Michigan Family Physician Winter 2021 Issue

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WINTER 2021-2022


Plus Save the date for the 2022 Michigan Family Medicine Conference & Expo, July 7-10, at the Grand Hotel on Mackinac Island

New Changes to CME Requirements for Family Physicians Volunteer Leadership Applications Due March 1

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Make HIV Screening the Standard of Care in Your Practice With CDC’s Screen for HIV Toolkit. Early diagnosis of HIV is critical for reducing HIV incidence and improving health outcomes for people with HIV. Yet 1 in 8 people with HIV are unaware that they have the virus. The Centers for Disease Control and Prevention’s (CDC’s) new Screen for HIV Toolkit contains useful resources for your practice and your patients with: • The latest CDC guidance on HIV screening. • Practical tips for integrating routine HIV screening into your practice. • Information to empower your patients to get tested, understand their test HIV results, and connect with support services.

To download or order CDC’s Screen for HIV Toolkit today, visit: cdc.gov/ScreenForHIV.

TABLE OF CONTENTS MAFP BOARD OF DIRECTORS Chair Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP President Srikar Reddy, MD, FAAFP President-elect Glenn Dregansky, DO, FAAFP Vice President Beena Nagappala, MD, MPH Speaker Rachel Klamo, DO Treasurer Bashar Yalldo, MD AAFP Delegates Robert Jackson, MD, MMM, FAAFP Loretta Leja, MD AAFP Alternate Delegates Tina Tanner, MD, FAAFP Mary Marshall, MD, RN, FAAFP Members-at-Large Harshini Jayasuriya, MD, FAAFP Brandon Karmo, DO Amy Keenum, DO, PharmD, FAAFP Holli Neiman-Hart MD, FAAFP Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD, FAAFP Teniesha Wright-Jones, DO, FACOFP Resident Member Himanshi Chopra, MD Student Member Adjoa Kusi-Appiah Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE


President Mary Marshall, MD, RN, FAAFP Vice President Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP Secretary/Treasurer Robert Jackson, MD, MMM, FAAFP Executive Vice President Karlene Ketola, MSA, CAE Trustees-at-Large Jennifer Aloff, MD, FAAFP David Kazanowski, MD Amy McKenzie, MD, MBA Elizabeth Pionk, DO, FAAFP

Jeanette Wilson, MD Bradford Woelke, MD Thomas Wolff, JD

Michigan Family Physician is published quarterly by Michigan Academy of Family Physicians and provided to MAFP members. Statements of fact and opinion are the responsibility of the authors and do not imply an opinion on the part of the Board of Directors or members of MAFP. Materials may not be reproduced without written permission. For subscription information, reprints, and back issues, email info@mafp.com. ©2021 MAFP. All rights reserved.

Editor: Dana Lawrence

Michigan Academy of Family Physicians 2164 Commons Parkway, Okemos, MI 48864 517.347.0098 | mafp.com


Michigan’s Plan to Reduce Implicit Bias for Improving Care Outcomes Cover Story



The Gift of Family Medicine

Leading, Collaborating, and Innovating into the New Year



President’s Message

CEO Insight

Advocacy Update

Changes to Continuing Medical Education Requirements for Family Physicians



State Budget Invests in MAFP Priorities

Preparing for the Medical Education Loan Repayment Restart Business Sense


Professional Development

Student and Resident Voices on MAFP Board of Directors Students & Residents

Academy News p. 20 | Members in the News p. 24 Family Business Medicine Network p. 28 | Events p. 30

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Timothy M. Heilman, DO

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Since 1964, we have maintained a strong referral relationship with doctors throughout Michigan. When you’re looking for a neurosurgery team for your patients, count on Lansing Neurosurgery’s physicians to provide comprehensive brain, trauma and spinal care, including pediatric and skull-base neurosurgery. We work alongside a team of professionals including: neurologists, OMM, pain specialists, pain psychologists, physical therapists, neuro-oncology, Compass cancer & radiation and imaging specialists with the goal to provide our patients and referring physicians with exceptional care, clinical expertise and state-of-the-art services. www.lansingneurosurgery.com

The Gift of Family Medicine By Srikar Reddy, MD, FAAFP As the end-of-year holiday season is well underway, I want to extend my thanks and appreciation to all my family medicine colleagues across the state. I hope you are able to find time to spend with your loved ones, as well as reflect on your own health, well-being, and priorities as we enter 2022. As I look back on the past several years, I can say I have personally never had more faith in the work of our specialty. My hope moving forward is we will continue to demonstrate the value of family medicine for the betterment and health of our patients, communities, and society as whole. In our practices across Michigan, we have learned to navigate new ways of doing things by incorporating non-traditional methods of care delivery. As always, we 6


are committed to getting our patients the healthcare they need and deserve, now while simultaneously trying to limit the spread of contagion like never before. As we look to tomorrow, I encourage all in our profession to continue honing these new skills so our specialty can continue to adapt when barriers and obstacles arise … because they undoubtedly will. Family medicine has come a long way, and we must remain dedicated to building on the lessons we have learned. I like to say family physicians now use the “hybrid model,” as today there are various ways to enhance primary care delivery, including via remote patient monitoring, schoolbased health centers, virtual care, and

digital health/artificial intelligence. I use the term “enhance” because we all know these modalities are accessories to, not a replacement for, continuity of care that results only from the physician-patient relationship. Moving into the new year, we must stay vigilant and accept that the COVID-19 pandemic is not yet behind us. Every one of our voices is needed to strongly advocate for protecting older adults through the federal Protecting Seniors Through Immunization Act, which is moving its way through Congress. We also need to continue educating patients and parents about the critical importance of using a multi-faceted approach to fighting


Together, family medicine is emerging stronger and more respected than ever. That is a gift in itself. I also wish you a happy and healthy holiday season and look forward to working alongside you in the new year. COVID-19 by getting vaccinated, wearing masks, handwashing, and maintaining a safe distance from others. Also, our specialty needs all of us to stay loudly vocal about the need for payment parity between telehealth care and inperson care. This will, importantly, help reduce patients’ confusion around health coverage benefits, with the goal of closing the gap in health disparities and getting our patients the care they need and deserve. And we must maintain our vigilance against potential encroachments on the scope of family medicine practice. We know we possess unique skills, knowledge, training, and experience that allow us to prevent disease and treat acute and chronic conditions across all ages and spanning the entire body, like no other specialty or allied health professional can. We are best positioned to lead care teams, comprised of a variety of people who provide essential assistance to us and our patients. It is important that we continue to educate lawmakers that patients are best served by ensuring many of the services provided by allied health professionals are done only under our supervision. Together, family medicine is emerging stronger and more respected than ever. That is a gift in itself. I also wish you a happy and healthy holiday season and look forward to working alongside you in the new year.

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Srikar Reddy, MD, FAAFP is president of Michigan Academy of Family Physicians. He practices family medicine at Ascension Medical Group in South Lyon. He also serves as Ministry Market regional medical director of virtual care for Ascension Medical Group Southeast Michigan and as a national Ascension virtual care lead and subject matter expert.

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Leading, Collaborating, and Innovating into the New Year By Karlene Ketola, MSA, CAE Author Suman Rai once wrote, “Inspiration and growth only come from adversity and from challenge, from stepping away from what’s comfortable and familiar and stepping out into the unknown.” While reflecting on the events of 2021, I’ve seen our members step up to meet the challenges and unknowns of the COVID-19 pandemic. Despite challenges and unknowns, there 8 WINTER 2021 | MAFP.COM

is much for which to be thankful, from the Academy viewpoint, as we close out the year. Michigan Academy of Family Physicians (MAFP) remains the state’s largest specialty physician association, with more than 4,200 members strong and growing. We are dedicated to assisting 2,280-plus family physicians and their practices as they work to ensure highquality, cost-effective healthcare for Michiganders of all ages; and Family

Medicine Foundation of Michigan (FMFM) remains committed to advancing the specialty and supporting more than 690 residents and 900 medical students. Thank you for your continued membership. My hope is that MAFP inspires you; plays a role in advancing your career; serves as a beacon through leadership, collaboration, and innovation; and is a forum for professional networking. While there isn’t


enough room on this page to highlight all your Academy’s 2021 accomplishments, below are a few that underscore how we are working for you.

Leadership •

Boards and committees comprised of nearly 70 volunteers successfully led MAFP, FMFM, and the Family Medicine Political Action Committee through a year of transition (the call for 2022-2023 volunteer leadership applications is on page 20) Michigan delegates introduced and debated resolutions for improving Academy policies at AAFP’s National Conference of Constituency Leaders, National Conference of Family Medicine Residents and Medical Students, and at the MAFP Annual Meeting MAFP advocated for legislative and policy priorities focused on ensuring all Michiganders have access to quality, affordable healthcare within a family physician-led medical home (page 10)

Collaboration •

Continued our work with Health Can’t Wait, a statewide multi-sector

coalition—of which MAFP was a founding member—that is committed to protecting the health of patients by seeking reforms to the prior authorization process Partnered with the Michigan Association of Osteopathic Family Physicians to host the 2021 Virtual Michigan Family Medicine Advocacy Day (registration for the March 23, 2022, event is open at mafp.com/events) Continued to engage in the Michigan Healthcare Stakeholders Opioid Stewardship Collaborative to combat opioid misuse through prevention, early intervention, and increasing access to evidence-based treatment Partnered with medical schools, residency programs, and AAFP on recruitment and retention initiatives (page 22)

Innovation •

Offered a total of 59.5 CME credits on a variety of topics essential to the practice of family medicine in the healthcare system of today and tomorrow Put forth member presentations at regional and national events, and

service on boards and committees of partnering organizations to represent the family medicine perspective and showcase the innovative work of Michigan family physicians Held statewide media roundtables on back-to-school vaccinations, encouraging COVID-19 vaccination, and fighting misinformation, reaching more than 25 million readers/listeners and garnering $148,000 in earned media Was called upon by the governor’s office in May for then MAFP Presidentelect Dr. Srikar Reddy to stand alongside Gov. Gretchen Whitmer during a televised press conference on the COVID-19 vaccine rollout in Michigan

While we celebrate these accomplishments, we recognize our work is not done. Results from AAFP’s 2021 member satisfaction study identified four issues where MAFP members would like the Academy to concentrate its efforts: 1) Increase overall payment; 2) Drive administrative simplification; 3) Protect family physician interests; and 4) Advocate for models valuing primary care. I assure you that MAFP is working on your behalf on these priorities at the state level. As we look ahead to 2022, I encourage you to get involved in MAFP. Please visit us at mafp.com for more information on our committees, CME and networking events, and leadership opportunities. As always, I encourage you to reach out and share your point of view. We are stronger together.

Karlene Ketola, MSA, CAE is Michigan Academy of Family Physicians’ chief executive officer and Family Medicine Foundation of Michigan’s executive vice president. She joined the MAFP/FMFM team in spring 2019 after serving as executive director of the Lansing-based Michigan Oral Health Coalition for 10 years. WINTER 2021 | MAFP.COM


State Budget Invests in MAFP Priorities By Matt Black Michigan Academy of Family Physicians’ advocacy work during the last quarter of 2021 was non-stop focused on the state budget and funding priorities. This coincided with the focus of legislative leaders and Gov. Gretchen Whitmer’s Administration on passing a supplemental budget bill to balance revenue; spending federal funds, such as those granted to the state to provide relief from the economic fallout of COVID-19; and finalizing the state’s Fiscal Year 2021-2022 spending plan before the Oct. 1 deadline. As always, MAFP’s funding priorities remained centered on supporting the practice of and advancement of family medicine, family medicine practices, and the patients in our state. Specifically, our advocacy team worked with appropriations leaders to advocate for funding for:

Michigan Doctors Improving Access to Care

Michigan Doctors Improving Access to Care (MIDOCS) is a relatively new program that was established to expand residency positions in primary care specialties and help recruit/retain physicians in underserved areas of the state. It received a $1 million increase in the state budget, bringing the program to a $6.4 million price tag for the year. 10 WINTER 2021 | MAFP.COM

MIDOCS family medicine residency programs are administered by Central Michigan University College of Medicine, Michigan State University College of Human Medicine, Wayne State University School of Medicine, and Western Michigan University Homer Stryker M.D. School of Medicine. michigandocs.org

Michigan State Loan Repayment Program

The Michigan State Loan Repayment Program (MSLRP) is a state/federal/ community partnership that offers medical education loan forgiveness in return for commitments to practice in healthcare professional shortage areas. State funding was maintained in the budget at $1.5 million; this draws the maximum amount of federal funding allocated for the state. michigan.gov/mslrp

Healthy Moms Healthy Babies

The Healthy Moms Healthy Babies program received an increase of $10 million to cover an expected bump in costs due to higher participation. This program expands Medicaid coverage for low-income new mothers and babies from 60 days to a full year postpartum. bit.ly/heatlhymomsnbabies

Healthy Michigan Plan

The state’s expanded Medicaid program currently provides healthcare coverage for more than 850,000 Michiganders, with 265,000-plus enrolling through the marketplace. It was allocated a $400 million increase due to increased enrollment. michigan.gov/healthymiplan Immediately following completion of the state budget, appropriations leaders got right back to work, collaborating with stakeholders to assess priorities for supplemental funding proposals using mostly federal funds. MAFP continues to have an open dialog with other state chapters of American Academy of Family Physicians to learn how each state is using federal funds to help advance primary care and family medicine. The increase in federal funds allocated to each state allows for a unique opportunity to test drive innovative pilot programs for training new family physicians in Michigan and keeping them practicing in the state following residency.


Ensuring the new electronic prescribing mandate (Public Act 134 of 2020) is the least onerous for family physicians as possible has been a significant priority for


MAFP’s advocacy team, as the original Oct. 1 effective date neared. The good news is that Michigan Department of Licensing and Regulatory Affairs (LARA) moved the expected effective date to Jan. 1, 2022, for prescribers to electronically submit all prescriptions to a patient’s’ chosen pharmacy. This date change was made to align the state’s e-prescribing requirement with the Centers for Medicare and Medicaid Services’ (CMS) similar requirement. However, since then, CMS released its 2022 Medicare Physician Fee Schedule Final Rule, which includes a provision for postponing the agency’s e-prescribing compliance date to Jan. 1, 2023. Per House Bill 4659, signed into law by Gov. Whitmer in October, there are now certain exceptions to the requirement that prescriptions be transmitted electronically to pharmacies in Michigan. Through MAFP’s advocacy work, dispensing prescribers are exempt from the e-prescribing mandate. Now, the rules promulgation process is underway. At the time of writing, public comment has been submitted and final rules are waiting to be reviewed before they are officially adopted and enrolled.

Scope of Practice

Preventing non-physician groups from securing scope of practice expansions remains a top priority for MAFP. In October, Senate Bill 680 was introduced in the Michigan Senate, which calls for expanding nurse practitioners’ (NP) scope of practice and would allow them to prescribe controlled substances without physician oversight. Currently NPs must collaborate with a supervising physician when performing duties beyond nursing, including prescribing controlled substances. As the MAFP advocacy team meets with legislators to discuss the potentially negative patient outcomes that would result from this bill’s passage, we are asking all members to contact their

state legislators to explain why physicianled, team-based care is the best care for patients. Earlier this summer, certified registered nurse anesthetists were recently granted the authority to practice without physician oversight in Michigan through state legislation that was part of a greater reform package. Another bill of concern would allow outof-state physicians to receive insurance reimbursement for treating Michigan patients via telemedicine without being licensed in our state. This would leave Michigan as an outlier because no other state currently allows a Michigan physician to treat patients in this fashion in their state.

Behavioral Healthcare

Reforming the behavioral healthcare system has been a priority for both the Michigan House and Senate. Each chamber has a different proposal, but both are set to repackage the regional Community Mental Health Authority in favor of a new statewide system that integrates behavioral and physical health and eliminate provisions that allow for only the most severe patients to receive care. At this writing, neither chamber has passed its respective proposal. Senate testimony on the legislation has been positive, with many stakeholders, including insurers, recognizing the work that primary care and family physicians are doing to help these patients. It has been recognized that, even without the proper tools and resources and while staying within their scope of education, family physicians continue to care for these patients.

Business of Medicine

While countless industries have adapted admirably to the changing environment caused by the pandemic, many legislators have placed a laser focus on ensuring a strong economic recovery for Michigan. This has allowed MAFP to highlight the business aspects of family medicine. Solo

and group practices are not only small businesses that support jobs and generate economic activity in a community, but they are also the foundation for a healthy community, which helps all other businesses remain open. In the same way that family physicians treat the whole person, family medicine advocacy work must encompass a wide range of issues. Thus, the need for engaged grassroots advocates within the Academy’s membership is essential. Staying on the top of legislators’ minds, by building and nurturing relationships, is key to ensuring they consider our opinions as bills are being drafted and voted on, and that we “are at the table, and not on the menu.” If you have an established relationship with a legislator, please email me at mblack@mafp.com so we can talk about how best to raise our issues of importance. I also encourage all of our members— from life to student members—to attend the FREE, in-person 2022 Michigan Family Medicine Advocacy Day (register at mafp.com/events) that MAFP and the Michigan Association of Osteopathic Family Physicians are hosting in downtown Lansing on Wednesday, March 23. The return to face-to-face meetings with legislators will strengthen our collective impact, elevate our unified voice, and increase our visibility on issues of importance for making Michigan a healthier state and a better place to practice family medicine.

Matt Black serves as Michigan Academy of Family Physicians’ director of government relations. He is responsible for directing the organization’s state public policy agenda, analyzing legislation and regulatory changes for potential impact on patients and the practice of medicine in Michigan, and bridging the gap between members and elected officials. WINTER 2021 | MAFP.COM


Changes to Continuing Medical Education Requirements for Family Physicians Live CME No Longer Required for Academy Membership

The American Academy of Family Physicians Board of Directors approved recommendations put forth by the Commission on Membership and Member Services as well as the Commission on Continuing Professional Development to eliminate the requirement that active members complete 25 live continuing medical education (CME) credits. This change will allow members to choose the learning format that best suits their needs and preferences, whether it be through live or enduring CME events, or both. Therefore, Michigan Academy of Family Physicians’ philanthropic arm, Family Medicine Foundation of Michigan, is offering live in-person and virtual activities in 2022, in addition to on-demand webinars (page 30). 12 WINTER 2021 | MAFP.COM

This CME requirement change goes into effect for active members whose 3-year (2019-2021) Academy membership reelection cycle closes Dec. 31, 2021, as well as for those in the 2018-2020 re-election cycle who received an extension to earn and report CME credits for maintaining membership. Active members must still report at least 150 CME credits every three years to maintain Academy membership; at least half of the credits must be Prescribed. An AAFP Prescribed credit is designated for activities designed primarily for physicians, with content directly related to patient care, care delivery, or certain non-clinical topics. To learn more about CME requirements for Academy membership, view your CME transcript, or report CME credits, visit aafp.org/cme.

Graduating Residents: Start Earning CME Credits for Academy Membership Beginning Jan. 1

Are you a family medicine resident who is completing training in 2022? If so, you can begin earning continuing medical education (CME) credits, starting Jan. 1, that will count toward your requirements for active membership in American Academy of Family Physicians/Michigan Academy of Family Physicians. Upon completion of residency or extended training, resident physician members may transfer to active membership. In addition to benefiting from the wealth of Academy resources, tools, networking opportunities, and events at a discounted price, active members may vote and comment/testify on resolutions at the AAFP Congress of Delegates (AAFP’s policymaking body), serve as a National Conference of Constituency Leaders delegate, and hold national committee appointments. Plus, first-year new physicians receive discounts on AAFP and MAFP active member dues. Learn more about new physician Academy membership at mafp.com/ get-involved/new-physicians-getinvolved.


Being a board-certified family physician indicates your commitment to ongoing quality improvement in your practice to improve patient outcomes. The American Board of Family Medicine (ABFM) recognizes the quality improvement processes that you are already doing and seeks to avoid duplication to save you time. If you are an AAFP Diplomate, you may claim your Blue Cross Blue Shield of Michigan (BCBSM) or National Committee on Quality Assurance patientcentered medical home (PCMH) certification as a Performance Improvement (PI) activity needed for Maintenance of Certification (MOC). Just upload an electronic copy of your PCMH certification at MyABFM Portfolio to receive 20 PI credits. This will satisfy your PI requirement for your three-year MOC cycle. If your practice is PCMH certified through another organization, please contact Ann Williamson, RN, CCRC at awilliamson@theabfm.org to assess if it meets ABFM’s PI requirements.

LARA Implements Changes to Licensure Requirements

Beginning June 1, 2022, physicians in Michigan are required to undergo training on implicit bias. The first reporting period this affects is for physicians renewing their medical license in 2023. A minimum of three hours of continuing education on implicit bias will be required every three-year relicensing cycle. New licensees will need two hours of training within the five years immediately preceding their application for relicensure. Any training hours earned after June 2021 can be used for license renewal after 2022. Requirements for MDs: • MDs with renewals in January 2022 need no training • Renewals in 2023 need one hour of training • Renewals in 2024 need two hours • Renewals in 2025 need three hours

National Journal Club Pilot Available for ABFM Diplomates

To help family physicians stay current with advances in medical literature; support shared decision-making with patients and families; and advocate for their patients with subspecialists, health systems, and payers; the American Board of Family Medicine (ABFM) has launched the National Journal Club Pilot activity. In addition to the Knowledge Self-Assessment (KSA) and Continuing Knowledge Self-Assessment (CKSA) activities, the ABFM National Journal Club Pilot activity is now available to all Diplomates and residents through the MyABFM Portfolio. For each article assessment completed, you will earn one certification point. Earn 10 certification points and fulfill your KSA requirement for each three-year stage by completing 10 article assessments. This new service provides convenient access to the latest peer-reviewed articles and the ability to earn valuable certification points. To meet requirements for family medicine certification, family physicians need to complete a total of 50 certification activity points in each three-year stage. All Diplomates with a three-year stage that ended Dec. 31, 2020, or is ending Dec. 31, 2021, will have an additional six months to complete all certification activities including stage and exam requirements. The new deadline to complete all stage requirements is June 30, 2022. Learn more at theabfm.org. MAFP is hosting several KSAs in 2022 (page 30).

Moving forward, every three-year license renewal cycle will need to report three hours of training

Requirements for DOs: • DOs with renewals in December 2021 need no training • Renewals in 2022 need one hour of training • Renewals in 2023 need two hours of training • Renewals in 2024 need three hours • Moving forward, every three-year license renewal cycle will need to report three hours See page 14 for more information on this new implicit bias training requirement from the director of Michigan Department of Licensing and Regulatory Affairs (LARA), Orlene Hawks. Another change to Michigan’s medical licensure/re-licensure requirements is in the area of pain and symptom

management. At least one of the three hours of continuing education focused on pain and symptom that is required every three-year re-licensing cycle must now include controlled substances prescribing. For each licensure cycle, Michigan also mandates physicians receive one hour of training in human trafficking (a one-time requirement) and one hour of training on medical ethics. There are no changes to these requirements currently. For more information on Michigan’s medical licensure requirements, visit mafp.com/ events-professional-development/ michiganmedical-licensure. Family Medicine Foundation of Michigan continues to offer continuing medical education training on these topics to help members meet their licensing requirements. See page 30 and visit our website at mafp.com/events for live and virtual programming.

Dana Lawrence is director of communications and member services at Michigan Academy of Family Physicians. She directs the organization’s communications strategy, including media relations, public relations, and social media presence; works to increase family medicine awareness and member engagement; and is the lead on medical student and family medicine resident initiatives.



Michigan’s Plan to Reduce Implicit Bias for Improving Care Outcomes By Orlene Hawks Healthcare is not just science but science directed by people. The last thing we think might be in the way of healing patients is our own bias. Yet one of the brutal lessons from the COVID-19 pandemic is that racial disparities and implicit biases persist in our society. In particular, the disproportionate COVID-related death rate among people of color focused a spotlight on the differences in how disease is recognized and treated among people with the same disease but with different racial backgrounds. 14 WINTER 2021 | MAFP.COM

These disparities often have their root in a caregiver’s implicit biases. Implicit biases that contribute to disparities are often unconscious, and as former Supreme Court Justice Ruth Bader Ginsburg said, “… unconscious bias is one of the hardest things to get at.” Recognizing that implicit bias factors into healthcare disparities, Gov. Gretchen Whitmer charged the Michigan Department of Licensing and Regulatory Affairs (LARA) to develop administrative rules to educate

and train healthcare professionals to recognize and address implicit biases. Motivated to quick action by the escalating death rate during the pandemic, my team worked with 86 stakeholder organizations, licensees, health professional boards, and legislative partners to craft nationleading rules governing implicit bias training for healthcare professionals. While rulemaking is generally a lengthier process, LARA was able to complete this in less than one year and the rules were enrolled June 1.


Implicit bias means an attitude or internalized stereotype affecting an individual’s perception, action, or decision making in an unconscious manner, often contributing to unequal treatment of people based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or another characteristic.

What is Implicit Bias?

As defined in the rules (bit.ly/ implicitbiasrules), implicit bias means an attitude or internalized stereotype affecting an individual’s perception, action, or decision making in an unconscious manner, often contributing to unequal treatment of people based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or another characteristic. As a Black professional woman, I can tell you I have often encountered these biases from wellmeaning people, from all walks of life, who have made assumptions about me solely based on my race, age, and/or sex. Everyone can have an implicit bias, and it is important to recognize that implicit biases often exist outside of conscious awareness, and therefore are difficult to control. They can shape behavior, including the behavior of healthcare professionals. One way to reduce disparities in health outcomes is to seek to eliminate the unconscious biases,

misconceptions, and stereotypes that can lead to differences in how healthcare is provided.

Pandemic Heightened the Need for Change

The promulgation of administrative rules requiring implicit bias training has its origins in Gov. Whitmer’s Executive Directive 2020-7 (bit.ly/ED2020-7), issued in July 2020. While implicit bias in practitioners was not an unknown malady prior to the COVID-19 pandemic, racial disparities in health outcomes came into sharp focus during the early stages of the pandemic. Reports that COVID-19 was four times more prevalent among Black Michiganders than white Michiganders, coupled with national data from the Centers for Disease Control and Prevention showing higher COVID-19-associated hospitalization rates for non-Hispanic Black persons than for white persons, and even higher hospitalization rates for Indigenous populations, were sobering. Death rates exposed more of the grim story with Black and Latino peoples nearly twice

as likely to die from the virus as white people. Sadly, these disparities are not limited to COVID-19, as people of color face disparities in terms of morbidity, mortality, and health status, with Black, Hispanic, and Indigenous Americans having higher infant mortality rates than white and Asian Americans, and the death rate from heart disease and stroke being highest among Black Americans. Such stark differences in healthcare outcomes compelled the Governor to issue a directive that LARA promulgate rules requiring healthcare professionals receive training on implicit bias and how it affects delivery of healthcare to improve outcomes for all Michiganders.

What’s in the Rules?

Starting June 1, 2022, more than 440,000 healthcare professionals licensed or registered in Michigan, representing 26 of 27 Article 15 license types (bit.ly/ licensetypes-article15), will be required to complete training. The rules require WINTER 2021 | MAFP.COM



new license applicants to complete a minimum of two hours of implicit bias training within the five years immediately preceding the issuance of a license or registration. For those already licensed, the requirement is one hour of education per cycle year prior to renewing licenses and registrations. The rules require training to be interactive and include information on the history and present nature of implicit bias, improving equitable access to healthcare to reduce disparities in care and strengthen healthcare outcomes, and develop strategies to self-identify and address implicit biases. The training can be delivered by: • A state or national health-related organization, such as Michigan Academy of Family Physicians • A state or federal agency

• • • •

An accredited college or university An organization specializing in diversity, equity, and inclusion issues A board approved educational program LARA’s Bureau of Professional Licensing will be sending out reminders and information to stakeholders and licensees about the new requirement as the implementation date gets closer, so be sure to look for those notices.

Michigan is committed to having the best healthcare workforce in the country with the best healthcare for all citizens. Through the collective efforts of our licensees, health professionals, and board members, we took a bold step to improve health outcomes and ensure the highest level of care, access, and equity for every individual. Not only are we promoting

high standards of technical knowledge and clinical skills, but we are also creating an environment where health professionals can better understand the ways in which they view and interact with the communities they serve. While there is more work to do, I am truly proud of the steps that we have taken. With the adoption of these new training standards, Michigan is leading the nation in addressing implicit bias within the practice of healthcare. I am confident we are laying a strong foundation of systemic change that will improve the delivery of healthcare and lead to better health outcomes. For more information regarding Implicit Bias Training Rules, reach out to BPLHelp@michigan.gov or call the Bureau of Professional Licensing at 517.241.0199.

Orlene Hawks is director of the Michigan Department of Licensing and Regulatory Affairs. Prior to joining LARA, she led the state’s Operation Excellence project dealing with Michigan Department of Health and Human Services’ Child Protective Services investigations. She previously managed the Quality and Program Services section in the Michigan Department of Community Health (DCH). She also managed the Child, Adolescent and Family Health Services section, directed the Office of Statutory and Legislative Compliance, and served as legislative liaison for DCH.

IMPLICIT BIAS CME COMING IN 2022 To ensure members have access to continuing medical education (CME) on how to recognize and address implicit bias, Michigan Academy of Family Physicians and Family Medicine Foundation of Michigan will be hosting webinars in 2022. Plus, the topic will also be the focus of CME at the 2022 Michigan Family Medicine Conference & Expo in July. Stay tuned to mafp.com/events!



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Preparing for the Medical Education Loan Repayment Restart By Jon Solitro , MA, CFEI Many financial relief programs the government created in response to the COVID-19 pandemic have ended or are set to expire soon. On the minds of many physicians is how to go about repaying medical education debt. In August, the U.S. Department of Education announced (bit.ly/3BzapJF) a final extension of the moratorium on student loan repayment, interest, and collections until Jan. 31, 2022. As that end-date approaches, borrowers must have a game plan. The medical education loan repayment situation has been in flux for many months. Strategizing around the constant changes has been no easy task. The good news is we 18 WINTER 2021 | MAFP.COM

now have some clarity, after being pushed back several times during the pandemic. I made a video on FinancialMD’s YouTube channel (bit.ly/FinancialMDYouTube) detailing some smart things to do with your unused loan payments. Considering you will likely have less net cash flow in 2022 once repayment resumes, it becomes all the more important to stay on top of your finances and budgeting.

borrowers will be sent a billing statement at least 21 days before a payment is due.1 Be sure to review your statement and know your repayment due date. As far as your payment amounts, those should still be the same relative to your discretionary income. Many physicians’ income has increased in the last 18 months. If that’s your circumstance, your payment likely went up, too.

Knowing Your Repayment Date and Amount

A Refresher on Income-based Repayment Plans

Your actual repayment date can vary depending on the terms of your loans. When the repayment moratorium is lifted,

It’s important to review the three types of income-driven repayment plans so you are prepared for resuming payments in 2022.


Considering you will likely have less net cash flow in 2022 once repayment resumes, it becomes all the more important to stay on top of your finances and budgeting.

Pay As You Earn Repayment Plan (PAYE Plan). Your payment is generally 10% of your discretionary income, but never more than the 10-year Standard Repayment Plan amount (studentaid.gov/manageloans/repayment/plans/ standard).

Physician (bit.ly/MFPwinter2020). The key point is you will likely get a lower interest rate by refinancing—we break down the steps to refinancing in the article. If this piques your interest, email FinancialMD at info@financialmd.com to request a two-page guide on refinancing student loans.

Revised Pay As You Earn Repayment Plan (REPAYE Plan). Your payment is generally 10% of your discretionary income.

Action Items

Income-based Repayment Plan (IBR Plan). Your plan depends on if you are a new or existing borrower. For new borrowers on or after July 1, 2014, your payment is generally 10% of your discretionary income but never more than the 10-year Standard Repayment Plan amount. If you’re not a new borrower on or after July 1, 2014, then your payment is generally 15% of your discretionary income, but never more than the 10-year Standard Repayment Plan amount.

If you recently transitioned into practice, you may still qualify for an incomebased repayment plan. Reach out to FinancialMD at info@financialmd.com or 888.203.6229 to review your situation.

Regardless of your status, payments will start soon. Here are three important action steps you can start today so your financial situation remains in good order after Jan. 31: • Budget. This is rarely a fun process. We get it. But accounting for your loan repayment in your day-to-day finances is a must. FinancialMD has a handy tool to help manage your budget—you can reach out to us to access it. You also can track your spending with Mint, a free online budget tracker and planner (mint.intuit.com). If you have fallen behind on budgeting, don’t feel bad. Many of us have been so busy since March 2020 that it has fallen by the wayside. Now is a great time to begin budgeting anew. •

Is Refinancing Right?

If you do not qualify for an income-based repayment plan, it may be time to look at refinancing. Refinancing could be the optimal strategy if you are not eligible for public service loan forgiveness—those working at a for-profit might be in this camp. We detailed the ins and outs of refinancing in the winter 2020 issue of Michigan Family

Check-in with your loan servicer. You will want to confirm your payment amount with your servicer, which may be FedLoan Servicing or Great Lakes. Plan your payments. Ask yourself: Does refinancing make sense now or in the future? Do I want to stay in the PSLF program? Do I trust the program? Whatever I decide, what is my expected loan pay-off date, and should I pay extra on it?

The answers to these questions depend on many criteria—your income potential, your employer (is it a non-profit or forprofit?), and your feelings about carrying debt. In our winter 2020 MFP article, we discussed how and why it often doesn’t make financial sense to put extra money toward debt. Still, paying off debt can have real psychological wins, too.

Seek Professional Advice

Above all, get help if you need it. While many physicians can do all of this on their own, seeking advice from an experienced financial professional is almost always worth it. After all, your time is valuable. There are certified public accountants and financial planners, such as FinancialMD, who specialize in helping physicians. It’s our goal to empower clients to have confidence and peace of mind knowing they have the right financial plan. For the latest news and updates on student loans, visit financialMD.com, or follow us on Facebook, Twitter, Instagram, or TikTok. We also publish a weekly video series and bi-weekly podcast to help young physicians stay on top of making smart financial decisions.

Jon Solitro, MA, CFEI is a financial planner, certified financial education instructor, and founder/chief executive officer of FinancialMD. He’s been working with physicians for the better part of a decade and has developed a simple, yet comprehensive financial planning process utilizing technology, for residents in training all the way up to retirement. WINTER 2021 | MAFP.COM


Is Volunteer Leadership Calling Your Name? We are now midway through the 2021-2022 program year of the MAFP Board of Directors, Family Medicine Foundation of Michigan Board of Trustees, Family Medicine Political Action Committee Board of Directors, and six committees focused on advocacy, member engagement, practice management, resolution review, professional development, and student and resident education. Combined, these boards and committees are comprised of nearly 70 volunteer leaders representing active family physicians, family medicine residents, and medical students in the state. Here’s what some of our current volunteer leaders have to say about their service and why they volunteer.

“The Family Medicine Political Action Committee promotes advocacy and legislation that supports the ideals of family medicine physicians and their patients. FMPAC has provided me knowledge that has been invaluable. I continue to learn and grow as to how to better support our patients through safe, effective, and ‘common sense’ legislation. I have come to better understand the climate in the Michigan Legislature that affects family physicians and our patients. I am motivated to raise awareness of MAFP among members and those in Lansing in order to impact health policy that will ultimately better serve our state.” Elizabeth “Libby” Pionk, DO, FAAFP (Bay City)

“I applied to serve on Michigan Academy of Family Physicians’ Practice Management Committee because I wanted to expand my understanding of the workings of the Michigan chapter and collaborate with other passionate physicians who advocate for their patients and are looking to affect change within healthcare.” Jamila Taylor, MD (Detroit)

“I am new to Family Medicine Foundation of Michigan’s Student and Resident Education Committee. As a residency faculty member for the last seven and a half years and a family medicine clerkship director for the past four years, I feel well positioned to serve the Academy in promoting a career in family medicine to students and residents.” Scott Ross, MD, FAAFP (Midland)

“I chose to apply for the Advocacy Committee because I am eager to learn more about advocacy as it relates to family medicine and because I want to gain familiarity with the process of establishing and revising policy. I hope to help primary care flourish into the future in our state.” Sarah Becker (student, Rochester Hills)

“I wanted to serve on a committee because it is extremely important to be involved and engaged in localand state-level organized medicine. Advocacy is a crucial part of our roles as family physicians, and it is an honor to collaborate with passionate colleagues around the state to address policy changes to promote the health and wellness of our patients. Physicians have a duty to be actively engaged in policy and professional sectors to go beyond what we can do within our clinics. This is especially crucial for family medicine physicians because we are integrated into our communities, and we see firsthand the needs of the community members.” Raven Batshon, MD (resident, Ann Arbor)

“As a program director, I wanted to be active on the MAFP Board of Directors so I can be a role model to my residents and peers. I would also like to contribute to the growth of MAFP and help with its missions and goals; and, as an African American, I represent a voice that can help to work on health equity, diversity, and inclusion goals.” Teniesha WrightJones, DO, FAOFP (Farmington Hills)

Are you interested in serving as a volunteer leader? Applications to serve on the MAFP Board (mafp.com/about-us/mafp-boardof-directors), Family Medicine Foundation of Michigan Board (mafp.com/mafp-foundation/mafp-foundation-board-oftrustees), Family Medicine Political Action Committee Board (mafp.com/advocacy/family-medicine-pac), or a committee are due by March 1 at mafp.com/about-us/committee-descriptions. 20 WINTER 2021 | MAFP.COM


MICHIGAN REPRESENTED BY FULL DELEGATION AT CONGRESS OF DELEGATES Drs. Robert Jackson, Loretta Leja, Mary Marshall, and Tina Tanner served as the Michigan delegation to the 2021 AAFP Congress of Delegates when it convened for a special virtual session Sept. 27-28. The Congress elected AAFP’s new president-elect, speaker, vice speaker, and three members of the Board of Directors. Due to community spread of COVID-19, this special virtual session was held in place of the in-person meeting scheduled for Kansas City, Missouri. The Congress will reconvene in Kansas City, Feb. 5-6, to consider resolutions submitted by chapters. This includes participating in reference committee hearings and voting on resolutions. To learn about the work of AAFP’s Congress of Delegates, visit aafp.org/about/congress-delegates.html.

MEET AAFP PRESIDENT Sterling Ransone, Jr, MD, AAFP was installed as American Academy of Family Physicians President during a special virtual session of Congress of Delegates on Sept. 28. In a recent Q&A interview with MedPage Today (scan the QR code), Dr. Ransone gave in-depth answers to questions about prior authorization, valuebased care, the importance of family physicians, COVID-19 and vaccine hesitancy, and more. You can look forward to meeting Dr. Ransone in person when you attend the 2022 Michigan Family Medicine Conference & Expo, July 7-10, at the Grand Hotel on Mackinac Island (mafp.com/events).

2022 Academy Dues Renewal: Pay Now. Stay Connected Membership in American Academy of Family Physicians and Michigan Academy of Family Physicians affords you access to discounted continuing medical education and professional development events, networking opportunities, and a wide variety of resources, tools, and initiatives to support the practice of family medicine—not to mention advocacy on behalf of your profession and your patients. While it’s impossible to put a completely accurate monetary value on all the benefits of membership, the price tag is calculated to be more than $4,520. Learn more about membership benefits at mafp.com/ membership/member-benefits and aafp.org/membership/benefits. To maintain your Academy membership and continue receiving its valuable benefits, renew your membership by Jan. 1. Visit aafp.org/quickpay to view your dues invoice and pay your dues in full, set up monthly installment payments, or sign up for auto renewal. Your Academy looks forward to serving and representing you in 2022 and beyond. WINTER 2021 | MAFP.COM


Resident Ambassadors Links to the Academy

A virtual meet-and-greet event held Sept. 30 kicked off the second cohort of the Michigan Academy of Family Physicians (MAFP) Resident Ambassadors program. Designed to strengthen the relationship between MAFP and family medicine residency programs in the state, the program facilitates communications to increase residents’ awareness of the Academy, its benefits, and how it supports them. Twenty-eight family medicine residents representing 25 of Michigan’s 38 residency programs are participating in the 2021-2022 program. If your program isn’t represented, it’s not too late to apply or appoint an ambassador (mafp.com/get-involved/ resident-ambassador-program).

Students Explore the Specialty Future of Family Medicine Conference & Residency Connection

Nearly 70 medical students convened for the eighth annual Michigan Future of Family Medicine Conference on Oct. 9. This year’s virtual conference provided an opportunity to explore the unique family medicine specialty through panel discussions on career pathways and preparing for residency, as well as workshops showcasing several clinical procedures that family physicians perform in the outpatient setting. Plus, there was a session on bias and cultural awareness in medicine. Students who registered for the conference also gained access to 30-minute webinars spanning six days following the conference. The webinars featured 20 residency programs, with directors, faculty, and current residents sharing program details and candidly answering questions. n 22 WINTER 2021 | MAFP.COM

“I highly recommend students attend this conference. Of Henry Ford Hospital Family Medicine Residency program’s eight interns, three were recruited from attending last year’s Michigan Future of Family Medicine Conference & Residency Connection.” — Richard Bryce, DO, program director, Henry Ford Hospital Family Medicine Residency


Resident and Student Voices on the MAFP Board During the 2021 Michigan Academy of Family Physicians Annual Meeting in July, Himanshi “Hima” Chopra, MD and Adjoa Kusi-Appiah were elected to serve as resident and student members on the Board of Directors. These leadership roles call on Dr. Chopra, chief resident at McLaren Oakland Family Medicine Residency, and Adjoa, Michigan State University College of Human Medicine Class of 2022, to represent the voices of their peers from across the state. Below are their reflections on why they sought volunteer leadership at the Academy and their experiences thus far.

Himanshi “Hima” Chopra, MD

My engagements with Michigan Academy of Family Physicians (MAFP) started in my intern year and have benefitted me in ways I couldn’t have imagined. The MAFP website at mafp.com, e-newsletter, and quarterly magazine were all resources I navigated to start exploring various participation and leadership opportunities. As an intern, I applied and was selected to be MAFP’s resident alternate delegate to American Academy of Family Physicians’ National Conference. I represented Michigan by writing and voting on resolutions—my first experience with advocacy. Through this position, I noticed many other leadership opportunities available to students and residents. I am now resident member on the MAFP Board of Directors and serve on Family Medicine Foundation of Michigan’s Student and Resident Education Committee. Residency is taxing. It pushes us to our limits so we can become better versions of ourselves. Being chief resident of my program has added to the plethora of responsibilities and assignments, but they allow me to help shape the program. So, I took this a step further and actively sought out leadership positions with MAFP. I believe in leading by example and being the change you want in the world. I knew that if I didn’t advocate for myself, then decisions would be made for me. If a career in medicine has taught me anything, it is that prevention is better than cure. So, I decided to run for positions that would allow me to advocate not only for myself but also my peers and those who will come after us. Through these positions and opportunities, I have sharpened my communication and public speaking skills. And through managing different aspects of residency, my chief resident responsibilities, and Academy leadership positions, I have also improved my organizational and time management skills. Additionally, I have been fortunate to motivate others around me to participate, volunteer, and lead. That has probably been the most gratifying return on my efforts. If you are interested in getting involved with the Academy, I encourage you to visit mafp.com and look under the “Get Involved” tab. There you will find board, committee, and delegate applications, as well as many opportunities to interact with your peers, attend conferences and events, present your research, and more. As a resident board member, I hope to be your resource and representation to the Academy this academic year. Please feel free to reach out to me with ideas, suggestions, resolutions, or concerns at Hima.Chopra@mclaren.org.

Adjoa Kusi-Appiah

Stepping foot into my first Michigan Future of Family Medicine Conference in 2018, I knew I had found my people. As family physicians led a conversation about the breadth and depth of the specialty, their joy, diverse experiences, and lens of advocacy affirmed I was in the right place. I then attended Advocacy Day the following year. The room was filled with physicians passionate about keeping primary care primary—their anecdotes were inspiring, and I became eager to join this powerful work. I quickly grew interested in leadership and spreading the word about family medicine; this led me to join my school’s Family Medicine Interest Group (FMIG). Encouraged by the great things happening within MAFP, I connected our FMIG with the Academy and its leadership. Together, we hosted an MAFP meet-and-greet over food and go-kart racing. Our students had a blast and, as a result, many plugged into family medicine and the Academy. Learning about new opportunities, I joined MAFP’s Member Engagement Committee and connected with leaders across the state. This folded into many more opportunities within the Academy, including mentorship, resolution writing, and community health research as an AAFP Emerging Leader. These experiences have shaped and grounded my interest in advocacy and community-engaged medicine. Being a student member of MAFP has revealed the endless possibilities of family medicine on a local and national level. Through the Academy, you can be paired with mentors, network across various regions in Michigan, engage in resolution writing, impact policies and legislation, and connect with AAFP. The Academy serves as a network for lifting up future and current family physicians. I received advice from MAFP’s 2019 alternate student delegate to National Conference, Dr. Sara Robinson, when it came to getting involved in MAFP and AAFP: “If you’re thinking about it, just do it. They are supportive and excited to have student leadership!” I now pass on this same advice to others. If you are looking for a way to become more involved, consider joining a committee; attending AAFP’s National Conference this summer, where you just might experience a “these-are-my-people” moment; and applying to represent Michigan as a National Conference Delegate. Visit mafp.com/get-involved to learn more. Plus, I strongly encourage you to attend Michigan Family Medicine Advocacy Day—one of my favorite events—on March 23 to be part of the advancement and patient-centered growth of family medicine. Most of all, don’t forget to connect with your school’s Family Medicine Interest Group. WINTER 2021 | MAFP.COM


MAFP Members are Doing Important Work Drs. Hamed, Rockwell Recognized as AAFP ‘Boundary Breakers’

Leading up to the Family Medicine Experience (FMX) national conference, held virtually Sept. 28-Oct. 2, American Academy of Family Physicians recognized exemplary family physicians who are “Boundary Breakers.” Among the featured physicians were MAFP Chair Mark Hamed, MD, MBA, MPH, FAAFP and Board Member Pamela Rockwell, DO, FAAFP.

WMed Students Bring MyChart to Spanish-speaking Patients

Andrew Lynch and Sorabh Singhal, students at Western Michigan University Homer Stryker M.D. School of Medicine, led a project to make WMed electronic health records available to patients in Spanish. With the enhanced accessibility, more than 300 primarily Spanishspeaking WMed patients can now schedule appointments, update medication lists, read peer-reviewed information about medical conditions, view lab results, update medication lists, pay bills, and enter insurance info in their native language. Learn more at med.wmich. edu/node/2914.

MAFP Honors 50-year Members

MAFP recognizes 10 physicians who have achieved the 50-year milestone of Academy membership (bit.ly/50YrMemb). Each of these longtime members joined the Academy in 1971 and are now Life members. Eligibility for Life membership entails holding active membership for a minimum of 25 years, holding five years of continuous membership immediately prior to election as a Life member, and being at least 70 years old or totally retired.



The American Academy of Family Physicians Degree of Fellow (FAAFP) is marking its 50th anniversary in 2022. The FAAFP designation recognizes Academy members who have distinguished themselves among their colleagues and in their communities through service to the specialty, the advancement of healthcare, and professional development through medical education and research. If you qualify for the Degree of Fellow (aafp.org/membership/welcome-center/involve/ fellow.html) and would like to participate in Michigan Academy of Family Physicians’ convocation ceremony taking place July 9, during the Michigan Family Medicine Conference & Expo on Mackinac Island, email Denna Bunting at dbunting@mafp.com by June 7. Nearly 500 MAFP members are AAFP Fellows.


Dr. Xu Named Michigan AHEC Co-Principal Investigator

Jinping Xu, MD, FAAFP, interim chair of Wayne State University School of Medicine’s Department of Family Medicine and Public Health Sciences, was named the new co-principal investigator of the Michigan Area Health Education Center (MI-AHEC). MI-AHEC was established in 2010 to improve access to primary care for all Michigan residents, many of whom live in areas that have too few health professionals. Dr. Xu is also a full professor, practicing family physician, and member of Family Medicine Foundation of Michigan’s Professional Development Committee.

Resident Physician Recognized for Excellence in GME

Hima Chopra, MD—chief resident at McLaren Oakland Family Medicine Residency in Pontiac and resident member on the Michigan Academy of Family Physicians Board of Directors—is a recipient of American Academy of Family Physicians’ 2021 Award for Excellence in Graduate Medical Education. She is one of just 12 residents from across the country to receive the prestigious award, ranking her among the top family medicine residents in the country in terms of leadership, civic involvement, patient care, and aptitude for and interest in family medicine (bit.ly/ GMEex). AAFP’s Excellence in GME Award is provided for second-year residents only. Applications (bit.ly/AAFPGME) are due June 18.

Beaumont FP Named an Unsung Hero

Asha Shajahan, MD was selected by the Detroit Free Press and the Metropolitan Affairs Coalition to receive this year’s Eleanor Josaitis Unsung Hero Award, in recognition of her exemplary patient care and tireless community outreach. Dr. Shajahan, a family physician in Grosse Pointe, is the graduate medical education director of health equity and health disparities for Beaumont Health and an assistant professor in the department of family medicine at Oakland University William Beaumont School of Medicine. Read more at shininglightawards. semcog.org/Honorees.

Resident Elected Delegate to COD

During American Academy of Family Physicians’ 2021 National Conference of Family Medicine Residents and Medical Students, Mikita Patel, MD was elected resident alternate delegate to Congress of Delegates (COD). Next year, she will move up to the full delegate position when the 2022 COD convenes in the fall.

Dr. Patel is training at McLaren Oakland Family Medicine Residency and served as this year’s resident alternate delegate to National Conference on behalf of Michigan Academy of Family Physicians. “I am passionate about making positive changes in resident wellness, preventive medicine, social determinants of health, and health equity. I am so excited about working with residents to create a better future in family medicine. I am truly honored to be their voice to Congress,” said Dr. Patel. Read more at bit.ly/CODdelegate.

Notable Woman in Healthcare

Amy McKenzie, MD, FAAFP— associate chief medical officer of provider engagement at Blue Cross Blue Shield of Michigan— was named a Crain’s Notable Women in Healthcare honoree. She is chair of the state of Michigan’s Certificate of Need Commission, a position she was appointed to by Gov. Gretchen Whitmer, and is a trustee on the Family Medicine Foundation of Michigan Board.

MSUCHM Student Appointed to Editorial Advisory Board

Julie Ngo, Michigan State University College of Human Medicine Class of 2023, was appointed to serve a one-year term as student representative to the Annals of Family Medicine Editorial Advisory Board. Annals of Family Medicine is a peerreviewed clinical research journal dedicated to advancing knowledge essential to understanding and improving health and primary care. . “I am honored to be selected for this position. As a first-generation medical student and first of my family to pursue higher education, I look forward to paving the way for those who will take these steps after me. I am very excited to be a bridge between medicine and research for the underserved and underrepresented communities,” said Julie. Read more at bit.ly/AnnFamMed.



Together We are Family Medicine Strong! 2022 Membership Renewal is Just a Click Away

When you renew your membership in American Academy of Family Physicians and its state chapter, Michigan Academy of Family Physicians—the only medical society devoted solely to primary care—you are joining THE community of family medicine that is more than 133,500 strong in the U.S. and 4,200 strong in Michigan.

Academy membership is valued at more than $4,500! Some member-favorites include: • • • • • • • • •

Free or discounted life-long learning events, including in-person and on-demand courses Office visit evaluation and management documentation resources Resident employment checklist Physician well-being resources A family physician guide to employment contracts Starting a practice toolkit Member Interest Groups Advocacy at the national and state level And so much more!

There are 3 easy ways to renew your membership by Jan. 1: 1. Quick pay 2. Monthly dues installment payments 3. Automatic renewal

Renew at aafp.org/together or call 800.274.2237

Cures Act: The Effect on Health IT Sound Documentation Practices Help Manage Risk By Alex Ealy, JD The 1996 Health Insurance Portability and Accountability Act (HIPAA) gave patients a right to view and request corrections to their medical records. In the intervening years, the widespread adoption of electronic health records (EHR), patient portals, and smartphone applications have led to an increase in patients accessing their medical records electronically. The digital evolution of the medical record has prompted a number of healthcare professionals and patient safety advocates to promote quicker access to information stored in the EHR. The 21st Century Cures Act, passed by Congress in 2015, provides new regulation on a variety of healthcare concerns including funding, research, access to new and experimental drugs, telehealth, and interoperability of health information technology (health IT). Authors of the Cures Act introduced a new phrase to the healthcare community related to the interoperability of health IT: “information blocking.”

Information Blocking Defined

Information blocking is defined by the Cures Act and paraphrased by HIT.gov as “a practice by a health IT developer of certified health IT, health information network, health information exchange, or healthcare provider that, except as required by law or specified by the Secretary of Health and Human Services as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information (EHI).”1 28 WINTER 2021 | MAFP.COM

While information blocking can occur when a healthcare provider intentionally restricts access to the patient’s medical record, it can also occur unintentionally as a byproduct of health IT. Physicians, like patients, can also experience information blocking. For example, information blocking can occur when physicians move from one EHR to another, or when they try to access a patient’s medical record held by another physician. Information blocking can also happen when physicians try to connect EHRs to local information exchanges.2

available for their patients are engaging in the practice of information blocking, unless one of the Cures Act’s regulatory exceptions applies. The OpenNotes organization—a group of clinicians and researchers committed to increasing patient access to their medical records—states that sharing medical notes can improve accuracy and patient safety, improve medication adherence, foster stronger relationships and better engagement, improve chronic care management, support care partners, and promote efficiencies.4

However, simple interference with the access, exchange, or use of EHI may not automatically constitute a violation of the Cures Act. To constitute a violation, actors, such as physicians, must have knowledge and intent to interfere with the access, exchange, or use of EHI.3 Essentially, provisions within the Cures Act seek to discourage physicians and entities from knowingly interfering with or discouraging access to a patient’s EHI. Healthcare providers found to be engaging in the practice may be subject to monetary penalties or reimbursement disincentives from federal healthcare programs, like Medicare and Medicaid.

The Cures Act references eight types of clinical notes that must be made open to patients, including: • Consultation note • Discharge summary note • Procedure note • Progress note • Imaging narrative • Lab report narrative • Pathology report narrative • History and physical5

When to Share Open Notes

The information blocking provisions of the Cures Act are often colloquially referred to as “open notes.” Healthcare providers who do not make clinical notes open and

Cures Act Violations

The American Medical Association has provided examples of potential violations of the Cures Act including: Formal restrictions: A provider or office policy requires staff to obtain a patient’s written consent before sharing any EHI with unaffiliated providers for treatment purposes.


Technical limitations: A physician disables the use of an EHR capability that would enable staff to share EHI with users at other systems. Isolated interferences: A physician has the capability to provide same-day EHI access in a format requested by an unaffiliated provider—or by their patient—but takes several days to respond.6

Exceptions to Information Blocking

While providers may read the requirements of the Cures Act and believe them to be burdensome, the information blocking rule contains exceptions for flexibility in operation. Knowing how the Cures Act differs from HIPAA is also helpful to understanding the scope of the act. HIPAA’s regulations affirmatively and specifically state what types of EHI can be shared with other providers, patients, and third parties. The Cures Act information blocking rule directs the providers to release records to patients and other providers in nearly all instances where an exception does not exist. The two categories of exceptions to information blocking within the Cures Act provide flexibility to healthcare providers and organizations without burdening them with administrative rigidity: • Not fulfilling requests for access: These exceptions include preventing harm to the patient or another, protection of health information privacy, protection of health information security, infeasibility, and health IT performance. • Procedures used for fulfilling requests: These exceptions include

limitation in content and manner, reasonable fees, and licensing.

Risk Management

With enforcement provisions of the Cures Act expected to be announced in the near future, it is important to train staff in sound documentation practices to help manage risk. Be mindful of the following as more and more patients expect instant access to their medical records: • Assume all notes will be read by the patient • Complete documentation in a timely manner • Avoid abbreviations that may be standard in the healthcare community but not easily interpreted by the patient • Avoid the use of pejorative terms such as “malingering;” instead, use factual observations in the chart • Use plain language and focus on clarity, for the benefit of the patient as well as other healthcare providers • Avoid copying and pasting from other sources • Before documenting difficult situations, attempt a conversation with the patient It is important to note the Cures Act’s information blocking rule does not override existing state and federal rules protecting patient confidentiality. Compliance with state and federal laws that require patient consent before production of medical records would likely not constitute information blocking. For example, a state may require certain conditions be met before releasing certain classes of EHI, such as HIV status or adolescent mental health information. In these instances, physicians should not release that EHI

FAMILY MEDICINE Business Network

ProAssurance is affiliated with the MAFP Family Medicine Business Network (FMBN) at the President’s Society level. FMBN is an exclusive program that provides an opportunity for companies to support MAFP and, even more importantly, affiliate with Michigan’s primary care physicians. ProAssurance provides medical professional liability insurance and risk management services for healthcare providers of all sizes and types. Its team uses regional expertise to create customized coverage solutions. ProAssurance is rated A (Excellent) by AM Best and is the third largest medical professional liability carrier in the country. Learn more at proassurance.com/Michigan.

without first obtaining consent from the patient.7 The compliance date for healthcare providers to meet the Cures Act information blocking requirements was Apr. 5, 2021. Healthcare providers will need to make the same information available on patient third-party applications by Oct. 6, 2022, to not be engaged in information blocking.8 The good news for physicians is that although the date for Cures Act compliance has passed, the final rule went into effect without applicable enforcement provisions—which means physicians still have time to bring their EHR systems and procedures into compliance. With proper planning and training, physicians and their organizations should be able to implement minor procedural changes to comply with Cures Act requirements.

Sources 1. www.healthit.gov/topic/informationblocking, emphasis added accessed March 18, 2021. 2. www.ama-assn.org/system/ files/2021-01/information-blockingpart-1.pdf accessed March 18, 2021. 3. Ibid. 4. www.opennotes.org/opennotes-forhealth-professionals accessed March 18, 2021. 5. www.healthit.gov/isa/united-statescore-data-interoperability-uscdi accessed March 18, 2021. 6. www.ama-assn.org/system/ files/2021-01/information-blockingpart-1.pdf accessed March 18, 2021. 7. www.ama-assn.org/system/ files/2021-01/information-blockingpart-1.pdf accessed March 18, 2021. 8. www.opennotes.org/onc-federal-rule accessed March 18, 2021.

Alex Ealy, JD is a risk resource adviser for ProAssurance, advising physicians and other healthcare providers on professional medical liability issues. In private practice, Ealy litigated civil cases and focused on workers’ compensation claims. He earned a bachelor’s degree from the University of Alabama and his law degree from Cumberland School of Law at Stanford University. He is the current president of the Workers’ Compensation Section of the Birmingham Bar Association and is a member of the Alabama Bar Association, American Society for Healthcare Risk Management, and Alabama Society for Healthcare Risk Management. WINTER 2021 | MAFP.COM



Return to In-person Events Michigan Academy of Family Physicians, through Family Medicine Foundation of Michigan, offers a wide range of in-person and virtual continuing medical education and professional development events to complement physicians’ lifelong learning requirements for Academy membership, family medicine certification, and medical licensure in Michigan. Events are designed to help family physicians increase knowledge, skills, and professional performance in areas related to scientific advancements in medicine, healthcare delivery, practice management, advocacy, and more. Plus, we offer events to facilitate networking. For the most up-to-date list of events hosted by MAFP and Family Medicine Foundation of Michigan, visit mafp.com/events. Questions? Contact MAFP Meeting Planner Denna Bunting at dbunting@mafp.com.


Interested in presenting at an MAFP / Family Medicine Foundation of Michigan event in 2022? Submit a presentation proposal at surveymonkey.com/r/ presproposal.

Feb. 26

Kansas City, MO | Michigan resident and student delegate applications due Apr. 1

On-demand Webinars

Approved for 8 CME credits | 8 am-12 pm ET

July 29

Package of 12 on-demand webinars | Approved for 13 CME credits through July 17, 2022 | Included are on-demand webinars on clinical ethics, human trafficking, and pain and symptom management; or you can attend the individual on-demand webinars on these topics listed below

Knowledge Self-Assessment: Hypertension

March 23

Michigan Family Medicine Advocacy Day

House Office Building, Lansing | FREE to members

Apr. 28-30

AAFP National Conference of Constituency Leaders

Michigan Reception at AAFP’s National Conference Kansas City, MO

Sept. 17

Knowledge Self-Assessment: Heart Disease

Approved for 8 CME credits | 8 am-12 pm ET

Kansas City, MO

Sept. 19-21

May 26

Washington, DC

44th Annual Michigan Family Medicine Research Day Location to be announced

July 7-10

Michigan Family Medicine Conference & Expo

Grand Hotel, Mackinac Island Reserve your room early at the discounted rate; space is limited

July 9

MAFP Annual Meeting

AAFP Congress of Delegates

Sept. 20-24

AAFP Family Medicine Experience Washington, DC


Michigan Future of Family Medicine Student Conference & Residency Connection Date and location to be announced

Nov. 12

Stay on Course: Your Ticket to Family Medicine

Clinical Ethics: A Pragmatic Approach Approved for 1 CME credit through May 1, 2022 | Meets the State of Michigan’s medical ethics training requirement for medical licensure

Human Trafficking: How Family Physicians Can Recognize and Assist Victims Approved for 1 CME credit through July 17, 2022 | Meets the State of Michigan’s human trafficking training requirement for medical licensure

Opioids: How We Got Here, How to Prescribe by the Rules & How to Address Patients’ Beliefs

Approved for 3 CME credits through July 17, 2022 | Meets the State of Michigan’s pain and symptom management training requirement for medical licensure

Grand Hotel, Mackinac Island FREE to members Award nominations due March 1 Resolutions due May 25

Women in Family Medicine Conference

Beyond Clinical & Curriculum

Location to be announced

On-demand webinar series on family medicine practice settings | Available through Feb. 1, 2022

July 28-30

Dec. 3

Knowledge Self-Assessment: Asthma

Business of Medicine

Approved for 8 CME credits | 8 am-12 pm ET

Chief & Senior Resident Leadership

AAFP National Conference of Family Medicine Residents & Medical Students 30 WINTER 2021 | MAFP.COM

On-demand webinar series on business of medicine topics Nearly 2.5 hours of leadership training

Behavioral Health & Addiction Treatment Services As the fourth largest behavioral health provider in the United States, we offer specialized services and treatment by highly credentialed professionals throughout Michigan for children, adolescents, adults and older adults.

Teletherapy Anywhere in Michigan

19 Outpatient Clinics

Urgent Care, 8 Inpatient Units & 3 Partial Programs



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