages highlighting this and comparing the cost of MSMS membership. 4. One of the areas we really focused our attention on was education/events, specifically to the growing list of on demand webinars which are sourced and color coded by topic.

MSMS Advocacy Impacts Rules Activity on Bona Fide Issue Thank you for taking action and contacting the Michigan Licensing and Regulatory Affairs Agency (LARA) and your lawmakers to share concerns with the potential ramifications

of the statutory definition of “bona fide prescriber-patient relationship” required when prescribing controlled substances, if it were to take effect as currently written. We’ve seen progress on this issue. On Wednesday, June 13, 2018, the Michigan Board of Pharmacy adopted Administrative Rule 338.6161a(3) with language reflecting the recommendations submitted by MSMS and other health care stakeholders. The language seeks to address concerns that have been raised, including the ability to provide quality care to patients during situations in which a prescriber is providing coverage for an unavailable colleague, another licensed member of the health care team has evaluated the patient, there is a transition of care from one setting to another or a medical emergency. To ensure this issue is resolved without needlessly interrupting patient care or adversely impacting professional licensing, MSMS and other partners requested that LARA consider language recognizing that, in certain scenarios, an in-person/telehealth medical evaluation may be repetitive, impractical or an impediment to the timely delivery of care to a patient. The MSMS proposal would effectively deem that in the circumstances outlined above, a bona fide relationship exists given the acting health care professional provides documentation in the patient’s medical record in accordance with medically accepted standards of care. The “bona fide prescriber-patient relationship” for prescribing controlled substances was originally defined in Public Act 247, part of a package of opioid bills signed into law in December 2017. Thankfully, earlier this year, the legislature took steps to delay the implementation of the law until March of 2019, instead requiring LARA to promulgate rules providing for exceptions when the relationship would not apply. With the Michigan Board of Pharmacy’s approval of the new language, the next step in the rules process will be consideration by the Legislature’s Joint Committee on Administrative Rules (JCAR). In light of the legislature’s adjournment for the summer, no further action on the rule is anticipated prior to the fall. MSMS will keep you apprised of future action on this important item.

VISIT OUR WEBSITE TODAY www.SaginawCountyMS.com 30

The Bulletin | June/July 2018

ADVERTISER INDEX When you have a need for a service, please consider our dedicated advertisers first!

31 Aperion Information Tech Ben Hamann 9 Barb Smith SUICIDE RESOURCE & Response Network 10 Covenant HealthCare 2 Covenant Diabetes Self-Management Program 26 Evergreen Physical Therapy 8 Jan Hauck – Century 21 7 Healthway Compounding Pharmacy 11 Advanced Diagnostic Imaging, P.C.

ADVANCED DIAGNOSTIC IMAGING is proud to be part

of mid-Michigan’s well-established medical community. Our highlyexperienced, sub-specialized radiologists are the region’s trusted leaders for professional diagnostic and interventional services.

Horizons Conference Center/Riverview Brownstones Lori Krygier Graphic Designer Norton + Kidd Accounting & Consulting, P.C. Peak Performance PC Services Shields Chiropractic St. Mary's of Michigan Wolgast Corporation

19 10 19 11 14 13 15

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• Digital Diagnostic X-Ray • ACR Accredited Ultrasound Service General / Vascular / Musculoskeletal • Specialty Vein Services VenaCure Laser® Treatment / Phlebectomy / Sclerotherapy • 24-Hour Report Turn-Around • Same Day Call Reports for Urgent Studies LOCATION:

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The Bulletin | June/July 2018 31

PRSRT STD U.S. POSTAGE PAID Saginaw, MI 48605 PERMIT #228

350 ST. ANDREWS ROAD | SUITE 242 SAGINAW, MI 48638-5988

ADDRESS SERVICE REQUESTED

2017-2018 KEY PROVIDERS

These Area Businesses Support Saginaw County Medical Society Membership Meetings. When you have a need for a service, please consider our Key Providers. Please mark your calendar for the following meetings and events in 2018-19. You will receive an email meeting notice and reminder each month for SCMS events. Non-SCMS events are listed as a courtesy and you must contact the sponsor directly to register. There are no Membership Meetings in July or August. Tuesday, September 18, 2018 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting joint with the Saginaw County Osteopathic Society with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “Why Preventative Medicine is Failing: Understanding the Human Nature behind Social Determinants of Health,” an ethics program designed to fulfill LARA requirements. Saturday, October 6, 2018 Horizons Conference Center – “Opioid Crisis and Pain Management” sponsored by CMU College of Medicine. Breakfast and registration begin at 7:30 a.m., with the program from 9 a.m. to 12 p.m. See page 9 for more information. Tuesday, October 16, 2018 HealthSource Saginaw - SCMS Board meets at 5:30 p.m. Membership Meeting with Social at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “Candidates’ Forum.” Spouse/ Significant Other invited. Thursday, October 18, 2018 Saginaw Country Club – CMU College of Medicine: Meet new physicians who are joining the CMU team in the Great Lakes Bay Region. Tentatively scheduled for 5:30-7:30 p.m. There are no Membership Meetings in November or December. Saturday, November 10, 2018 CMU College of Medicine, 1632 Stone Street, Room 1008, Saginaw – safeTALK Suicide Alertness Training, 8-8:30 a.m. registration with training from 8:30 a.m. to 12 p.m. Training is limited to 30 people. See page18 for details and to register.

Tuesday, November 20, 2018 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m. Monday, December 3, 2018 Saginaw Country Club – 15th Annual SCMS Alliance Jingle Mingle. There is no Board Meeting in December. Tuesday, January 15, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting joint with the Saginaw County Dental Society with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “Surviving Acts of Violence.” Tuesday, February 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m. Saturday, March 16, 2019 Horizons Conference Center - 15th Annual Health Fair “The Doctor Is In!” from 9 a.m.-12 p.m. Tuesday, March 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m. Tuesday, April 16, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “TED Talks” (tentative). Tuesday, May 21, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and Annual Meeting at 7 p.m. Program: “Update on CMU College of Medicine.”

Joan Cramer/SCMS | Office 790-3590 | Fax 790-3640 | Cell 284-8884 | jmcramer@sbcglobal.net