Covenant Cancer Care Center continues to team up with one of the top cancer centers in the nation, MD Anderson Cancer Network®, a program of the MD Anderson Cancer Center. This collaboration gives Covenant access to world-renowned cancer expertise.
Covenant Cancer Care Center is the region’s leading cancer care provider with the accreditations to prove it.
For additional information, visit us at CovenantCancerCare.com.
President Tiffany K. Kim MD President-Elect Mark G. Greenwell MD
Past President Anthony M. Zacharek MD
Secretary Caroline G.M. Scott MD
Treasurer Miriam T. Schteingart MD Board of Directors
Christopher J. Allen MD
Furhut R. Janssen DO
Mary J. McKuen MD
Kai Anderson MD
Jennifer M. Romeu MD Elizabeth M. Marshall MD
Bulletin Editor Louis L. Constan MD
Retiree Representative
Caroline G.M. Scott MD
Resident Representatives
Jessica H. Faris MD (OB)
Mohammed A. Saiyed MD (FM)
Yuri J. Kim MD (IM)
Medical Student Representatives
Ann Sobell, MD Candidate, Class of 2023 Mary Galuska MA, MD Candidate, Class of 2024 MSMS Delegates
Elvira M. Dawis MD
Anthony M. Zacharek MD
Christopher J. Allen MD Miriam T. Schteingart MD
Kala K. Ramasamy MD Jennifer M. Romeu MD Karensa L. Franklin MD Judy V. Blebea MD Elizabeth M. Marshall MD
MSMS Alternate Delegates
Caroline G.M. Scott MD
Waheed Akbar MD Mohammad Yahya Khan MD Nicholas E. Haddad MD Mary J. McKuen MD Kai Anderson MD
Claudia C. Zacharek MD Cecilia E. Kraus-Horbal DO
Peer Review Ethics Committee
Waheed Akbar MD, Chair
Caroline G.M. Scott MD
James R. Hines MD
MSMS Region 7 Representative
Mildred J. Willy MD
MSMS President
Thomas J. Veverka MD
Executive Director
Joan M. Cramer
Administrative Assistant
Keri L. Benkert
MSMS Member Service Representative
Heather L. Foster (517) 336-5719
SCMS/MSMS 2023 Membership Dues Now Payable Free CME if paid by 11/30/22
Calendar of Meetings and Events for 2022-2023
Proposed Amendment to SCMS Bylaws
SCMS Mission, Vision and Values
How to Write a Resolution to the MSMS House of Delegates
President’s Letter
Retirees Meet for Lunch
From the Editor
Writers Welcome
Office Space for Sale or Lease
Barb Smith SRRN
LARA e-prescribing Effective 1/1/23
Key Provider of the Month Covenant Medical Group Cardiology
Ascension St. Mary’s
Applications for Membership
MSMS Updates Advocacy/Engage
Behavioral Health Mediation
ACEP - Supporting Medicare Providers Act of 2022 (H.R. 8800)
MI Bill Intended to Shorten ER Waits for Youth in Mental Health Crisis
Covenant HealthCare
GLBHC Accepting Adult Outpatient Psychiatry Referrals
Birthdays – November
Member News – Dr. Wendy Biggs
Caduceus Meeting for Recovering Health Care Professionals
Advertiser Index
PRiSMM Telehealth Suicide Prevention Toolkit Resource
Key Providers
Calendar of Meetings and Events for 2022-2023
The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.
Louis L. Constan, MD
EXECUTIVE DIRECTOR
Joan M. Cramer
Lori Krygier
Saginaw County Medical Society
350 St. Andrews Rd., Ste. 242, Saginaw, MI 48638-5988
Telephone (989) 790-3590 | Fax (989) 331-6720
Cell (989) 284-8884 | jmcramer@sbcglobal.net
Hours By Appointment | SaginawCountyMS.com
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.
Patience is a virtue…so they say. But why? Patience is defined as the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset. In our society, this is not an easy task. With technology at our fingertips, we have developed the need for instant gratification. With this, some of us have lost our ability to be patient, or at the least our desire to be patient. Especially as physicians.
With all the requirements, click boxes, time constraints, RVUs, etc., put on us “to be productive,” it is easy to forget about the patients and our need to have patience with them. Patience for being late, patience for not being compliant, patience for lack of self-awareness. But how do we learn to be patient? Taking the time to learn who they are, what hardships they are facing and at times what makes them a difficult patient, can help. Being an active listenerconcentrating on what's being said and actively responding - is a trait that aids us in being patient. Being grateful for what we have can help us learn patience. If we are thankful for what is in front of us, we aren’t searching for better circumstances, being thankful that patients chose you to care for them.
I tend to become impatient when I am busy, which is the most important time to learn to be patient. Patients show up late, haven’t completed their paperwork or went to the wrong location…it is easy to say reschedule them, I don’t have time for this! But what if they traveled a great distance to see you, or have a traumatic past that creates anxiety for this visit, which in turn, makes them late? Don’t get me wrong, I know there are times to enforce the rules but maybe there is room for a little grace? For the chronic problem, yes, boundaries are imperative but for a first-time offense…maybe a little patience.
Why is it important for us to be patient? According to the Greater Good Magazine (which has now become one of my favorite sites!) there are four benefits to being patient:
1. Patient people enjoy better mental health; less depression and anxiety and they cope better with stressful situations.
2. Patient people are better friends and neighbors (and physicians?). Patience can be a form of kindness to those we love. It also allows us to be more empathic to those we treat.
3. Patience helps us achieve our goals. The achievements that mean the most are the ones that take time to accomplish, which requires a form of patience (maybe as physicians we have had patience all along?).
4. Patience is linked to good health. According to a 2007 study by Schnitker and Emmons, they found that patient people were less likely to report health problems like headaches, acne flair-ups, ulcers, diarrhea and pneumonia.
William Osler once said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Learning to be patient allows us to see our patients as the human beings they are and encourages us to form relationships and help the patient as a whole.
Practicing patience will not only help us be better physicians but better people. We became physicians to help those in need, not just the ones that show up on time and concisely inform us on what is wrong. I try to remind myself that those that frustrate me the most are likely the ones that need my help the most.
“Being an active listener - concentrating on what's being said and actively respondingis a trait that aids us in being patient.."
As a thank you for your loyalty as a member of the SCMS/ MSMS and for paying early all physicians who pay their 2023 dues in full by November 30 will receive a $100 coupon towards a CME course at an MSMS educational session. Visit https:// msms.org/lms for upcoming live events and on-demand webinars.
HOW TO PAY
• Online CLICK HERE
• Fax to (517) 481-3976
• Mail to: MSMS Membership Department | PO Box 950 East Lansing, MI 48826-0950
• Installment payments available – call (517) 336-5716
SCMS/MSMS dues are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense (check with your tax specialist). SCMS dues are 100 percent deductible, and 81.1 percent of MSMS dues are deductible (a portion of MSMS dues is attributable to lobbying activities). The SCMS and MSMS are non-profit organizations focused on improving the lives of physicians so they may best care for the people they serve. Click HERE for Benefits of SCMS membership.
The strength and effectiveness of SCMS/MSMS as your professional association is predicated on strong membership. The free CME course is just a small token of appreciation for your continued support of organized medicine.
For questions about membership or if you have not yet received your 2023 dues invoice, please contact Joan Cramer, SCMS Executive Director at jmcramer@sbcglobal.net or (989) 284-8884.
• Because all physicians need to “fund their voice.”
• National polls show physicians as one of the most respected professions. Sadly, they don’t use their clout often enough to preserve their profession and protect their patients.
• There is strength in numbers. Together we are stronger.
Read previous issues of The Bulletin at www.SaginawCountyMS.com under the Bulletin tab
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!
THE GROUP ALWAYS MEETS IN THE BACK ROOM. If you are told no one from the group is there, please go directly to the back room and check for yourself!
If you have questions, please contact Joan Cramer at (989) 284-8884 or Dr. Caroline Scott at (989) 295-2721.
Our goal is to save lives through prevention, intervention, and aftercare.
Our Network trains individuals in evidence-based suicide prevention with the hope of destigmatizing suicide, increasing help-seeking behaviors, and caring for those impacted by suicide.
To request trainings or resources, contact info@srrn.net I www.srrn.net I 989.781.5260
There’s nothing quite as wonderful as a baby. A brandnew life. Smiling, laughing, so full of joy. You look at one, perhaps as he takes his first halting steps, marveling how he embraces life, a life where he can be anything, where he can do anything. Except when he cannot; perhaps because the cards are stacked against him. And such was the substance of the presentation at our September Membership Meeting by Alison Arnold, Ed.D. The problem is ACE, not the elastic bandage, but the Adverse Childhood Experience. You see, and this is pretty obvious of course, babies need a lot of, well, babying, in order to develop into mentally and physically healthy adults. And they don’t get that when:
• They go hungry because their parents cannot afford to feed them.
• They get hit by someone they love.
• They are afraid because they witness frightening, violent acts, perhaps between their parents.
• They are not much touched, perhaps because the one who loves them is alone, overwhelmed, inexperienced or away working most of the time.
• There has been a death in the family (maybe one of the parents) and the
surviving parent is grieving. Consider this: Those one million COVID deaths left nine million grievers. Many of those were—or are—caretakers of young children.
• Their caretaker is a substance abuser and is incapable of taking care of himself, much less a needy child.
• Their caretaker has a mental illness (which affects 20% of American adults at any given time).
These situations can be too, too common in the lives of children1. I personally was hit by four ACE’s as a young child; 260,000 Michigan High School students today have experienced at least one ACE; and 4,400,000 Michigan adults knew at least one ACE 2 .
But, kids are resilient, right? Usually they turn out OK? Except when they don’t. Adults with ACE’s in childhood have higher risk of lifetime low income, alcohol abuse, drug abuse, trouble with the law, heart disease and cancer. Yes cancer! And that’s not even the worst part. There is a proven dose-response relationship with the number of ACE’s you experience and the risk of these adverse outcomes. So the more ACE’s, the higher risk of any or all of these problems. Today, 15% of Michigan High School students have four or more ACE’s
And 63% have at least one ACE
And the usual support systems we expect will help children—churches, schools and NGO’s—can’t help much because most of them are geared to older children. With ACE issues, most of the damage is done before the child ever leaves home. We cannot help the child without helping the parent, without helping every parent.
And even if these unfortunate children have managed to grow up successfully without major mental issues…there’s still higher risk of heart disease and cancer. Do we even consider this when deciding what screening tests to do on our patients?
What can be done? Quite a bit is already being done, according to Dr. Arnold. Early childhood intervention programs, food distribution programs, “Earned income credit,” training teachers and doctors (that’s us at this meeting) to be “trauma aware,” and expanding mental health services. Bottom line; more investments in our young children; more help for their families. Mental health services. Physical health services. Better schools. Job training. Neighborhood improvement. Help the children by helping their caretakers. That’s, for sure, a lot to do.
There is a proven dose-response relationship with the number of ACE’s you experience and the risk of these adverse outcomes.
1
continued from page 6
ACE’s, not just another diagnosis on a checklist. Too important for that. Our beautiful young child needs help to be what he could be…and do what he could do. Unhampered by ACE’s, his potential could be unlocked, benefiting every one of us, including me and you—but requiring the involvement of every one of us to ensure this happens.
And, yes, spanking does indeed count as “being hit by someone you love.”
2 See miacedata.org
If you find it difficult to communicate with your doctor; if you find it hard to get personal attention from an 'impersonal healthcare industry'; if you don't understand all those insurance-company rules; if you don't know how to change your bad health habits; if you think you may be on unnecessary medications; if you are perplexed by those annoying health-product advertisements; and if you'd like to know which are your greatest health risks - you'll appreciate this Family Doctor's advice, gleaned from 44 years of practice.
Each chapter is illustrated with real-life examples from his and other doctors' practices. Each chapter ends with 'bonus' essays written by the author and published in newspapers and magazines giving the doctor's viewpoint. This will give you a unique perspective and allow you to 'get into the mind' of a doctor. Sweet!
Available on Kindle (different cover but same book) and paperback.
Available on Amazon by clicking HERE 1
If you would like to write an article of interest to your colleagues for publication in a future issue of The Bulletin, please contact Joan Cramer at jmcramer@sbcglobal.net for further information.
Articles are not designed for self-promotion, but rather as information for members.
Medical Arts Building I 4705 Towne Centre Road, Suite 204 Saginaw, Michigan 48604 2,450 square feet Call for details (989) 284-2659
All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society (SCMS).
The Bulletin is made available electronically for members as an informational service. Reliance on any such information is at the user's own judgment.
The SCMS, its officers and employees, cannot guarantee the accuracy, reliability, completeness or timeliness of any information, and may not be held liable for any individual’s reliance on our web or print publications. For questions or the latest information, please contact Joan Cramer of the SCMS at (989) 284-8884 or jmcramer@sbcglobal.net
Mission: To prevent suicide through education, connection to resources, and support for those impacted by suicide.
approximately 191,295 people exposed to a suicide death. Families are not alone. This event is here to care for and to support them on their grief journey. Your sponsorship will help make this a minimal registration fee event for all our families. As you may know, many survivors have incurred hardships following their loss and it is our intention to bring them hope and healing without the added burden of financial stress.
If you have any questions about sponsorships or the event in general, please feel free to contact me. The Sponsor Form is available by clicking HERE.
Barb Smith, Executive Director barb.smith@srrn.net
Phone: (989) 781-5260
Dear Community Partner,
The Saturday before Thanksgiving is recognized as the International Survivors of Suicide Loss Day, a day to support loved ones bereaved by suicide. We are inviting you to be a sponsor for our annual Hope Starts Here event taking place at the Bavarian Inn Lodge in Frankenmuth on Saturday, November 19, 2022. The day includes a keynote speaker, shared experiences by a panel of survivors of suicide loss, resource tables, art therapy, food, connecting with others, and closing ceremonies.
We are pleased to announce Gwen Kapcia as our keynote speaker. Gwen is a licensed social worker in the state of Michigan and holds a certification in Thanatology, the study of death, dying and bereavement. She has spent her entire career in grief and loss, spanning from hospice care, funeral home aftercare support, and Executive Director at Starlight Ministries. She knows what grief feels like for her, but most of her experiences come from walking alongside thousands of bereaved individuals who bravely taught her about grief. Along with directing six camps for bereaved children, she has co-authored a faith-based curriculum for bereaved children and adults. Gwen is the founder of Your Grief Guide, which supports bereaved individuals and provides training for those supporting them. Through online classes, virtual checkpoints, and educational presentations, she aims to convey and normalize the reactions to loss.
According to a study by Dr. Julie Cerel, for every suicide in the United States, there were 135 people exposed to each death. In 2020, Michigan lost 1,282 people to suicide, leaving
Registration for this event is $20 per person which includes lunch. Please click on the link below for more details about the event and to register. Note: This event is intended for those 16 years and up. There is limited seating, so please register soon.
CLICK HERE TO REGISTER FOR HOPE STARTS HERE or call (989) 781-5260
• 2021 - We delivered trainings to over 6,950 participants and cared for over 1,400 people impacted by suicide
• 2022 - We have trained over 7,300 people thus far
We will continue to do this work in honor of our loved ones lost to suicide, and to care for those who have been impacted by the death of a suicide.
The National Suicide Prevention Lifeline is now 988 Suicide & Crisis Lifeline
988 has been designated as the new three-digit dialing code that will route callers to the new Suicide & Crisis Lifeline. The old Suicide Prevention Lifeline phone number (1-800-273-8255) will remain available to people in emotional distress or suicidal crisis, even after 988 was launched nationally.
The Lifeline’s network of over 200 crisis centers has been in operation since 2005, and has been proven to be effective. It’s the counselors at these local crisis centers who answer the contacts the Lifeline receives every day. Numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed and more hopeful after speaking with a Lifeline counselor.
The Department of Health and Human Services released data showing a 45% increase in overall volume in August 2022 compared with August 2021, representing 152,000 more contacts that include calls, chats and texts. Are you in a crisis? Call 988 or text TALK to 741741.
Tuesday, November 15, 2022 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in November.
There is no Board or Membership Meeting in December.
Tuesday, January 17, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting Joint with the Saginaw County Dental Society - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.
Speaker - Sudeep R. Aryal, MD
Topic - “Dental Health and Heart Disease”
Email meeting notices will be sent in early January.
Online reservations are required.
Tuesday, February 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in February.
SCMS Health Fair “The Doctor Is In!”Horizons Conference Center Date TBD
Tuesday, March 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in March.
Tuesday, April 18, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.
Speaker TBD
Topic TBD
Email meeting notices will be sent in early April. Online reservations are required.
Saturday-Sunday, April 22-23, 2023 - The Henry in Dearborn 158th Annual MSMS House of Delegates
Tuesday, May 16, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Annual SCMS and SCMS Foundation Membership Meetings
- Social (cash bar) at 6:30 p.m., followed by dinner, meetings and program at 7 p.m.
Email meeting notices will be sent in early May.
Online reservations are required.
12th Annual SCMS Foundation Golf Outing – date TBD
Read previous issues of The Bulletin at www.SaginawCountyMS.com under the Bulletin tab
In March 2022, the Nominating Committee consisting of Dr. Millie Willy, Past President as Chair, Dr. Tony Zacharek as President and Dr. Tiffany Kim as President-Elect, asked the SCMS Board to consider amending the Bylaws to allow all delegates and alternates to have a vote. It was the Nominating Committee’s opinion that if we have active and retired members giving of their time and serving the SCMS, they should be entitled to a vote. New members to the Board generally start as an alternate delegate as they learn the Board process. Past presidents serving as alternate delegates offer a wealth of history and experience on SCMS issues.
Per the Bylaws, officers and directors have voting privileges. Each June, the officers and directors vote for three delegates who are not already serving in a voting position as an officer or director to be voting members of the Board. Any additional delegates and alternate delegates do not have a vote. Alternate delegates include past presidents who want to stay involved on the Board. SCMS quorum is one-third of voting Board members.
After thoughtful consideration, the Board voted at the September 18, 2022, Meeting to approve an Amendment to the Bylaws. The relevant sections of the Bylaws follow, with text to be removed in red-strikethrough, and text to be added highlighted yellow:
The delegates, and in their absence or disability, the alternate delegates, shall attend and faithfully represent the members of this Society in the House of Delegates of the Michigan State Medical Society, and shall make a report of the proceedings of the House of Delegates at the next following regular meeting
of this Society. To be eligible for election as a delegate or an alternate, the member must have been an active member of this Society for at least two years.
Section 1. The Board of Directors shall consist of the president, president-elect, the immediate past president, the secretary, the treasurer, the editor of the Bulletin, six directors to be elected from among the membership, and three members which shall be elected from the pool of MSMS Delegates the duly elected delegates and alternate delegates. The current president shall act as chair of the Board. The secretary of this Society shall act as secretary of the Board. The Past President will remain on the SCMS Board whether s/ he retires or remains in active practice. The Board will appoint a retiree representative to the Board to serve a one (1) year term. The Board of Directors shall have the power to appoint resident representative(s) and medical student(s) for terms to be determined at their discretion to serve on the Board. The resident representative(s) and medical student(s) shall not be subject to Section 2 of Chapter XIV herein requiring attendance at fifty percent (50%) of Board meetings, but the resident representative(s) and medical student(s) shall make every effort to attend as many meetings as possible so as to effectively represent their peers. The retiree representative, resident representative(s) and medical student(s) will be non-voting members of the Board.
In accordance with the Bylaws and SCMS policy, the proposed Bylaws Amendment will be published in two issues of The Bulletin, and brought before the membership for a vote to approve at the next occurring Membership Meeting on Tuesday, January 17, 2023.
If any member has questions or concerns about the proposed Bylaws Amendment, please email Joan Cramer at jmcramer@sbcglobal.net by December 31, 2022.
The SCMS Board of Directors formed an Ad Hoc Committee of Drs. Chris Allen, Lou Constan, Tiffany Kim, Miriam Schteingart and Tony Zacharek to develop the Mission, Vision and Values Statements of the SCMS. The Committee met on Tuesday, August 16, 2022, via Zoom.
The purpose of the Committee was to establish the Mission, Vision and Values Statements of the SCMS based on prior Board discussion.
• The MISSION STATEMENT communicates the purpose of the organization.
• The VISION STATEMENT provides insight into what the organization hopes to achieve or become in the future.
• The VALUES STATEMENT reflects the organization’s core principles and ethics.
The Committee’s recommendations were approved by the SCMS Board of Directors at their meeting on Tuesday, September 18, 2022.
• Bringing physicians together for the common good
• We aim to improve the lives of physicians and the patients we serve
In accordance with SCMS policy, the proposed Mission, Vision and Values Statements will be published in two issues of The Bulletin, and then brought before the membership for a vote to approve at the next occurring Membership Meeting on Tuesday, January 17, 2023.
If any member has questions or concerns about the proposed Mission, Vision and Values Statements, please email Joan Cramer at jmcramer@sbcglobal.net by December 31, 2022.
www.SaginawCountyMS.com
The Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) is providing you with this notification regarding important implementation updates for Public Acts 134,135, and 136 of 2020 which require electronic prescribing (e-prescribing) of prescriptions.
As you may be aware, the law will soon require prescribers to electronically transmit controlled and non-controlled substance prescriptions. Pursuant to authority provided in MCL 333.17754a(10), BPL’s enforcement of the electronic prescribing standard will coincide with the Centers for Medicare & Medicaid Services' (CMS) enforcement schedule for Part D prescription drug programs. As a result, BPL will
initiate enforcement of Michigan’s new electronic prescribing standard on January 1, 2023.
BPL has created a form that can be used by prescribers who may fall into one of the narrow categories in the law and wish to apply for a waiver of the electronic prescribing requirements of MCL 333.17754a. The form can be found on our website
If you would like to apply for a waiver, complete the form and email it to bpldata@michigan.gov or mail it to PO Box 30670, Lansing, MI 48909. Please note that requests sent by postal mail will take longer to process than requests sent by email.
As a reminder, we have a frequently asked questions document on our website that you may find useful. Should you have any questions, please contact bplhelp@michigan. gov or visit our website at www.michigan.gov/bpl.
The House of Delegates (HOD) is the official policy-making body of the Michigan State Medical Society (MSMS). Resolutions and Board Action Reports are the vehicles used to debate and determine the policies, priorities and direction of MSMS during the ensuing 12 months and beyond. Therefore, a well-crafted resolution is essential in order to present the most effective case for those issues that are of importance and concern to you.
reviewed by MSMS staff for comparison to existing MSMS and AMA policy, legal considerations, and appropriate editing. They are then assigned numbers and referred to one of the six House reference committees or placed on the "Reaffirmation Calendar."
All resolutions for which the “Resolved” state either MSMS or AMA existing policy will be placed on a "Reaffirmation Calendar" and voted upon at Sunday's session. A delegate can ask the Committee on Rules and Order of Business to extract a resolution from the Reaffirmation Calendar for referral to a reference committee. The Committee on Rules and Order of Business meets on Saturday morning prior to the opening of the House.
Please note, pursuant to adopted HOD Resolution 65-14, any resolutions "submitted to the MSMS HOD that require action by the AMA may only be submitted by MSMS members that are also members of the AMA."
The reference committees are responsible for listening to testimony on the rationale and merits of the submitted resolutions, discussing the issues raised for and against resolutions, and making recommendations to the HOD on the fate of the resolutions.
Resolutions are presented to the MSMS HOD by voting delegates on behalf of their county delegation, specialty society, ethnic medical society, MSMS membership section, or as individual delegates. In order to be considered as regular business of the HOD, resolutions must be submitted to MSMS by 5 p.m. on either March 1 or the next business day if March 1 falls on a Saturday or Sunday. Once received, resolutions are
If you have an idea for a resolution, contact Joan Cramer at the Saginaw County Medical Society jmcramer@ sbcglobal.net with your idea. The proposed resolution idea will be placed on the agenda for the next SCMS board meeting, where it will be reviewed for relevance, content and support.
For additional information on resolution writing, visit the House of Delegates page on the MSMS website by clicking HERE
A Naloxone vending machine was installed recently at the Saginaw County Health Department (SCHD). It is the first of its kind within the Great Lakes Bay Region and a vital tool to address the opioid crisis and the stigma of substance use.
At no charge, the vending machine dispenses: 1) fentanyl test strips to detect the presence of fentanyl in street drugs; and 2) Naloxone (also known as Narcan), a life-saving opioid overdose-reversal tool that bystanders can use to revive an individual long enough to get paramedics on the scene. These products are free to anyone — no questions asked and no identification required — Monday through Friday, 8 a.m.-5 p.m., in the SCHD lobby, 1600 N. Michigan Avenue in Saginaw.
“Overdose deaths are a growing public health concern,” says Christina Harrington, MPH, SCHD Health Officer, pointing to the 299% increase in opioidrelated deaths in Michigan since 2011. “In 2020, 2,171 Michiganders died by opioid overdose – 55 in Saginaw County alone,” she notes. “Improving access to life-saving supplies by housing this vending machine in our building is an easy yes for us!”
The vending machine and its contents are designed for anyone, including friends, family, and community who know or interact with someone at risk for opioid overdose including those:
• Taking high doses of opioids as prescribed for pain
• Living with opioid use disorder
• Misusing opioids prescribed for others or using illicit opioids like heroin or fentanyl
The vending machine project is part of an ongoing partnership between SCHD and the CAREring Quick Response Team (made up of the Michigan Health Improvement Alliance, Ten16 Recovery Network, Mobile Medical Response and other partners). Program support for the vending machine was funded by a grant from the Michigan Department of Health and Human Services
“This is an incredible opportunity to get help and hope into the hands of not just people who use opioids or other substances, but every community member,” said Andrea Foster, Chief of Staff and Director for Program Development, Opioid Response with the Michigan Health Improvement Alliance. “Naloxone is vital to battling the opioid crisis, and lethal doses of fentanyl are turning up in more and more substances. You never know when you may need to save a life.”
Saginaw now joins Ann Arbor, Jackson and several northern communities offering free Narcan and fentanyl test strips from a vending machine.
The installation comes shortly after other local efforts to raise awareness about harm reduction including:
• The four-story mural on the side of SCHD building inspired by a local recovery group.
• A new syringe exchange program called Room 202 on the second floor of SCHD.
• Launch of BWell Saginaw, a multi-organization public health initiative focused on mental health/substance use, obesity/chronic disease management, and maternal/child health.
Additional grant funds may be used for additional naloxone vending machines. Those interested in installing a vending machine in Bay or Saginaw counties may contact Andrea Foster for more information at a.foster@mihia.org
In recognition of World Patient Safety Day which took place on September 17, and the Michigan Health Improvement
on
Alison Arnold, Ed.D. Central Michigan University Interdisciplinary Center for Community Health & Wellness
At the September 18, 2022, SCMS Membership Meeting, Alison Arnold, Ed.D., presented a very informative program on “Revisiting ACEs: The Roots of Wellness and Building Our Inner and Collective Resilience.”
Dr. Arnold has graciously allowed us to post her presentation on the SCMS website under the Meetings tab (Archived SCMS Membership Meeting Programs)
Following are some of the slides Dr. Arnold used in her presentation. To learn more about ACEs, please visit our website and view the entire program as referenced above.
The MI ACE Data Dashboard referenced in the presentation can be viewed by clicking HERE.
NCHS
• 13.6% of U.S. children between the ages of 5 and 17 years had received mental health treatment in the past 12 months.
• 10.0% of children had received counseling or therapy from a mental health professional
• 8.4% had taken prescription medication for their mental health.
continued from page 13 Alliance’s commitment to Zero Harm in the region, we are excited to announce several milestones in the ongoing work to reduce adverse drug events (ADEs) and support patient safety in the region.
The Michigan Health Improvement Alliance has worked to address medication safety in a number of ways, starting back in 2020, with a planning grant from the Michigan Health Endowment Fund to develop an implementation plan for reducing medication overload in older adults. That effort has transitioned into a second grant from the Health Fund to continue efforts to advance medication safety in partnership with the Michigan State Medical Society (MSMS) and the Michigan Pharmacists Association (MPA).
Through this work, we have developed several strategies and steps for promoting awareness and education about the importance of medication safety, including:
• Education materials for patients, families, caregivers and more about the harmful effects that can come from improper medication management
• Advocating for the role of pharmacists in the patient’s primary care team
• Outreach and partnerships with several local senior networks and organizations
• Use of data to support individual provider practices in their patterns of prescribing
• A focus on organizational policy and practice to review medications and stop them when appropriate
Please join us in spreading awareness about this important effort.
The Saginaw County Medical Society Membership Meeting was held on Tuesday, September 18, 2022, at Horizons Conference Center. Tiffany K. Kim MD, President, called the meeting to order at 7:02 p.m. Dr. Kim welcomed members, CMU residents, CMU medical students, Saginaw Valley Osteopathic Society (SVOS) members, speaker Alison Arnold Ed.D., and guests.
Dr. Kim thanked the following Key Providers in attendance for their ongoing support of SCMS programs:
• Ascension St. Mary’s – Nicole L. Stewart, Program Specialist, and Christopher A. Garces MD, Breast Surgical Oncologist
• Bieri Hearing Specialists – Sarah Harris and Angela Lasecki Au.D.
• Covenant HealthCare – Marcus Atkins, Physician Liaison and Sudeep Aryal MD, Covenant Medical Group Cardiology
• HealthSource Saginaw – Mathew Hoard PT, Tony Holstine and Katie McDonald M.A.
• Renue Physical Therapy – Kim Barcalow PT-DPT, Mindy Bierlein PT-DPT and Tom Hetzner
Dr. Kim welcomed SVOS President, Jonathan Horbal DO, to the podium to conduct SVOS business.
Dr. Kim then conducted the following business of the SCMS:
• The Minutes of the May 17, 2022, Annual Membership Meeting were attached to the Agenda and published in The Bulletin MOTION: Approve the May 17, 2022, Meeting Minutes as printed. MOTION APPROVED.
• Introduced new members attending the meeting: Residents:
• Ana Camagay MD - PGY-1 Emergency Medicine
• Rebecca Dimanche MD - PGY-1 Emergency Medicine
• Clinton Dsouza MD - PGY-1 Family Medicine
• Mathew Kunz MD - PGY-1 Internal Medicine
• Brittany Ladson DO - PGY-1 Emergency Medicine
• Valerie Lamoureux MD - PGY-1 Family Medicine
• Phuong Thao Nguyen MD - PGY-1 Family Medicine
• Alina Philip DO - PGY-1 Pediatrics
• Zhe Fu Jeff Tu MD - PGY-3 Psychiatry
• Dhruv Verma MD - PGY-1 Family Medicine
Affiliate Member
• Brianna C. Pitre DC, Shields Chiropractic
• Encouraged members to stay up-to-date with the SCMS by reading The Bulletin which is available on our website www.SaginawCountyMS.com under the Bulletin tab.
• Reminded members CMU CME is presenting Implicit Bias Training 2022 on Saturday, October 8 at Horizons. The training fulfills LARA requirements for licensure, and is open to all health care professionals but space is limited. There is no cost to attend, but online reservations are required.
• Invited members to register for the 31st Annual Robert M. Heavenrich MD Endowed Guest Lecture on Thursday, October 20, 2022, at Horizons. The event is free of charge but reservations are required.
• Informed members the National Suicide Prevention Lifeline is now 988 Suicide & Crisis Lifeline. 988 has been designated as the new three-digit code that will route callers to the new Suicide & Crisis Lifeline. The old National Suicide Prevention Lifeline (1-800-273-8255) remains available to people in emotional distress or suicidal crisis. Calls to 988 increased 45% in August 2022, compared to August 2021, after 988 was launched in July 2022.
• Great Lakes Bay Health Centers are now accepting referrals for adult outpatient psychiatry. Members were asked to contact Amra Bader, Behavioral Health Supervisor at (989) 907-2765 or abader@glbhealth.org for more information.
• Reminded members SCMS/MSMS 2023 Membership Dues are now payable. If 2023 dues are paid by November 30, the member will receive $100 free CME from MSMS.
Dr. Kim reminded members they must sign in at the registration table and complete the online evaluation at https://med.cmich.edu/cmecert within 30 days to receive CME credit. DOs will receive a certificate of attendance from the SCMS, and must self-report to the AOA.
Dr. Kim introduced Alison Arnold, Ed.D., who presented a program on “Revisiting ACEs: The Roots of Wellness and Building Our Inner and Collective Resilience” which was followed by a Q&A. Dr. Arnold’s PowerPoint presentation will be available on the SCMS website under the Meetings tab (Archived SCMS Membership Meeting Programs)
L-R Drs. Chris and Dafina Allen, Dr. Brianna Pitre and Mary Galuska
L-R Drs. Meena Ramani, Ana Camagay, Rebecca Dimanche, Kathleen Cowling, Brittany Ladson and Dhruv Verma Renue Physical Therapy L-R Mindy Bierlein, Tom Hetzner and Kim Barcalow
Middle Row: Bieri Hearing L-R Sarah Harris and Angela Lasecki
L-R Drs. Miriam Schteingart, Stephanie Duggan, Liz Marshall and Patrick Botz Alison Arnold
L-R Drs. Cecilia Kraus-Horbal, Taylor Gaudard, Karensa Franklin and Jennifer Romeu
L-R Drs. Valerie Lamoureux, Phuong Thao Nguyen and Dhruv Verma
continued from page 16 The MI ACE Data Dashboard referenced in the presentation can be viewed by clicking HERE.
Dr. Kim thanked Alison for her very informative presentation, and once again reminded members to sign in at the registration table and log into the CMU CME website to claim CME credit.
The next SCMS Membership Meeting will be held on Tuesday, October 18, 2022, at Horizons. Thomas J. Veverka MD, MSMS President, will give a presentation on “The Future of Medicine. ”
Following will be a Candidates’ Forum for the November election.
There being no further business, the meeting was adjourned at 8:30 p.m.
Respectfully submitted, Joan M. Cramer Executive Director
beat is heard while a patient attempts to synchronize a physical movement to match the
Quick, precise brain neurotiming is critical for synchronizing thought & movement, which is critical in Human performance.
Ascension St. Mary’s Hospital proudly introduces Elise J. Landa, MD, pulmonary and critical care specialist. She joins Ascension Medical Group (AMG) and fellow physicians M. Shaffi Kanjwal, MD; Ravinder Bhanot, MD; Shrinivas Kambali, MD; Alex Anderson, PA; and Shawna Nievierowski, NP
Board-certified in internal medicine, Dr. Landa completed her internal medicine residency, and pulmonary and critical care medicine fellowship at Ascension Providence Hospital in Southfield, Michigan. She earned her medical degree from the University of Medicine and Health Sciences in St. Kitts, and holds a Master of Public Health degree from Walden University.
During her fellowship, Dr. Landa led one of the intensive care unit (ICU) teams managing COVID-19 patients during the initial surge.
Dr. Landa is a member of multiple professional affiliations including the American College of Chest Physicians, American Thoracic Society, and the Society of Critical Care Medicine.
She treats all pulmonary diseases with special interests in the diagnosis and treatment of asthma, COPD, interstitial lung disease, chronic respiratory failure and pulmonary hypertension. Dr. Landa will care for critically ill patients in the ICU at Ascension St. Mary's Hospital, and see patients at the AMG Pulmonary & Critical Care office, located at 1015 S. Washington Avenue in Saginaw. For more information, call (989) 907-7636.
Breast Cancer Survivors Celebrated at the Annual Saginaw Spirit Pink Out Hockey Game
Ascension St. Mary’s and the Saginaw Spirit partner for the 15th Annual Pink Out Hockey Game at the Dow Event Center on Sunday, October 30 at 5:30 p.m. to increase awareness of breast cancer and raise funds for the hospital’s breast care fund. A special pre-game tribute will honor local breast cancer survivors. Fundraiser tickets are $16, with $5 from each ticket sale going toward the Ascension St. Mary’s Breast Care Fund. Tickets are available online at www.saginawspirit.net/groupsales with the group ID: PinkOut22 and password: Ascension, or at the Saginaw Spirit office. Pink Out game specials include a free gift to the first 2,500 attendees, and an exclusive player Pink Out jersey auction following the game.
Ascension St. Mary’s Breast Care Fund provides mammograms and follow-up ultrasounds for qualified uninsured and underinsured patients. To date, more than $75,000 has been raised from the Pink Out event to benefit area patients.
No Cost Screenings for Lung Cancer Offered in November November is lung cancer awareness month, and Ascension St. Mary’s Hospital is offering a no-cost, low dose CT screening of
the lungs. The event will be Saturday, November 5, from 9 a.m.–3 p.m. at Ascension St. Mary’s Towne Centre, 4599 Towne Centre Road, Saginaw.
A low dose CT scan of the chest is one the simplest screening exams a person can have. It’s quick and easy, completely painless and results in a minimal amount of radiation exposure. Detailed images allow providers to see any abnormalities within the lungs before individuals may even notice symptoms, often catching cancer in the early stages when it is treatable.
Individuals eligible for the CT lung screenings must meet the following criteria:
• Be between the ages of 50-77 years old
• Currently a smoker or have quit within the past 15 years
• Have, at minimum, a 20-pack year smoking history (i.e. 1-pack a day for 20 years, 2-packs per day for 10 years, etc.)
For questions, or to register, call (989) 493-9610. Walk-ins will be accepted.
Each year, Crain’s 40 Under 40 program recognizes the young leaders taking the region to new heights. Nishtha Sareen, MD, interventional cardiologist at Ascension St. Mary’s Riverfront Cardiology and medical director of the Women’s Heart Clinic at Ascension Providence Hospital, made this year’s list. Congratulations Dr. Sareen!
The 28th annual Ascension St. Mary’s Foundation Cornette Ball is scheduled for Saturday, November 19, at 5:30 p.m. at Horizons Conference Center. The festive evening includes a cocktail hour, a magnificent gourmet meal and live music by Detroit’s Intrigue.
The Spirit of St. Vincent Award is presented annually to a highly respected physician who has rendered long and noteworthy service to the Great Lakes Bay community and beyond. This year’s honoree is Joseph Adel, MD, FAANS, a board-certified, dually trained neurosurgeon with Ascension Medical Group. Dr. Adel
When you experience signs of a stroke, it’s important to call 911 or go to the nearest emergency room.
Ascension St. Mary’s emergency rooms provide early stroke intervention, and all of our ERs are connected to specialists at our Comprehensive Stroke Center, recognized for excellence in the care of stroke patients.
Through the latest technology, our team of stroke specialists collaborate on diagnosing your stroke in as little as seconds and deliver the care that’s right for you. We’re beside you from the ER through recovery and rehabilitation.
If you are experiencing a life-threatening emergency or difficulty breathing, go directly to the ER or dial 911.
provides endovascular interventional procedures, as well as, open cerebrovascular and skull-base neurosurgery to a wide spectrum of patients with complex cranial disorders including acute stroke, aneurysms and arteriovenous malformations.
Special recognition will also be given to the 2020 and 2021 Spirit of St. Vincent honorees, Medley Larkin, DO, and
Applications for membership for second reading and approval at the October 18, 2022, Board Meeting:
Sudeep Raj Aryal MD (Covenant Medical Group Cardiology)
Specialty: Internal Medicine - Board Certified 2014, Cardiology
Medical School: R.G. Kar Medical College, Kolkata, India, 2010
Residency: University of North Dakota, Fargo, ND, Internal Medicine, 7/11-6/14
Fellowship: Edward Harrow Clinical Research Fellowship at Eastern Maine Medical Center, Bangor, ME, 8/15-6/16
Fellowship: Advance Heart Failure, Cardiac Transplant, Mechanical Circulatory Support and Pulmonary Hypertension Disease, University of Alabama, Birmingham, AL, 7/16-6/18
Fellowship: Research Fellowship, Division of Cardiovascular Disease, University of Alabama, 7/18-6/19
Sponsors: Doctors Kai Anderson and Claudia C. Zacharek
Rikat E. Baroody MD (CMU Health - Surgery)
Specialty: Surgery - Trauma, Critical Care - Board Certified 2021 Medical School: State University of New York (SUNY) Upstate Medical University, College of Medicine, Syracuse, NY, 2013
Residencies: The Alpert Medical School of Brown University, Providence, RI, Surgery Preliminary, 2013-14; Lincoln Medical Center, Bronx, NY, Surgery Categorical, 2014-15; and CAMC –WVU Charleston Division, Charleston, WV, General Surgery, 2015-19
Fellowship: Wright State University, Dayton, OH, Surgery Critical Care, 2019-20
Sponsors: Doctors John Blebea and Chet A. Morrison
Franchesca Garcia Robles MD (CMU Health - Pediatrics)
Specialty: Pediatrics - Board Certified 2016; Palliative and Hospital Medicine
Medical School: University of Puerto Rico School of Medicine, San Juan, PR, 2013
Residency: University of Puerto Rico, Pediatrics, 2013-16
Research: Research Fellow at San Juan City Hospital-Centro Medico PR, Pediatrics, 2016-18 and Post-Doctoral Master’s in Clinical and Translational Research, University of Puerto Rico, 2016-20
Fellowship: Mercy Health, St. Mary’s Hospital, Grand Rapids, MI, Hospice and Palliative Medicine, 2018-19
Sponsors: Doctors Anthony M. Zacharek and Claudia C. Zacharek
Steven Hermiz MD (Covenant Plastic Surgery)
Specialty: Surgery - Plastic, Hand, Reconstructive and Cosmetic, Board Certified 2020
Medical School: Ross University School of Medicine, New Brunswick, NJ and Dominica, West Indies, 2012
Steven McLean, MD, since an in-person gala was not held due to the pandemic.
For ticket and event sponsorship information, contact Tammy Weighman at Tamera.Weighman@ascension.org or (989) 284-3773.
Residency: University of South Carolina/Palmetto Health, Columbia, SC, General Surgery, 7/12-6/18
Research Fellowship: University of North Carolina, Chapel Hill, NC between PGY-3 and PGY-4 Academic Year of General Surgery Residency, 7/15-6/16
Fellowship: Medical University of South Carolina, Charleston, SC, Plastic, Reconstructive and Hand Surgery, 7/18-6/21
Sponsors: Doctors Ronald C. Barry and Anthony M. Zacharek
Adeeba S. Khan MD (CMU Health - Pediatrics)
Specialty: Pediatrics - Board Certified 2011; International Board of Certified Lactation Specialist - Board Certified 2017 Medical School: Sri Venkant Sai Medical College, India, 2006 Residency: Children’s Hospital of Michigan/Detroit Medical Center, Pediatrics, 7/8-8/11
Sponsors: Doctors Christopher J. Allen and Dafina W. Allen
Narong Kulvatunyou MD (CMU Health-Surgery)
Specialty: Surgery - Acute Care - Board Certified 2002; Surgery - General - Board Certified 2001
Medical School: University of Alabama at Birmingham, Birmingham, AL, 1994 Residency: New York Methodist-Cornell University Hospital, General Surgery, 1994-99
Fellowship: University of Massachusetts, Worcester, MA, Surgical Critical Care, 1999-2000
Fellowship: University of Minnesota, Minneapolis, MN, Surgical Research, 2000-01
Sponsors: Doctors Chet A. Morrison and Samuel J. Shaheen Christina L. Maser MD (CMU Health-Surgery)
Specialty: Surgery - General - Board Certified 2006; SurgeryEndocrine Medical School: Michigan State University College of Human Medicine, 1999
Residency: William Beaumont Hospital, Royal Oak, MI, Surgery, 1999-2005
Fellowship: Yale University School of Medicine, New Haven, CT, Surgical Endocrinology, 2005-06
MHA: University of Southern California, Price School of Public Policy, Healthcare Administration, 2017-19
Sponsors: Doctors Samuel J. Shaheen and Julia M. Walter
*Application for Affiliate Member
Brianna C. Pitre DC (Shields Chiropractic)
Specialty: Chiropractor
Education: Palmer College of Chiropractic, Davenport, IA, 2021
Sponsors: Doctors Anthony M. Zacharek and Claudia C. Zacharek
It’s now easier to find your elected officials and contact your lawmakers directly
budget proposal that would provide a Medicaid rate increase for primary care services. The budget bill which contains the funding, Senate Bill 828, appropriates nearly $95 million toward the initiative. Senate Bill 828 successfully passed the Senate Appropriations Subcommittee on Community Health/ Human Services on April 20, 2022, and now resides in the Senate Appropriations Committee for consideration.
Bipartisan legislation was recently introduced in the House of Representatives aimed at protecting patients from the burden of prior authorizations. The Improving Seniors’
Timely Access to Care Act of 2022 (HR 3173) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors. Specifically, the bill would:
• Create an electronic prior authorization program that adheres to federally developed standards and includes the electronic transmission of prior authorization requests and responses, as well as, a real-time process for items and services that are routinely approved;
• Improve transparency by requiring plans to report to Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials;
• Require plans to adopt transparent PA programs that are reviewed annually and allow for modification of prior authorization requirements based on providers' adherence to evidence-based medical guidelines; and
• Hold plans accountable for making timely prior authorization determinations and providing rationales for denials.
The demand and need for such reforms is growing — particularly as more seniors choose Medicare Advantage for their health insurance needs. For far too long, insurance companies have hidden behind prior authorization requirements in order to cut costs and boost their bottom line, all at the expense of the patient. The Improving Seniors’ Timely Access to Care Act of 2022 would change this dynamic by taking meaningful steps to curb insurers’ abuse of prior authorization requirements in order to save money, as well as, protect patients from care disruptions.
Lower payment rates in Medicaid have historically created substantial barriers for Medicaid beneficiaries in accessing health care, and these low reimbursement rates combined with increasing Medicaid enrollment exacerbates the financial instability of physician practices that provide essential care to Medicaid patients. The Medicaid uplift, which applies to both adult and pediatric primary care services, will expand access to care for Medicaid beneficiaries, support primary care and physician practice sustainability and improve patient health. Now, more than ever patients need timely access to primary care, and this important initiative will ensure that physician practices stay open to continue caring for patients who trust them. Please contact your Senator today and urge them to support the Medicaid primary care rate increase in Senate Bill 828.
For thousands of auto accident victims and their families, Michigan’s no-fault system was a saving grace, providing essential lifetime care and access to needed therapies and treatments. Sadly, that system has been dismantled, leaving limited access to care for accident survivors and consumers.
One key element of the new auto insurance law that requires an immediate fix is the provider fee schedule, which caps reimbursement for most post-acute brain injury rehabilitation services, including home care, at 55% of what the provider was charging for these services on January 1, 2019.
However, new House and Senate bills, HB 4486 and SB 314, offers a budget-neutral solution that would enable the continued care of survivors. HB 4486 and SB 314 will adjust brain injury rehabilitation, home care and other therapy services to align with the fee schedule reimbursement cap of 200% of the Medicare reimbursement rate, which will keep quality providers viable and protect access to care.
It’s a crucial time to tell your legislator that you support HB 4486 and SB 314, and that they have a responsibility to protect auto accident victims’ right to recover. You are welcome to add your own experience and story to personalize the message.
Click HERE to contact your lawmakers on the following issues The Senate Appropriations Subcommittee on Community Health/Human Services recently adopted an MSMS-initiatedTell Congress to Support the Improving Seniors' Timely Access to Care Act of 2022
Urge Your Senator to Support Increased Funding for Primary CareAdvocates: Tell Your Lawmaker to Protect Access to Care by Supporting HB 4486 and SB 314
Telehealth has proven to be an important care delivery method, especially for those in underserved communities, areas with physician shortages, and areas with limited access to primary care services. During the onset of the COVID-19 pandemic, physicians quickly adopted telehealth to ensure continuity of care while minimizing the spread of COVID-19. Payers also temporarily removed some of the regulatory and administrative barriers that were limiting telehealth use and payment of telehealth services, including payment at in-person rates. From then to now, including the most recent Omicron surge, patients have flocked to telehealth appointments in droves, accessing their physicians in a way that is safe, timely and effective.
With patient access becoming more limited and payments reverting to pre-pandemic rates, the time is right to make these equitable policies permanent given that telehealth is, and will continue to be, an effective method of health care delivery. House Bill 5651 will require payment and coverage parity for telemedicine services the same as if the service were provided in-person, ensuring patients have access to quality care while allowing telehealth to remain a sustainable option for physicians to offer.
Please contact your state Representative today and urge them to vote ‘Yes’ on House Bill 5651.
The Senate’s efforts to reform Michigan’s Medicaid program by introducing and discussing Senate Bills 597 and 598 are necessary and much appreciated. Integrating physical and behavioral health care services is critical to ensure each patient receives the person-centered care required to maximize their overall well-being. Further, when physicians, other health care professionals, and patients are supported in working together as a team toward common goals, better coordination, communication, and outcomes ensue.
To be responsive to the needs of patients across the entire spectrum of symptom severity, legislation must include a clinical model that removes existing barriers and care delays by advancing seamless integration amongst clinicians across specialties and care settings. A system grounded in collaborative care provides the expertise necessary to provide patients with the highest quality care across all clinical areas such as prevention, chronic disease management and acute care. Senate Bills 597 and 598 take some positive steps toward needed integration, however, further improvements are necessary to address the many hurdles our patients are facing.
Senate Bill 680 was recently introduced in the Michigan Senate that will allow for full independent practice for nurse practitioners (NPs). Under the bill, not only would NPs be allowed to provide direct care without physician supervision or collaboration, they would also be allowed to prescribe opioids and other controlled substances. Further, the bill wouldn’t even require additional training or education for NPs.
We know this isn’t what’s best for patients. They want and deserve a robust care team that collaborates for their best interest. The way to do that is NOT creating silos of care. It’s NOT putting those with less training and experience in charge of their care. Let your Senator know this isn’t the right plan for Michigan’s patients.
There is a new, free mediation program in Michigan designed to resolve matters related to experiences with Community Mental Health
In behavioral health mediation, a neutral third party will guide parties through a confidential communication, information sharing and decision-making process. The mediator ensures all parties have a voice and there is a power balance at the table.
Behavioral health mediation improves communication and teaches participants to work together and problem solve by establishing root issues, identifying positions and recognizing solutions. It provides a space for all parties to share concerns and frustrations by being a confidential and impartial process.
If a settlement is reached, the mediators will assist parties in writing an enforceable agreement that is crafted by the parties. Through mediation, one does not lose any of one’s due process rights (i.e., local appeal, grievance/complaint, etc.) by participating.
Behavioral health mediation is a process that provides a safe space to share concerns with a mediation professional. It also allows clients an impartial process where parties have an equal voice. This type of mediation is quick, with most cases settled in less than 30 days. Even if mediation doesn’t result in an agreement, most Michigan residents find the court alternative experience to be a success. Benefits include improved relationships, trust built and reduced stress level. And, mediation is a confidential process, meaning each party’s interests remain private.
Make Sure Your Senator Knows Nurse Practitioners Should Be Part of the Care Team, Not Independent From It!
What’s the Sign-Up Process?
Step 1: Fill out the “Request Mediation” form.
Step 2: A specialist will confirm eligibility.
Step 3: Case will be referred to their local Community Dispute Resolution Program center.
Step 4: The Community Dispute Resolution Program center will contact them and the appropriate Community Mental Health or Prepaid Inpatient Health Plan to conduct a formal
intake process to understand the issues between the parties.
Step 5: Following the intake process, the Community Dispute Resolution Program center will schedule a mediation session within 10 business days.
This free, conflict-resolution option is available to those who qualify and paid for by the Michigan Department of Health and Human Services.
Emergency physicians could once again face drastic reductions to Medicare payments at the end of the year due to sequestration and Medicare’s “budget neutrality” requirements – a more than 10% cut that would jeopardize patient access to lifesaving emergency care.
Newly introduced bipartisan legislation, H.R. 8800, would address one of the most significant portions of the broader Medicare cuts that will go into effect in January 2023. Introduced by Rep. Ami Bera, MD (D-CA) and Rep. Larry Bucshon, MD (R-IN), the bill provides an additional 4.42%
to the Medicare Physician Fee Schedule conversion factor for 2023. The bill also encourages the Administration and Congress to commit to a broader look at long-term reform to bring much needed stability and certainty to the Medicare physician payment system, safeguard access to high-quality care by advancing health equity and reducing disparities, and promote value-based care innovation.
We need a strong showing of legislators to co-sponsor this bill and make preventing the cuts a priority for Congress.
As Congress approaches the end of the year, legislators need to hear from you that these cuts will further destabilize the health care safety net and threaten patient access to care. Click here to quickly email your Representative today!
Between 25-50% of patients with typical chest pain and “normal coronary arteries” on angiography may have coronary microvascular dysfunction (CMD).
Smokers, diabetics and women are more likely to develop this disease. Recognition is important as these patients may have a worse prognosis when compared to patients with normal microvascular function. Treatment of CMD and prevention of cardiovascular events is similar to that for atherosclerotic heart disease.
Chest pain, or angina, can be caused by a variety of conditions. Sometimes, the coronary angiogram may not show any significant obstructive coronary artery disease (CAD) and yet the angina continues.
CMD may be the culprit. CMD is referred to as spectrum of structural and functional alterations at the level of coronary microcirculation, leading to an impaired coronary blood flow (CBF) and ultimately leading to myocardial ischemia. This raises a red flag because:
• Even without evidence of blockages in the major heart arteries, people with ongoing chest pain have high five-year rates of cardiovascular events.
• Undetected, CMD may contribute to later development of CAD and myocardial infarction (MI).
• Getting ahead of the problem can thus prevent major issues that impact quality of life.
Many researchers think CMD shares certain risk factors with arteriosclerosis, including elevated cholesterol, high blood pressure, smoking, diabetes, obesity, inactivity, poor diet, age and family history of heart disease. The potential mechanisms of CMD appear to be heterogenous, including enhanced coronary vasoconstrictive reactivity at the microvascular level, impaired endothelium-dependent and independent coronary vasodilator capacities, and increased coronary microvascular resistance secondary to structural factors.
Unlike CAD, in which symptoms are typically first noticed with physical activity, CMD angina is usually first noticed during routine daily activities or times of mental stress and can occur at rest too. Other signs include shortness of breath, sleep issues, fatigue and lack of energy.
Non-invasive tests include a PET scan or cardiac MRI, however, the most accurate and efficient diagnostic approach is to perform additional invasive testing at the time of the initial coronary angiography to measure blood flow and resistance.
Covenant HealthCare, which is certified to use the Coroventis™ CoroFlow™ Cardiovascular System, is one of the few hospitals in Michigan to accurately perform this test and make a CMD diagnosis. After the angiography, CoroFlow™ is used to assess for CMD – which only adds 10 minutes to the procedure time. It is safe, proven and effective at developing the best line of treatment. CMD is diagnosed when Coronary Flow Reserve (CFR) is < 2.0 and Index of Myocardial Resistance (IMR) is >25.
The primary goal of treatment is to reduce pain and prevent further complications. Nonpharmacological treatment includes weight loss, exercise and smoking cessation. Medical treatment is with calcium channel blockers, nitrates, antiplatelet agents, statins, and diabetes and BP control.
CMD may play a role in other cardiovascular conditions such as nonischemic cardiomyopathies, takotsubo syndrome and heart failure. While research is ongoing for CMD prevention, diagnosing and treating this condition can make a world of difference in patient health and well-being. For more information, contact Covenant Cardiology or visit covenantcardiology.com
Covenant HealthCare welcomes Sudeep Aryal, MD, as a member of the Covenant Medical Group. Dr. Aryal joins the Covenant Cardiology team as an Invasive Cardiologist. He offers services such as cardiology consults, coronary angiography, echocardiograms, exercise stress testing, loop implants, stress echocardiograms and TEE/ cardioversions. The office is located at 900 Cooper Ave, Suite 4100, Saginaw, MI 48602 and the team can be reached at 989.583.4700.
Most people experience difficulty sleeping at some point in their lives. Some people feel refreshed after only six hours of sleep. However, most adults need around eight hours of sleep each night to feel rested.
If you or someone you know have trouble getting a good night’s sleep, the Registered Sleep Technologists at Covenant HealthCare Sleep Medicine Center offer free sleep support in a group setting to openly discuss:
• Sleep disorders such as sleep apnea, restless leg syndrome and delayed sleep phase disorder
• Therapy
Is your patient’s chest pain due to coronary microvascular dysfunction? Covenant has tools to help.
Dr. Manoj Sharma, Covenant Cardiology (excerpt from The Chart)
Sleep Support sessions meet the third Wednesday of the month from 6:30-7:30 p.m. Join our sleep team to ask questions and get sleep support in a group setting. Meetings take place at Covenant HealthCare, 515 North Michigan Avenue, Fourth Floor, Saginaw, Michigan 48602. Have questions? Call 989.583.2930.
The Covenant HealthCare Sleep Center is accredited by the American Academy of Sleep Medicine and offers a wide variety of services including: Nocturnal Polysomnography (a/k/a a sleep study) for adults and children, Positive Airway Pressure Titration, Multiple Sleep Latency Testing, Home Sleep Apnea Testing (for patients who meet specific criteria), a Consultation/Physician Clinic, and a board certified sleep physician who specializes in supporting children of any age.
GLBHC priority is to serve the underserved, uninsured, and underinsured. We offer transportation along with multiple other integrated services to address your patients’ needs like dental, laboratory and on site pharmacy, and community health workers to address social disparities. This is our priority population and we do well serving them!
Who: Adults with mild to moderate mental health conditions
What: Outpatient psychiatry services
When: Now!
Where: Davenport Location Bay City South Location 3023 Davenport Ave 690 S Trumbull St Saginaw, MI 48602 Bay City, 48708
How: To learn more about our new referral process, please contact Amra Bader, Behavioral Health Supervisor at (989) 907 2765 or abader@glbhealth.org
Of Special Note:
GLBHC is not a crisis intervention program. If patient is currently suicidal/homicidal/danger to self or others, please seek emergency intervention for them by contacting your local Community Mental Health or sending to the Emergency Room
*Saginaw Community Health Mental Health Authority (800) 233 0022
*Bay Arenac Behavioral Health (800) 327 4693
Hyperbaric Oxygen Therapy (HBOT) is the administration of 100% oxygen in a pressurized environment. Diffusing oxygen throughout the body promotes angiogenesis, allowing a chronic wound to get the nutrient and oxygen rich blood it needs to heal. Specialized wound care, including HBOT, is often necessary for optimal treatment of chronic wounds. HBOT is an effective adjunctive therapy used in conjunction with advanced wound care. Along with proper attention to nutrition and other underlying medical problems, we achieve greater healing results. HBOT is a proven treatment for:
• Chronic Refractory Osteomyelitis
• Lower Extremity Diabetic Ulcers
• Radiation Cystitis/Proctitis or Radiation Necrosis
“There are approximately 6.5 million patients in the U.S. suffering from chronic wounds (e.g. diabetic foot ulcers and pressure ulcers) and approximately 140,000 patients are hospitalized every year with new wounds. Currently, over 23 million people have been diagnosed with diabetes.”*
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Bridge Michigan Michigan’s nonpartisan, nonprofit news source Robin Erb | Bridge Michigan September 22, 2022
There are too few staff and too few inpatient beds for inpatient mental health care, so Michigan’s youngest residents can wait days, even weeks, in hospital emergency rooms.
• In Michigan, kids in mental health distress can linger for days — even weeks — in ER’s before getting care
• A bill would allow hospitals to broaden who can evaluate patients in crisis in an effort to speed treatment decisions
• Critics say quick evaluations are not the problem, it’s the lack of psychiatric beds and personnel
Michigan’s threadbare mental health system faces problems that are daunting and complicated, but a new bill in the state House is intended to speed up the decision on whether a patient in crisis should be hospitalized, its sponsor said.
The measure follows years in which, particularly during the COVID pandemic, Michigan children and teens in mental health crisis spent days or weeks in emergency rooms awaiting evaluation or treatment because there were no openings at specialty facilities or psychiatric units to treat them.
“It's not … a bill that will fix all the issues in Michigan’s mental health services, but it is a step in the right direction,” State Rep. Graham Filler said of the measure, which would apply to both minors and adults who are in crisis.
On September 21, House Bill 6355, sponsored by Filler, R-Greenbush Township, received its first hearing before the House Health Policy Committee. It would require a community mental health (CHM) worker to evaluate a patient in crisis within three hours of being notified by a hospital that the patient needs evaluation. If a CMH worker isn't available in three hours, a “clinically qualified” hospital employee could do the assessment and, in turn, decide whether the minor needs inpatient care at the hospital or another facility.
The hearing included testimony from Nicole Knight, a registered nurse and the mother of a teen with mental health issues. Knight described endless waits in emergency rooms when her son was in crisis — once for 43 days. It only added to the anxiety of a boy “who is not used to being housed in a 10-by10 room. That leads to restraint and sedation and further trauma that just deepens the trauma he already experienced,” she told the committee.
“If a person seeks care in the emergency room, it should be treated with priority,” said Knight, who founded a Facebook page, Michigan Parents for Mental Health Reform. Doing so, she testified, “helps to decrease the stigma and it also saves lives.”
Michigan has long suffered from a shortage of mental health personnel and inpatient beds for people in severe crisis. Bridge Michigan documented those problems in 2021 in a series chronicling what one hospital president called “a tidal wave of sadness” among young patients. In the series, hospital leaders described how emergency departments came to serve as holding stations for the most troubled young patients; places where they could be monitored, but not receive the treatment they needed for their underlying illness.
“When a person's in the throes of a psychiatric crisis, the last thing they want is to be waiting for hours and hours in an emergency room,” Marianne Huff, President and CEO of the Mental Health Association in Michigan, told the committee.
And that’s the heart of the issue, said Filler, the bill’s sponsor. “Having a patient wait for hours or days can be extremely detrimental,” he said. “People with mental illness need immediate care the same way that people with other injuries or illnesses do.”
But Alan Bolter, associate director of the Community Mental Health Association of Michigan, which represents the state’s community mental health agencies, said the bill does not address the major hurdle to prompt evaluation and care.
As it now stands, Michigan’s Mental Health Code requires each of Michigan’s community mental health agencies to have screening staff available around-the-clock to respond to a crisis. Under a contract agreement with the Michigan Department of Health and Human Services, these staff members must respond to an ER crisis within three hours at least 95 percent of the time, Bolter told the committee. They exceed that standard, he testified, responding within three hours more than 97 to 98 percent of the time.
The real problem, Bolter said — in a point also raised by representatives in their questioning — is the lack of mental health staff, which in turn, leads to too few inpatient beds for both adults and children. Additionally, he said, the bill would allow hospitals to sidestep community mental health workers — who he said are best positioned to assess a patient’s mental health needs — by allowing qualified hospital personnel to see patients in their absence. Even when that happens, he said, local, tax-funded, community health agencies would pick up some of the cost for inpatient care. (Under the bill, hospital staff permitted to evaluate patients in the absence of a CMH worker would need at least a master’s level degree in a behavioral health specific profession to perform assessments.)
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Bypassing CMH workers in the evaluation process would also raise the possibility of patients being hospitalized when they would be better served in an outpatient setting, he said. “We've all heard stories…of individuals in emergency departments for 10 days, 15 days, 20 days, 30 days,” Bolter said. “All of this is extremely tragic; however, this legislation does not, from our perspective, solve that problem.”
State Rep. Lori Stone, D-Warren, also focused on the lack of psychiatric staff across the state. “My understanding is that a significant amount of patient delay… is largely due to the lack of providers in the mental health space because of the (low) rates of reimbursement” they are paid by health insurers, she said.
Filler, the sponsor, agreed that the bill doesn’t solve those larger, more complicated issues of insurance reimbursement and staffing. “Technically, this is not an access-to-care bill, Representative,” he replied to Stone. “This is a… quickness-ofevaluation bill.”
Representatives did not vote on the bill. It remained in committee, which has not yet scheduled further hearings.
creativity to work for
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Happy Special Birthday!
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Third Thursday of each month at 7 p.m. Zion Lutheran Church 545 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 AMA Women Physicians Section (WPS)
Inspiration Award honors and acknowledges physicians who have offered their time, wisdom and support throughout the professional careers of fellow physicians, residents and students.
Wendy S. Biggs, MD, Professor and Family Medicine Comprehensive Community Clerkship Director at CMU College of Medicine, was named a 2022 Inspiration Award winner in September. Dr. Biggs was nominated by M-4 Mariavictoria Lorenzo.
Wendy S. Biggs, MD
“Dr. Biggs is caring, compassionate, and goes beyond for her patients and students.” Nominated by Mariavictoria Lorenzo
Congratulations, Dr. Biggs!
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Preview the telehealth toolkit, developed by Central Michigan University. Your input will enhance and benefit the resources for service providers in Michigan!
Preventing Suicide in Michigan Men is a five-year, Centers for Disease Control grantfunded program aimed at reducing suicide in men ages 25 and older. To achieve this goal, the Michigan Department of Health and Human Services has implemented a comprehensive, multi-sector partnership and action plan that targets the male population in the state.
The Michigan PRiSMM project is being led by the MDHHS. By 2024, the statewide PRiSMM initiative will work to reduce the number of suicide deaths and attempts among men ages 25 and older by at least 10 percent. From 2014–2018, more than 6,700 Michiganders lost their lives to suicide. Two-thirds of the suicide deaths in Michigan are adult men.
CMU’s partnership with the PRiSMM initiative is to create and disseminate the toolkit and, in the process, cultivate a statewide training network for suicide prevention and telehealth.
For more information, sign up for an overview, or to give us feedback on the toolkit, please contact the CMU Interdisciplinary Center for Community Health and Wellness at icchw@cmich.edu.
CMU, an AA/EO institution, strongly and actively strives to increase diversity and provide equal opportunity within its community. CMU does not discriminate against persons based on age, color, disability, ethnicity, familial status, gender, gender expression, gender identity, genetic information, height, marital status, national origin, political persuasion, pregnancy, childbirth or related medical conditions, race, religion, sex, sex-based stereotypes, sexual orientation, transgender status, veteran status, or weight (see http://www.cmich.edu/ocrie). 20237 MGX 100 qty (10/21)
Tuesday, November 15, 2022 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m. There is no Membership Meeting in November. There is no Board or Membership Meeting in December.
Tuesday, January 17, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Membership Meeting Joint with the Saginaw County Dental Society - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.
Speaker - Sudeep R. Aryal, MD Topic - “Dental Health and Heart Disease”
Email meeting notices will be sent in early January. Online reservations are required.
Tuesday, February 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in February.
SCMS Health Fair “The Doctor Is In!”Horizons Conference Center Date TBD
Tuesday, March 21, 2023 - CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting - 5:30 p.m.
There is no Membership Meeting in March.
Tuesday, April 18, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m. Membership Meeting - Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.
Speaker TBD
Topic TBD
Email meeting notices will be sent in early April. Online reservations are required.
Saturday-Sunday, April 22-23, 2023 - The Henry in Dearborn 158th Annual MSMS House of Delegates
Tuesday, May 16, 2023 - Horizons Conference Center, 6200 State Street, Saginaw Board Meeting - 5:30 p.m.
Annual SCMS and SCMS Foundation Membership Meetings
- Social (cash bar) at 6:30 p.m., followed by dinner, meetings and program at 7 p.m.
Email meeting notices will be sent in early May.
Online reservations are required.
12th Annual SCMS Foundation Golf Outing – date TBD
All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.
*subject to change
