MACOMB MEDICAL SOCIETY - July/August/September 2024

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Medicus Macomb

Journal of the Macomb County Medical Society

July, August, September 2024 | Vol. 32 | No.3

Editor

Adrian J. Christie, MD

Managing Editor

Heidi L. Leach

Graphic Designer

Lori Krygier

2024 MCMS OFFICERS & DELEGATES

President Lawrence F. Handler, MD

President-Elect

Narendra D. Gohel, MD

Treasurer & Secretary

Daniel M. Ryan, MD

Delegates

Terrence P. Brennan, MD

Adrian J. Christie, MD

Burton G. Engel, MD

Narendra D. Gohel, MD

Lawrence F. Handler, MD

Khaled M. Ismail, MD

Carolann Kinner, DO

Cheryl D. Lerchin, MD

Aaron W. Sable, MD

Akash R. Sheth, MD

MSMS Region 2 Director

Daniel M. Ryan, MD

Executive Director

Heidi L. Leach

,

Macomb Medicus Journal is published quarterly by the Macomb County Medical Society. Winter: Jan/Feb/ Mar, Spring: Apr/May/Jun, Summer: Jul/ Aug/Sep, Fall: Oct/Nov/Dec. Subscription to the Macomb Medicus is included in the society’s annual membership dues.

Statements and opinions expressed in articles published in the Macomb Medicus are those of the authors and not necessarily those of the Macomb County Medical Society. Advertisements do not represent approval or recommendation of the Macomb County Medical Society.

Address changes and all communications relative to articles and advertising in the Macomb Medicus should be addressed to: Editor, Macomb County Medical Society, P.O. Box 551, Lexington, Michigan 48450-0551 or email HLeach@macombcms.org

All material for publication, including advertisements, must reach the Society office no later than the 10th (business) day of the month preceding the date of issue, e.g. December 10 for the Winter issue. Thank you. No portion of the Macomb Medicus may be used for publication elsewhere without permission from the publisher.

Latonya Riddle-Jones, MD, on the Importance of Self-Monitoring Blood Pressure Programs and NEW Medicaid Coverage

Nearly half of adults have hypertension and an estimated 1 in 4 adults with hypertension have their hypertension under control according to the CDC. One evidence-based intervention to improve blood pressure control is through self-measured blood pressure (SMBP) which is a partnership between patients and the physician that includes the use of a home blood pressure device.

Michigan Medicaid now covers blood pressure devices and reimburses for clinical services related to SMBP. This increased coverage, which went into effect in 2022, will improve access to some of the most vulnerable patient populations – the kinds of patients Michigan physician Latonya A. Riddle-Jones, MD treats everyday.

“My patients work all the time, usually shift work and come from all socioeconomic backgrounds. Half are on Medicaid and as much as I would love for them all to be able to come in for regular appointments – it’s often difficult for them to get the time off work during our regular business hours because to do so means they are losing out on getting the hours they need to make ends meet.” said Dr. Riddle-Jones. “Many of my patients have multiple chronic diseases, it might be HIV, hypertension, high cholesterol, diabetes – and being able to teach them how to take their own BP measurements with a validated device at home and call in with their numbers is going to make a huge difference in keeping these conditions under control.”

With Medicaid coverage for SMBP devices and services, patients can now obtain a home blood pressure device at no cost, and physicians and their staff can be reimbursed for the time they spend in person or on the phone educating patients about device usage, collecting the patient’s SMBP readings data and discussing treatment changes if warranted.

Not only does use of SMBP allow the physician to gather more data points from the patient, it makes the in-office time physicians do get with their patient far more efficient and promotes early intervention.

“My patients can take their readings twice a day at home and we can understand their baseline and adjust medications accordingly – allowing us to prevent heart attacks, strokes and other incidents that might normally land a patient in the ER just because they have a cuff at home and can call us with the numbers.”

SMBP coverage is on the rise across the U.S. as more lawmakers see the importance of it for managing chronic disease. According to the 2024 SMBP Landscape Assessment compiled by the American Medical Association (AMA), 42 states reported coverage for SMBP home devices and 36 of those also covered standalone SMBP cuffs, up from 38 and 31 in 2022. This expansion in coverage has the potential to impact an additional 1.4 million Medicaid beneficiaries across the U.S. with hypertension.

“There is a lot of distrust among some of the most vulnerable patient populations – especially those with more limited resources and communities of color. They often experience a white-coat effect when taking measurements in office which can make them nervous and make those measurements unreliable” said Dr. Dr. Riddle-Jones.

“Patients are often rushing to the office, in order to get an accurate measurement representative of their baseline blood pressure we need them to sit down and rest for about 15-20 minutes to get the best reading. This isn’t always long enough or reflective of their usual baseline reading because of circumstances and setting. At home readings give us more data points and often more accurate readings because the patient is more relaxed.”

Michigan State Medical Society and the AMA are working together to promote physician awareness of the increased Medicaid coverage now available for SMBP devices and clinical services in Michigan.

To learn more about what MSMS and the AMA are doing to promote adoption and prescribing of SMBP please check out AMA’s website for Michigan specific guidance on coverage and resources related to SMBP F

MEDICAL RESERVE CORPS UPDATES

groups or promoting disease screenings.

The Medical Reserve Corps (MRC) is an integral part of Macomb County’s defense against public health emergencies. With the end of the COVID-19 pandemic, the MRC now focuses on emergency preparedness activities across the county. You’re most likely to see MRC volunteers participating in community outreach events, staffing first aid stations at events like the Selfridge Air Show and participating in various exercises as mock victims. Out in the community, the MRC provides training for youth and seniors. In fifth grade classrooms across Macomb County, volunteers teach students how to create a communication plan and prepare an emergency kit. Similar preparedness programming is available for seniors. MRC also offers Stop the Bleed training throughout Macomb County.

The MRC was formed after the terrorist attacks of September 11, 2001, to organize medical and public health professionals eager to volunteer. The MRC recruits, trains and activates medical and public health volunteers to “respond to community health needs during disasters and other public health emergencies.” Visit the Medical Reserve Corps website for more information about the Corps and to learn how you can join. To learn more about the MRC in Macomb County, contact Liz Disney at mchd_mrc@macombgov.org.

COMMUNITY HEALTH IMPROVEMENT PLAN: WORKGROUPS AND STUDENT MENTAL HEALTH PROJECT

The 2024-2028 Community Health Improvement Plan (CHIP) is underway! Workgroups began meeting in February for the three CHIP priority areas:

• Behavioral Health and Substance Use

• Social Determinants and Built Environment

• Chronic Disease and Healthy Lifestyles

Workgroup members include residents and local organizations working to improve health in Macomb County. Each workgroup is tasked with implementing the strategies outlined in the 2024-2028 CHIP, such as creating peer-to-peer support

The Behavioral Health and Substance Use workgroup worked with Center Line High School to design posters and flyers promoting mental health awareness. Four student projects will be used in media campaigns and posted in Center Line Public Schools to encourage students to connect with available services. You can find more information on this project here.

BATHING BEACH WATER MONITORING

The Macomb County Health Department monitors bathing beach water at Lake St. Clair Metropark Beach in Harrison Township, Walter & Mary Burke Park in New Baltimore, Memorial Park Beach in St. Clair Shores, Stony Creek Baypoint Beach in Washington Township, and Stony Creek Eastwood Beach in Shelby Township. Water testing is conducted to identify levels of E. coli bacteria. If sample bacteria levels exceed levels established in the Michigan Public Health Code, the beach will be closed to the public until bacteria levels fall to acceptable levels.

So if you’re planning on going for a swim, our website has information on current beach conditions, sampling procedures, and historical beach testing data that you might find helpful.

PRIORITIZING SEXUAL HEALTH – THE 2024 MOTOR CITY PRIDE FESTIVAL

At the 2024 Motor City Pride Festival, our Sexually Transmitted Infections (STI) and HIV programs offered free condoms and information on increasing STI rates, private STI testing, and treatment. It was encouraging to see parents come with their teens, showing the need for early sexual health education. Motor City Pride had an impressive turnout, and we are proud of our commitment to promoting sexual health.

For more information and resources on sexual health, visit our website. F

The MCMS would like to wish the following members a very Happy Birthday!

July

Richard Arden, MD

Nagina Aslam, DO

Basivi Baddigam, MD

Seif Bugazia, MD

William Carion, MD

Mariann Channell, MD

Michael Demers, MD

Michael Di Loreto, MD

Lillman Dwarka, MD

Jeremy Fischer, DO

Thomas Graves, MD

John Guest, MD

Noori Ibrahim, MD

Malathy Kilaru, MD

Carolann Kinner, DO

Linda Lu Kosal, DO

Donna Kushner, MD

George Kypros, MD

Cheryl Lerchin, MD

Ronald Levin, MD

Richard Lubera, MD

Anne Nachazel, MD

A. A. Palacio-Chang, MD

Swarn Rajpal, MD

Naveed Siddique, MD

Mary Veremis-Ley, DO

Elias Zeine, MD

August

Zeena Al-Rufaie, MD

Jagatbhai Amin, MD

Ramon Aparece, MD

Allen Babcock, MD

Matthew Brewster, DO

Gerald Brueckner, MD

Ricardo Chalela, MD

Amnat Chandra, MD

Robert Chang, MD

Gordhan Diora, MD

Sharyn Doden, DO

Stuart Gildenberg, MD

Theresa Hsu, MD

Danilo Iglesias, MD

Joseph Kinzie, MD

Robert Lechy, MD

Ghada Mesleh, MD

Donald Muenk, MD

Ganga Nadarajah, MD

Abimbola Osobamiro, MD

Chakradhar Reddy, MD

Renato Reyes, MD

Kathleen Rheaume, MD

Cameron Rowe, DO

Reina Salazar, MD

Andres Santiviago, MD

Gary Stencel, MD

Mason Talkington, MD

Salvatore Ventimiglia, MD

Bhavana Vyas, MD

Abdallah Zamaria, MD

September

Mark Decco, MD

Ramy Alosachie, MD

Ralph Babcock, MD

Paul Chuba, MD

Stephen Field, MD

Narendra Gohel, MD

Kristen Kavanagh Cococcetta, DO

Jane Krasnick, MD

Geetika Kukreja, MD

Amar Majjhoo, MD

Somsak Metriyakool, MD

Robert Mobley, MD

Antonio Morreale, MD

Nimisha Naik, MD

Eric Neisch, MD

Garry Ng, MD

Nwanneka Odumodu, MD

Thao Pham, DO

Akash Sheth, MD

Brian Stewart, DO

John Vollmer, MD

Sanjay Vora, DO

Tri-County Legislative Committee

MACOMB FOOD PROGRAM

Provides immediate relief to those in need of food through a network of more than 70 pantry sites, hunger relief organizations, and the Fresh To You Mobile Pantry. The program supplies food at no cost to income eligible seniors and families with children throughout Macomb County. For more information visit the Macomb Food Program website or call (586) 469-6004.

RENT AND MORTGAGE ASSISTANCE

Income-eligible Macomb County residents facing eviction, foreclosure, or homelessness may be assisted in resolving their emergency. Eligibility and guidelines will vary based on available programs. For more information contact your local Community Action Center at (586) 469-6964. For residents of Warren, Roseville, Eastpointe or Centerline call (586) 759-9150.

UTILITY ASSISTANCE - ELECTRICITY, GAS

Income eligible Macomb County residents facing utility shut off may be assisted in resolving their emergency. Utility assistance may be available for electric service, natural gas service, and deliverable fuels used to heat the home. Eligibility and guidelines will vary based on available programs. For more information contact your local Community Action Center at (586) 469-6964. For residents of Warren, Roseville, Eastpointe or Centerline call (586) 759-9150.

WATER RESIDENTIAL ASSISTANCE PROGRAM (WRAP)

Eligible households are offered credits on their water and sewer bills so that they pay no more than 3% of their household's annual income for up to two years. Eligible seniors and permanently disabled persons can obtain bill credit assistance without an expiration date.

To qualify for WRAP, households must be in a community in the service area, have a combined income at or below 200% of the federal poverty level, be primarily responsible for the water or sewer bill and have to reside in the home they rent or own. For more information and to apply visit the Macomb Community Action’s website or call (586) 469-6464.

TRANSPORTATION ASSISTANCE

This department provides transportation to essential medical appointments and other specific locations for eligible Macomb County residents. For more information visit Macomb Community Action’s website or call (586) 469-5225.

MYRIDE2 - CONNECTING SENIORS & ADULTS WITH

DISABILITIES TO RIDES

AgeWays (formerly Area Agency on Aging) MyRide2 service can help find transportation options for seniors and adults with disabilities – helping them get to the store, to doctor’s appointments, or out to visit friends and family. Myride2 is a transportation concierge service that arranges transportation from start to finish. There is no charge for arranging transportation through myride2, but there may be a cost for any transportation services they use. Payments are made directly to transportation providers. For more information visit MyRide2 website or call (855) 679-4332.

Macomb County Assistance Programs for Your Patients

In this tough economy many of your patients may be struggling to meet their basic needs as well as those of their families.

There are programs available to help. Below are some resources you can direct your patients to for assistance.

HOME INJURY PREVENTION

The Home Injury Prevention Program installs devices to ensure safety and prevent falls in the homes of eligible Macomb County seniors. A home assessment determines which safety devices will be installed. Services are free but contributions are appreciated. For more information visit Macomb Community Action’s website or call (586) 469-6329.

HOUSING REHABILITATION

The Housing Rehabilitation Program provides assistance to eligible homeowners to repair their homes to achieve decent, safe and sanitary housing. Assistance is provided in the form of a no-interest loan. For more information visit Macomb Community Action’s website or call (586) 466-6256.

WEATHERIZATION ASSISTANCE

The Weatherization Assistance Program performs the installation of energy efficient items to conserve energy in Macomb County homes. These improvements reduce energy use and can save an average of 30% on heat and utility bills. A home energy audit determines which items will be installed. Services are free for income-eligible residents. For more information visit Macomb Community Action’s website or call (586) 469-6329.

WARMING & COOLING CENTERS

There are places across Macomb County where individuals can find respite from the extreme heat and cold. For a full list visit Macomb Community Action’s website

DIRECT CARE PROGRAMS – TO HELP SENIORS

STAY LIVING AT HOME

Home care services help seniors and people with disabilities continue to live safely in a home setting. These services provide assistance with daily activities a senior might have trouble doing for themselves – things like bathing, dressing, meal preparation or housekeeping.

AgeWays (formerly the Area Agency on Aging) has several programs that offer direct care for Southeast Michigan families. For more information visit the AgeWays website or call (800) 852-7795.

PROGRAMS OFFERED SPECIFICALLY FOR SENIOR THROUGH MACOMB COUNTY SENIOR SERVICES

The following programs are offered to Macomb County residents age 60 or older. For more information on any of these services visit the Macomb County Senior Services website or call (586) 469-5228

ADULT DAY CENTER

Provides daytime assistance for aging adults in need of structured activities, exercise, and supervision. The credentialed center can provide caregivers with a needed break while giving older adults a chance to socialize with their peers and remedy the isolation and loneliness many experience. For more information call (586) 469-5580.

FRIENDLY CALLER

Program volunteers reach out over the phone to connect with seniors interested in a friendly social conversation. It’s an informal social call that can last anywhere from 10 minutes to 30 minutes depending on interest and natural flow of conversation.

HANDY HELPERS

Provides assistance with household maintenance tasks such as replacing light bulbs or faucets, washing windows and walls, repairing furniture, pest control, yard clean up, leaf raking, weatherizing, and more.

RESOURCE ADVOCACY

Provides consultation for seniors to assess needs, recommend services and assist with tax credits, Medicare Part D enrollment, Medicaid application process, community resources, and more.

NUTRITION ASSISTANCE

DINING SENIOR STYLE

A daily lunch program for seniors at 24 locations throughout Macomb County. Seniors are provided a well-balanced meal while also socializing with their peers.

MEALS ON WHEELS

Delivers a ready to eat meal to homebound residents no longer able to leave their homes on a regular basis without assistance or able to prepare meals.

ENSURE PLUS PROGRAM

Meals on Wheels offers cans of Ensure Plus as a supplement for Macomb County’s most vulnerable homebound seniors with a prescription from their physician for Ensure Plus.

HOLIDAY MEALS ON WHEELS

Holiday meals are available for seniors who would be otherwise home alone on the holiday. A special hot lunch is freshly prepared that day, including many traditional favorites. Meal delivery is available for Easter, Thanksgiving, and Christmas.

SENIOR PROJECT FRESH COUPONS

Offers income-eligible seniors the chance to purchase fresh produce such as carrots, tomatoes, melon, and even honey. Seniors who participate will receive a $20 coupon book to use at local farmers' markets and stands.

We would like to welcome the following New Member.

Dumitru O. Sandulescu, MD

Internal Medicine

Medical School: University of Medicine and Pharmacy of Craiova (Romania), 1978. Post Graduate Education: St. Joseph’s Mercy Oakland, completed in 2004. Currently practicing at Dumitru Medical Center, 38300 Van Dyke Ave., Ste. 104, Sterling Heights, MI 48312, p. 586-274-4699, f. 586274-4660, www.sterlingheightsmedicalcenter.com

We would like to welcome the following New Resident Members from Henry Ford Macomb Hospital.

Eugersa Agolli, DO

Mohammad Alali, MD

Omar B. Alneser, MD

Thebuoshon Amalathasan, MD

Kaitlyn Anderson, DO

Gabriella Born, DO

Xhenis Brahimi, DO

Jonathan Chacko, DO

Stephanie Chang, DO

Grace E. Cho, DO

Ryian A. Choudhury, DO

Sharyn N. Doden, DO

James R. Donohue, DO

Scott D. Faist, DO

Ariana E. Faraji, DO

Brendan Keelan, DO

Tehrim Khan, MD

Shefali Khanna, MD

Madeha Khwaja, MD

Kelvin Loke, DO

Nicolle Maikawa, MD

Bianca M. Mannariat, MD

Reveen Maqdasy, MD

Jared Mayfield, MD

Maryam Munir, MD

Ahmed Kunwer Naveed, MD

Ashlesh C. Nekkanti, MD

Aldo E. Padilla, DO

Alexander G. Platt-Koch, DO

Leon Popaj, MD

Lauren Powers, DO

Tyson Roderique, DO

Satya Sajja, MD

Solomiya Svytka, DO

Mason A. Talkington, MD

Austin Truong, DO

Matthew Weatherly, DO

MSMS Quarterly Membership Updates

Tom George, MD, MSMS' CEO, hosts quarterly legislative updates via Zoom. Members’ questions can be submitted ahead of or during the webinar.

Please be sure to join Dr. Tom George on: October 9th at 7 pm

Take Charge of Your Mental Health

Achieving and maintaining mental wellness is the foundation for keeping the entire body healthy.

To support that effort, Macomb County Community Mental Health is proud to offer a great on-line, personalized program, My Strength.

“The health club for your mind,” MyStrength provides programs and support for many types of emotional and physical challenges, including:

• Reducing stress

• Improving sleep

• Managing depression

• Managing anxiety

• Mindfulness & meditation

• Balancing intense emotions

• Pregnancy & early parenting

• Managing chronic pain

MyStrength offers daily tips for the mind, body and spirit, and:

• Is Safe, Secure, and Confidential—Your privacy is our top priority, and MyStrength maintains the highest level of security available to create a completely confidential and safe environment.

• Has Proven Resources—based on the latest research and professional advice from best-selling authors.

• Is Packed with Tools — MyStrength offers many resources to improve mental health, with the latest research and professional advice.

It’s easy to get started; Go to mystrength.com and enter access code MCCMHComm and begin your journey to stronger overhall health!

MyStrength has helped many people across the country from the comfort and privacy of their homes.

There is no cost to join, and it is simple to get started. Go to www.mystrength.com. Select “Sign Up” and enter the access code: MCCMHComm. Complete the Wellness Assessment (it takes about ten minutes) and be on your way with personalized tools and supports.

Go Mobile! Using the access code, get the myStrength app for IOS and Android devices at www.mystrength.com/mobile

New Risk Equation Could Mean Preventive Statins for Far Fewer Americans

PREVENT equations, if adopted, could reduce the number of people recommended to take statins for cardiovascular disease prevention

If national guidelines are revised to incorporate a new risk equation, about 40% fewer people could meet criteria for cholesterol-lowering statins to prevent heart disease, according to a study by researchers at the University of Pittsburgh, Beth Israel Deaconess Medical Center and University of Michigan.

Published in JAMA Internal Medicine, the study examines the potential impact of widespread adoption of the PREVENT equations, which were released by the American Heart Association in November 2023 to update physicians’ go-to calculators for assessing patients’ 10-year risk of heart attack or stroke.

At a population level, the number of adults recommended for statins could decrease from 45.4 million to 28.3 million. At the same time, the study showed that most people who would be recommended to take statins aren’t currently taking them.

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” said lead author Timothy Anderson, MD, MAS, a primary care physician at UPMC and health services researcher and assistant professor of medicine at Pitt.

Jeremy Sussman, MD, MSc, is senior author of the study, a general internist and an associate professor of internal medicine at the U-M Medical School, as well as a member of IHPI. He recently published findings about the key role of primary care physicians in preventive cardiovascular care

For their analysis, the team used nationally representative data from 3,785 adults ages 40 to 75, who participated in the National Health and Nutrition Examination Survey from January 2017 to March 2020.

The researchers estimated 10-year risk of atherosclerotic cardiovascular disease, or ASCVD, using the Predicting Risk of cardiovascular disease EVENTs, or PREVENT, equations and compared the results to risk estimated using the previous tool, known as Pooled Cohort Equations, also known as PCE.

The PREVENT equations were developed by the American Heart Association to more accurately represent risk across the current United States population, as the PCE equations were based on patient data that were decades old and lacked diversity.

PREVENT also reflects more recent insights into the biology of ASCVD.

Current statin use as well as metabolic and kidney diseases are incorporated into the new calculation, while race has been removed from it, reflecting a growing awareness that race is a social construct.

Using PREVENT, the team found that among the study’s entire cohort, 10-year risk of developing ASCVD was 4%, half as high as the risk calculated by the PCE (8%). The difference was even larger for Black adults (5% versus 11%) and for adults between the ages of 70 and 75 (10% versus 23%.)

An estimated 4.1 million patients who are currently taking statins would no longer be recommended to take them based on PREVENT.

For these patients and their physicians, clear and careful communication is key, said Anderson.

“We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when the PCE was introduced back in 2013. The data have changed,” he said.

At the same time, it’s important to note that everyone’s risk will inevitably change over time, as well, he adds.

“For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk five years down the

continued from page 8 road, for the simple reason that everybody’s risk goes up as we get older.”

In addition to Anderson and Sussman, the study was authored by Linnea Wilson, MPH, of Beth Israel Deaconess Medical Center.

This research was supported by the National Institute on Aging (AG074878).

Paper cited: “Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations,” JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2024.1302

This article was originally published on the Michigan Medicine News website. F

CME Requirements for Licensure

Every three years physicians are required to complete the following continuing education for license renewal.

150 hr. Continuing Medical Education

75 hr. of which must be Category 1 CME credits for MDs

60 hr. of which must be Category 1 CME credits for DOs

3 hr. Pain & Symptom Management with 1 hr. Controlled Substance Prescribing

1 hr. Medical Ethics

3 hr. Implicit Bias for renewals after June 1, 2024

In Addition to CME

One time – training for Identifying Human Trafficking Victims

One time – training for Opioids & Controlled Substances Awareness for Prescribers

One time – the Medication Access and Training Expansion (MATE) Act, requires DEA registered prescribers to have 8 hrs. training in opioid use disorders

Macomb County Medical Society Annual Meeting

F Tuesday, October 15, 2024 F

Cocktails at 6 pm Dinner at 6:30 pm Program at 7 pm

Location TBD

McLaren Macomb Hospital

MCLAREN MACOMB PARTNERS WITH FAN TO ADD FREE NARCAN DISPENSER

McLaren Macomb has partnered with Families Against Narcotics (FAN) in an effort to reduce the prevalence of opioid overdose in Macomb County by making potentially lifesaving NARCAN available at no cost.

The organizations’ partnership added a NARCAN dispenser to the entrance of the McLaren Macomb emergency department. Indented solely for community use, this free resource is available to any member of the public.

In partnering with FAN and offering NARCAN, McLaren Macomb is increasing readily available access to the opioid overdose treatment.

Patients treated for an overdose in the emergency department are discharged with a prescription for NARCAN, though for many, getting to the pharmacy to fill the prescription is not possible, or they decline to do so due to the stigma associated with it.

Able to hold 96 containers, McLaren Macomb emergency department staff will monitor the dispenser’s NARCAN supply and contact FAN when a resupply is needed. A QR code is included on each box taking recipients to a site providing instructions and additional resources.

TRACEY FRANOVICH NAMED MCLAREN MACOMB PRESIDENT AND CEO

Tracey Franovich, RN, MHA, MBA, has been named President and Chief Executive Officer at McLaren Macomb, effective May 5, 2024.

Franovich assumes executive leadership of the Mount Clemens hospital and its multiple care campuses following the retirement of Tom Brisse earlier this year. Brian Balutanski, McLaren Health Care Corporate Controller and previously the Chief Financial Officer of McLaren Macomb, served as the hospital’s interim President and CEO.

Franovich was serving as President and CEO of McLaren Oakland in Pontiac. She will assist hospital leadership with the transition while a search for a permanent successor is conducted at McLaren Oakland.

“In her time with McLaren, Tracey has demonstrated herself to be an effective leader who not only prioritizes clinical quality care and experience, but also someone who can visualize and plan for the organization’s long term,” said Chad Grant, McLaren Health Care Executive Vice President and Chief Operating Officer. “We are excited that Tracey will continue with McLaren and advance our service throughout the communities of Macomb County.”

Under her leadership at McLaren Oakland, the hospital broke ground on a significant expansion and enhancement of its ambulatory facility in Oxford, successfully earned re-verification as a Level II Trauma Center, and expanded cardiovascular clinical capabilities, while improving clinical quality and enhancing patients’ health care experiences.

Franovich initially came to Michigan and McLaren Health Care in Jan. 2022 from Franciscan Alliance, a health system serving Indiana and south suburban Chicago, where for 17 years she earned promotions increasing her areas of oversight and responsibility, ultimately reaching Vice President of Operational Transformation.

“We are certainly very appreciative of Tom Brisse for his leadership and service to this county,” said James C. George, Chair of the McLaren Macomb Board of Trustees. “In meeting Tracey and learning more about her experience and leadership approach, we feel confident that McLaren Macomb will continue to be an impactful asset to our community.”

A nurse by training, Franovich spent several years in direct patient care upon earning her degree from Purdue University. She also completed a Bachelor’s in Allied Health Administration from Calumet College, a Master’s in health care administration and Master of Business Administration from the University of St. Francis. F

Lisa McDowell, McLaren Macomb Director of Patient Care Services; Isabella Djokic, FAN Rescue Program Coordinator; Marissa Engardio, FAN Rescue Program Director; Dr. Joseph Carlier, McLaren Macomb emergency physician and Macomb County Street Medicine volunteer; Tricia Haener, McLaren Macomb Chief Nursing Officer; David Clayton, Harm:Less Program Coordinator

Macomb County, Michigan

Population Demographics

878,453

Economic and Social Indicators

Pregnant women who received rst trimester prenatal care:

Leading causes of death for Macomb County residents: 94.3% of households in Macomb County have a computer and 91.2% have access to broadband internet

UPDATED CLINICAL RECOMMENDATIONS REGARDING INFLUENZA A (H5N1)

Influenza A (H5N1) has been spreading across dairy and poultry farms throughout the country, including in Michigan. Earlier this year, a human case was identified in a Texas farmworker; and more recently, two human cases have been identified in Michigan farmworkers.

Sporadic human cases are not unexpected, given the current knowledge regarding disease transmission of H5N1. Sustained human-to-human transmission has not been reported at this time. The situation remains a low risk to the general public. However, this is a situation we would like to highlight for the following reasons:

• Increasing numbers of impacted animals create more opportunities for human exposure.

• Human cases can range in severity, but it is important to identify even mildly symptomatic cases, to better understand disease transmission dynamics.

• The cases identified thus far have occurred in individuals with exposure to infected animals. The first case in Michigan, occurred after a splash of infected milk to the eye, resulting in conjunctivitis. The second case occurred after direct contact with an infected cow in the absence of PPE, resulting in respiratory symptoms. These cases highlight the importance of PPE in high-risk settings.

In light of the above, we respectfully ask the following:

1. Ask your patients with influenza-like illness about exposures to wild birds, poultry, dairy cows, or other potential interactions with sick animals.

2. Individuals with compatible signs/symptoms plus risk factors should be tested for influenza A (H5N1) - send samples to the Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories (BOL) as described below.

3. Have a low clinical threshold for starting antiviral medications*, such as oseltamivir, in patients with clinical symptoms and risk factors – even while testing is pending.

4. If you work with a high proportion of individuals working on poultry or dairy farms, please remind them about the importance of wearing personal protective equipment (PPE) to protect themselves from contaminated materials.

5. Remind patients of the risks of drinking raw or unpasteurized milk, which includes potential exposures to influenza A (H5N1), as well as pathogens like Campylobacter, Cryptosporidium, E. coli, Salmonella, or Listeria monocytogenes.

*If treatment is not clinically indicated, please don’t let that deter you from testing. Case ascertainment is important at this time.

Recommendations

Here are a few things we hope you will keep in mind as public health agencies continue to monitor the situation:

• Be aware that this illness is primarily circulating in wildlife, domestic poultry, and dairy cattle.

• Consider the possibility of influenza A (H5N1) virus infection in persons showing signs or symptoms of conjunctivitis and/or respiratory illness who have relevant exposure history

• Relevant Exposure History refers to:

o Persons who have had contact with wildlife, domestic birds, livestock (especially dairy cattle) or other animals within the week before symptom onset.

o Considering if the ill person has prepared or consumed uncooked or undercooked food, including unpasteurized milk or dairy products.

o Considering if the ill person had prolonged exposure to potentially infected birds or animals in a confined space.

• Patients that present with these symptoms and exposures should be tested for novel influenza infection. Testing should be coordinated with local health departments and MDHHS regional epidemiologists. Then, tests should be sent to the MDHHS Bureau of Laboratories (BOL) to be quickly analyzed.

• Follow these recommendations to collect and submit specimens to the BOL.

• While there is no vaccine available for influenza A (H5N1) the seasonal influenza vaccine can protect populations at risk of exposure to influenza A (H5N1) by reducing the risk of coinfection between seasonal and avian strains.

• Antiviral drugs, such as Oseltamivir (Tamiflu) and Zanamivir (Relenza), can be effective in treating novel influenza infection. Early treatment works best and may be especially important for people with a high-risk condition.

• Advise patients to avoid eating or drinking raw (or unpasteurized) milk products

If you have any questions, please contact MDHHS – Monday through Friday, 8 a.m. to 5 p.m., at (517) 335-8165; and after hours or on holidays at (517) 335-9030.

NEW DRUG SHOWING UP IN ILLICIT DRUG SUPPLY, RESULTING IN OVERDOSE DEATHS ACROSS MICHIGAN

The Michigan Department of Health and Human Services is warning Michigan residents about medetomidine, a new drug identified in overdose deaths.

Medetomidine is a veterinary tranquilizer, similar to xylazine, that can cause adverse effects including slowed heart rate, low blood pressure and decreases in brain and spinal cord activity. It is not approved for use in people.

According to data provided by the Swift Toxicology of Opioid Related Mortalities (STORM) project at Western Michigan University Homer Stryker M.D. School of Medicine, since March, three overdose deaths have identified medetomidine during postmortem toxicology testing. The deaths occurred in Ingham, Berrien and Wayne counties. In addition to medetomidine, testing also identified fentanyl and other potent manufactured drugs.

MDHHS is particularly concerned about this drug for the following reasons:

• Medetomidine can cause central nervous system depression and death.

• Like xylazine, medetomidine is not reversed by medications such as naloxone or Narcan.

• Unlike xylazine, testing strips are not yet available to detect this particular drug.

“Medetomidine is considered more potent than xylazine and we want to make sure Michigan residents are aware of this new and dangerous drug showing up in overdose deaths in our state,” said Dr. Natasha Bagdasarian, chief medical executive. “Even though naloxone doesn’t directly reverse the effects of medetomidine or xylazine, these tranquilizers are usually found in combination with opioid drugs like fentanyl, that can be reversed. For this reason, we continue to urge individuals who use drugs and their loved ones to carry naloxone to prevent overdose.”

MDHHS is urging local substance use disorder organizations, health care providers and harm reduction agencies to take the following actions:

• Raise awareness and promote harm reduction practices –medetomidine like xylazine may be increasingly found in the illicit drug supply. Layer harm reduction strategies to lessen the risk of overdose: take it slow, use less, carry naloxone, do not use alone, monitor breathing, etc.

• As with xylazine, give rescue breaths in case of respiratory depression.

o What You Should Know About Xylazine | Drug Overdose | CDC Injury Center

• Distribute naloxone as well as fentanyl and xylazine test strips – Organizations can request free naloxone from MDHHS to increase capacity. Connect individuals with more ways to access naloxone: order online at

nextdistro.org/Michigan and have it delivered at no cost; get it at a pharmacy (Naloxone Standing Order, no prescription required); or contact a Syringe Service Program for naloxone, fentanyl and xylazine test strips, sterile needles, testing for HIV and Hepatitis C and other life-saving resources.

• Explore the Substance Use Vulnerability Index on the MDHHS dashboard to start conversations around gaps and barriers that may exist in your community.

MDHHS will continue monitoring STORM and other rapid data sources and will share information as it becomes available. Agencies aware of any medetomidine-involved overdoses or exposures since January 2024 are asked to share this information at MDHHS-MODASurveillance@Michigan.gov.

MDHHS DIRECTOR ELIZABETH HERTEL APPLAUDS PASSAGE OF FY25 BUDGET

Michigan Department of Health and Human Services Director Elizabeth Hertel issued the following statement on the passage of the balanced and bipartisan FY2025 budget.

“The fiscal year 2025 budget continues to move our state in the right direction with investments that keep kids safe, expand behavioral health access, strengthen Medicaid coverage, assist families, support the health care workforce and make a difference in the lives of our friends and neighbors across the state,” said Hertel. “I appreciate the support of Governor Whitmer and the Legislature which allows us to improve the health, safety and prosperity of Michigan families.”

Key items included in the MDHHS budget include:

• $161.5 million to establish new Certified Community Behavioral Health Clinics sites across the state to serve as many as 35,000 additional individuals, providing them with behavioral health services.

• $18.1 million in funding to continue the Healthy Moms, Healthy Babies program which helps new and expectant mothers receive the care they need and reduce racial disparities in infant and maternal mortality.

• $37 million in new funding for the Family Independence Program, including the first meaningful change to the FIP payment rate since 1990, and expanded supplemental payments to families with young children.

• $40 million for federally qualified health centers and $17.2 million autism Medicaid rate increases.

• $38 million for Child Caring Institutions to restructure rates and payments to provide financial certainty to providers and placement stability for children.

• $25 million for substance use disorder treatment to the Opioid Healing and Recovery Fund and $8.3 million to establish Medicaid reimbursement for hospital-based substance use disorder services provided by peer recovery specialists.

• $20 million to provide new funds to communities that identify innovative approaches to support expectant parents and newborns.

• $7.3 million to ensure individuals experiencing behavioral health crises have access to the Michigan Crisis and Access Line 24 hours a day, seven days a week.

• $1.5 million to increase the clothing and holiday allowances for children in foster care. This investment is the first increase in state support to foster parents for clothing and holiday presents in over 20 years, increasing the clothing allowance by 40-50% (depending on the child’s age) and tripling the holiday allowance. F

MEDICAL RECORDS OF RETIRED PHYSICIANS

If you are retired or will be retiring shortly, please contact the MCMS at 877-264-6592 or email HLeach@macombcms.org and let us know how patients can retrieve their records. If the records have been destroyed, please inform us of that also!

U P C O M I N G

August 14 ~ The Case for Trust: Activate the 8 Pillars of Trust to Mitigate Burn Out

MSMS Grand Rounds, FREE Live Webinar, 12 pm – 12:45 pm, .75 AMA/PRA Category 1 CME Credit.

September 11 ~ From Pills to Pathology: Navigating the Wild World of Drug-Induced Liver Mishaps

MSMS Grand Rounds, FREE Live Webinar, 12 pm – 12:45 pm, .75 AMA/PRA Category 1 CME Credit.

September 16 ~ Tri-County Legislative Meeting

In-person meeting with cocktails & hors d’oeuvres, 6:30 pm location TBD. Join us for this opportunity to directly engage with legislators from Macomb, Oakland, and Wayne Counties. To register email Heidi Leach at HLeach@macombcms.org.

September 23 ~ Reducing Unconscious Biasan Imperative (RUBI)

MSMS Monday Night Medicine, Live Virtual, 5:30 pm – 8:30 pm, 3 AMA/PRA Category 1 CME Credits. This conference fulfills three hours of LARA's requirement for implicit bias training. Cost: $140 members, $190 non-members, free for student/ resident members.

October 4 ~ Updates on Wellness for your Medical Practice Conference – 2024

MSMS/MOA In-Person Meeting, 8:45 am – 4:45 pm, MOA Headquarters in Lansing, 7 AMA/PRA Category 1 CME Credits. Cost: $250 for MSMS Members. Registration limited to 50 participants.

October 9 ~ Physician Documentation for Evaluation and Management (E/M) Under the New Rules

MSMS Grand Rounds, FREE Live Webinar, 12 pm – 12:45 pm, .75 AMA/PRA Category 1 CME Credit.

ACTIVATE YOUR POLITICAL VOICE

The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society. MDPAC supports pro-medicine candidates running for the State legislature, Michigan Supreme Court and other statewide positions. Join today!

October 15 ~ MCMS Annual Meeting

Save the Date for our Annual Dinner Meeting, 6 pm cocktails, 6:30 pm dinner, 7 pm program. Topic and location to be announced.

October 28 ~ Tri-County Legislative Meeting

Live Virtual Meeting at 7 pm via Zoom. Join us for this opportunity to engage with legislators from Macomb, Oakland, and Wayne Counties. To register email Heidi Leach at HLeach@macombcms.org

November 8 ~ A Day of Board of Medicine Renewal Requirements

MSMS In-Person Meeting, 8:30 am – 4:45 pm, Double Tree by Hilton in Ann Arbor. Conference fulfills: 3-hrs DEA MATE Act, 3-hrs Pain Management, 1-hr Medical Ethics, 3-hrs Implicit Bias. 7 AMA/PRA Category 1 CME Credits. Cost: $270 members, $350 non-members, $180 retirees, free for student/resident members.

November 19 ~ Michigan's Extreme Risk Protection Order: What Clinicians Need to Know - Session 2 FREE Live Virtual, 12 pm – 1 pm, 1 AMA/PRA Category 1 CME Credit.

December 9 ~ Implicit Bias Training

MSMS Monday Night Medicine, Live Virtual, 5:30 pm – 8:30 pm, 3 AMA/PRA Category 1 CME Credits. This conference fulfills three hours of LARA's requirement for implicit bias training. Cost: $140 members, $190 non-members, free for student/ resident members.

December 11 ~ You Be the Risk Manager: Navigating Difficult Patient Interactions

MSMS Grand Rounds, FREE Live Webinar, 12 pm – 12:45 pm, .75 AMA/PRA Category 1 CME Credit.

When to Offer Naloxone to Patients

Only 1 naloxone prescription is dispensed for every 70 high-dose opioid prescriptions. As a healthcare professional, you play a critical role in ensuring patients receive naloxone.1

Offer naloxone to all patients prescribed opioids, particularly to patients who are at an increased risk for opioid overdose. In addition, offer naloxone to a patient's family and caregivers and direct them to resources that will teach them how to administer naloxone.

Three forms of naloxone products are available: nasal spray, injection, and auto-injection. Refer to the Substance Abuse and Mental Health Administration’s (SAMHSA) Opioid Overdose Prevention Toolkit to educate patients, caregivers, and the community about the benefits of having naloxone readily available, the different forms and how to use them. For example, if household members, including children, or other close contacts accidentally ingest or experience an opioid overdose having naloxone nearby is critical. Helping people identify places that dispense naloxone can increase the number of people who carry it.

Far too little naloxone is being dispensed in the United States.1

• In 2018, rural counties had the lowest dispensing rates and were nearly 3 times more likely to be low-dispensing counties compared to metropolitan counties.

• Primary care clinicians wrote only 1.5 naloxone prescriptions per 100 highdose opioid prescriptions—a marker for opioid overdose risk.

• Over half of naloxone prescriptions required a copay.

Dispensing naloxone in areas hardest hit by the opioid overdose epidemic can increase the number of lives saved and the opportunity to link people to treatment.1

Visit Prescribe to Prevent for resources about prescribing naloxone in primary care settings.

MSMS ANNUAL HOUSE OF DELEGATES

The Annual Meeting of the Michigan State Medical Society House of Delegates was held on May 11, 2024, at the Crowne Plaza Lansing West in Lansing. This year’s one-day, in-person meeting included the MSMS Board of Directors and 210 delegates from across the state.

The House of Delegates serves as the legislative and policymaking body of the MSMS, representing a diverse array of medical professionals from various specialties throughout the state. They also ensure that the collective voice of the medical community is heard, fostering a democratic process where each delegate has the opportunity to contribute to shaping the future of healthcare. Through this structure, the House of Delegates upholds the principles of representation and accountability, aiming to enhance the quality of patient care and advance the medical profession.

A total of 42 resolutions were reviewed by the full House this year. For more information on the new policy adopted during the House visit msms.org

MARK KOMOROWSKI, MD BECOMES PRESIDENT OF MSMS

The MSMS formally welcomed Mark Komorowski, MD (Bay County), a board-certified Plastic Surgeon, as the new President. Dr. Komorowski was installed as president during the 159th annual meeting of the MSMS House of Delegates in Lansing on May 11th.

Dr. Komorowski has served the community as the Chief of Staff and Chief of Surgery at McLaren Bay Region. A graduate of St. George’s University, Dr. Komorowski will serve a one-year term as president of the society. Prior to his term as president, he served a one-year term as president-elect of the society and two years as Chair of the MSMS Board of Directors.

Dr. Komorowski also serves as the Chair of the Michigan Delegation to the American Medical Association, as the President of both the Bay County Medical Society and Great Lakes PO, and sits on the board of directors of the Physician Associates of MidMichigan physician organization. He is also a member of the American Society of Plastic Surgeons and the American College of Surgeons.

MEET MSMS NEW PRESIDENT-ELECT

Amit Ghose, MD was elected as the President-Elect of MSMS at the annual House of Delegates meeting on May 11th. Dr. Ghose has over 35 years of clinical experience in three countries on three continents. He has witnessed the challenges faced by patients and healthcare providers. Whether practicing in clinics or urban hospitals, he has dedicated his career to improving access, quality, and equity. Has worked as an advocate and has been engaged with legislators to advocate for policies that prioritize preventive care, mental health services and physician well-being. He’s been involved with MDPAC for over 10 years, serving as the Chair for 2020-2023.

Dr. Ghose has served on the Ingham County Medical Society Board of Directors and served as President. He has served 9 years on the MSMS Board of Directors, working on various efforts: the campaigns to reform prior authorization, nullify healthcare tax, expand Medicaid within the state and increase funds for residency programs. He served as an MSMS Delegate to the AMA in 2022 after serving 4 years as an Alternate Delegate. He also served on the task force to rewrite the Bylaws of the AMA International Medical Graduate section.

His vision for MSMS includes increasing grassroots involvement of members and increasing individual and group memberships by explaining the value of organized medicine.

AMA ANNUAL MEETING WRAP-UP

Your Michigan Delegation to the American Medical Association (AMA) worked hard on your behalf during the AMA’s Annual Meeting held in Chicago, Illinois, from June 7-12, 2024. Under the leadership of Mark Komorowski, MD, Chair; Christie Morgan, MD Vice Chair; and Courtland Keteyian, MD, Secretary-Treasurer, Michigan submitted seven resolutions and several Delegation members served on key committees and Councils.

The highlight of the meeting was the election of Bobby Mukkamala, MD, as the AMA President-Elect. Dr. Mukkamala served on the AMA Board of Trustees and is a former President of the Michigan State Medical Society. His successful campaign was coordinated by Dr. Morgan and Joshua Richmond, MSMS Senior Director of Membership.

As has become the tradition, Michigan Delegates and Alternate Delegates were highly visible during the meeting with three serving on Reference Committees: Chris Bush, MD (Committee D Public Health), Theodore Jones, MD (Constitution and Bylaws), and David Whalen, MD (Committee C Medical Education). Council members Michael Chafty, MD, JD (Legislation), Betty Chu, MD (Medical Service), Pino Colone, MD (Constitution and Bylaws), and Louito Edje, MD (Medical Education) presented Council reports and input during

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committees. Jann Caison-Sorey, MD, continued to serve as Chair of the AMA’s Committee on Conduct at AMA Meetings and Events and Brooke Buckley, MD, spoke at the Opening Session in her role as Chair of the AMPAC Board of Directors. Other Delegation members were assigned to respective Reference Committees to speak on behalf of Michigan’s resolutions, provide input on issues of concern, and monitor debate.

Dr. Komorowski reiterated that “Michigan physicians continue to be well-respected within the AMA HOD.” He also shared, “I am proud of the Delegation’s efforts to advocate for polices that support physicians and their ability to care for patients, promote science, and improve health outcomes.”

Michigan’s resolutions are listed below.

218 (A-24) Designation of Descendants of Enslaved Africans in America – Referred for study.

250 (A-24) Endorsement of the Uniform Health-Care Decisions Act – Referred for study.

251 (A-24) Streamline Payer Quality Metrics – Adopted as substituted.

320 (A-24) Anti-Racism Training for Medical Students and Medical Residents – Policy H-65.952 was reaffirmed in lieu of Resolution 320.

413 (A-24) Sexuality and Reproductive Health Education – AMA Policy H-170.968, “Sexuality Education, Sexual Violence Prevention, Abstinence, and Distribution of Condoms in Schools,” was reaffirmed.

434 (A-24) Universal Newborn Eye Screening – Not adopted. 716 (A-24) Impact of Patient Nonadherence on Quality Scores – Adopted as amended.

For highlights from the AMA Annual Meeting, visit https:// www.ama-assn.org/house-delegates/annual-meeting/ highlights-2024-ama-annual-meeting. If you have questions regarding the Michigan Delegation to the AMA, please contact Stacey P. Hettiger at shettiger@msms.org.

UPDATES ON WELLNESS FOR YOUR MEDICAL PRACTICE CONFERENCE

In partnership with the Michigan Osteopathic Association, we are pleased to announce a new joint educational opportunity entitled “Updates on Wellness for Your Medical Practice” to be held Friday, October 4, 2024, from 9:00 am –4:30 pm, at the Michigan Osteopathic Association Headquarters (2112 University Park Dr., in Okemos). This 7-hour conference will focus on bringing the concept of general wellness into the physician’s practice with an emphasis on lifestyle medicine in Michigan.

Lifestyle Medicine and Functional Medicine are evidence-based approaches to preventing, treating, and reversing diseases by replacing unhealthy behaviors with positive ones. Both medical practices focus on six areas of human behavior: eating healthfully, being physically active, managing stress, avoiding risky substance use (tobacco, alcohol, and illicit drug use), getting adequate sleep, and having healthy relationships or a strong support system.

The goal of lifestyle and functional medicine is to use therapeutic lifestyle behavior changes as the primary modality to address the root cause of chronic disease. Lifestyle Medicine and Functional Medicine are not currently mainstream medical practices and will become even more important as the burden of chronic disease continues to rise nationally and globally.

Registration is limited to 50 participants. Cost: $250 for MSMS Members. 7 Category 1 AMA PRA CME Credits. Register here

Topics and speakers include:

Billing/Insurance – Kristi Artz, MD, Spectrum Health

Microbiome and Lifestyle – Elizabeth Swenor, DO, Henry Ford Health

Overall Sleep Hygiene – Virginia Skiba, MD, Henry Ford Health

Cardiology/Healthy Diet – Joel Kahn, MD, Kahn Center for Cardiac Longevity

Childhood Obesity – Christina Lucas-Vougiouklakis, DO, Henry Ford Health

Shared Medical Office Visits – Aarthi Chandarana, DO, Henry Ford Health

Lifestyle and Mental Health – Melissa Sundermann, DO, Trinity IHA

A WIN FOR PHYSICIAN REIMBURSEMENT!

BCBSM/BCN will begin reimbursing for a problem-focused evaluation and management (E/M) services at 50% of the physician fee schedule when performed on the same date of service as a preventive medicine service. The preventive medicine service will be reimbursed in full.

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Preventive Medicine codes are 99381 – 99387, 99391 – 99397, 99401 – 99404, 99406 – 99409, and 99411 – 99412

E/M codes are 99202 – 99215, 99211 – 99215, 99341 – 99345, and 99347 – 99350

Modifier 25 must be appended to the problem-focused E/M code to receive proper reimbursement. It is important to remember that modifiers should only be used if the documentation supports the use of a modifier.

Modifier 25 – Significant, Separately Identifiable E/M Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. F

Norbert P. Czajkowski, MD

March 5, 1939 – May 5, 2024

Dr. Norbert P. Czajkowski, “Dr. C”, age 85, of St. Clair Township, passed away May 5, 2024. He was born March 5, 1939 in Detroit to the late Joseph and Janina Czajkowski. He married Deborah Ashbaugh on August 24, 1996.

He proudly served with the U.S. Army during the Vietnam War as a physician achieving the rank of Major. He earned his doctorate from Wayne State University School of Medicine in 1963, started his first practice in Birmingham and later began his private practice Fraser Eye Care Center. He studied under Dr. Svyatoslav Nikolay Fyodorov to learn the Radial Keratotomy surgical procedure and was the pioneer of RK in the United States.

Dr. Czajkowski was an amazing man that we all respected and admired. He was always ahead of his time. He was a tower of strength and always approached his practice with dignity and respect for his patients and the staff that worked with him. Loving husband, father, grandfather and friend. His hobbies were building his observatory, making musical instruments, an exotic car collector, woodworking, photographer, an animal lover, amongst many other hobbies. He self-taught himself all of his hobbies. It can be said that his theory was Go Big or Go Home. He was truly second to none. He was one of a kind. He is survived by his wife, Deborah Czajkowski; children, James (Jessica) Czajkowski, Lori Marqua, Angela (Jim) Greaux, Mark Ashbaugh; grandchildren, Collin, Chase, Taylor, Andrew, Tyler, Morgan, Keeley, Braylon, Joshua, Sophia, Kaylee, Morgan. He is also survived by his brother; Ron (Debbie) Corey; nephew, Joseph (Rachel) Corey; niece, Megan (Spencer) Wood and many colleagues and special friends and his fur baby Rosy. He was preceded in death by his son, Robert Czajkowski and his mother that raised him, Sophia Czajkowski.

Memorial contributions may be made to the Blue Water Area Humane Society 6266 Lapeer Rd. Clyde Twp. MI 48049. F

FREE CME with MSMS’ on Demand Webinars

Available at www.msms.org/Education

Grand Rounds Webinar Series:

Cognitive Dysfunction in HIV and Alzheimer's

DEA MATE Act Training

Gravity of Licensing Disciplinary Actions

Harm Reduction in Practice and Policy Strategies

LGBTQ Health in MI: An Overview of Efforts to Improve Care & Reduce Health Disparities

Licensing App, Renewal and CME Requirements

Medical Management for Obesity in Adult Patients

MI's Extreme Risk Protection Order: What Clinicians Need to Know

Navigating Opioid Prescribing in Michigan

Point of Care Testing & Provider Performed Microscopy: Meeting CLIA Requirements

Surviving Litigation

Trauma Informed Leadership

What Does "Value" Mean for Health Equity?

Practice Management Webinar Series:

Ask the Experts – Legal Panel

Complaints, Grievances, Quality Improvement...OH MY!

Correct Submission of Chronic Care Management and Depression Screening

Cyber Security for Mobile Devices

Embezzlement: How to Protect Your Practice

Evaluation & Management Services, Efficient Compliant Documentation

HHS-OIG's Battle Against Health Care Fraud

Medical Records Basics

Patient No Show Policy Payer Panel

Telehealth Update

HIPAA Privacy Rule to Support Reproductive Healthcare Privacy | Resources for Interested Parties

The Biden-Harris Administration, through the Office for Civil Rights (OCR) at the U.S. Department of Health & Human Services (HHS), has issued a Final Rule modifying the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to enhance reproductive health care privacy. This action seeks to safeguard reproductive health care access and privacy along with bolstering patient-physician confidentiality.

The Final Rule fortifies privacy by prohibiting the use or disclosure of protected health information (PHI) related to reproductive health by covered entities (e.g., physicians, hospitals, health plans, health care clearinghouses) and their business associates. The Final Rule also permits covered entities to use or disclose PHI for non-prohibited purposes under the Privacy Rule.

Prohibited purposes include using PHI to: investigate any person for seeking, obtaining, providing, or facilitating lawful reproductive health care; to impose liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care; and to identify any person for the purposes of investigation or liability.

To enforce the prohibition, the Final Rule mandates that covered entities obtain a signed attestation from requestors affirming that the PHI will not be used for prohibited purposes. This requirement applies to requests for PHI for health oversight activities, judicial and administrative proceedings, law enforcement purposes, and disclosures to coroners and medical examiners.

The Office of the National Coordinator for Health Information Technology (ONC) has confirmed that complying with OCR’s reproductive health regulations will not constitute information blocking. For example, if a request is made to a physician for reproductive health PHI, and the physician requests that an attestation be signed that the PHI will not be used for prohibited purposes and that attestation is not signed, is not complete, or cannot be relied on, a physician can withhold that PHI without being considered an information blocker.

The AMA has been urging both OCR and ONC to provide much needed education and resources to help physicians implement and comply with the regulations and to protect patient and physician information from misuse. In response to their requests, the administration developed the materials below.

Physicians must be in compliance with the Final Rule by December 23, 2024.

Below are several helpful resources provided by OCR. These include:

• Resources to help communicate with other clinicians and community members

• A fact sheet summary of the rule.

• A recorded briefing by OCR staff reviewing the rule.

• Model attestation for a requested use or disclosure of protected health information. F

BOBBY MUKKAMALA, MD, WINS OFFICE OF AMA PRESIDENT-ELECT

Bobby Mukkamala, MD, an otolaryngologist from Flint, Michigan, was voted president-elect of the AMA by physicians and medical students gathered at the 2024 AMA Annual Meeting. Following a year-long term as president-elect, Dr. Mukkamala will be inaugurated as AMA president in June 2025.

“It is a turbulent time to be a physician in this country,” said Dr. Mukkamala. “Challenges like an unsustainable Medicare payment system, excessive prior authorization, and physician burnout have put our health system in a precarious place. But the AMA is fighting these battles in Congress, in state capitols, and in our communities to achieve a better future where physicians can spend more time with their patients. I am honored to be chosen by my peers as the AMA’s president-elect and I am eager to continue fighting for better health care for all our communities.”

Dr. Mukkamala has been active in the AMA since he was a resident physician at Loyola University Medical Center in Chicago. He is chair of the AMA Substance Use and Pain Care Task Force, serving as a strong voice in advocating for evidence-based policies to end the nation’s overdose epidemic.

The son of two immigrant physicians, Dr. Mukkamala was inspired to go into medicine and return to his hometown of Flint to serve the community that welcomed his family decades before. He played a central role in response to the Flint water crisis, serving as chair of the Community Foundation of Greater Flint with a focus on funding projects to mitigate the effects of lead in children.

As an otolaryngologist, Dr. Mukkamala sees patients at all stages of life and all phases of health. He will succeed Bruce A. Scott, MD, as the second consecutive AMA president to specialize in otolaryngology.

Dr. Mukkamala is a past recipient of the AMA Foundation’s “Excellence in Medicine” Leadership Award. He was elected to the AMA Council on Science and Public Health in 2009 and chaired the council 2016 – 2017, before being elected to the AMA Board of Trustees in 2017. He won reelection to the board in 2021.

He has served as a member of the Michigan State Medical Society’s board of directors since 2011, as board chair for two continued on page 21

years, and as its president. He is also a past president of the Genesee County Medical Society and continues to serve on its board of directors.

PROPOSED RULE FOR THE 2025 MEDICARE PHYSICIAN PAYMENT SCHEDULE

On July 10th, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2025 Medicare physician payment schedule. While the AMA staff will analyze and develop a summary of the 2,000+ page proposal, we wanted to make you aware of a handful of key issues.

The 2025 Medicare conversion factor is set to decrease for the fifth straight year by approximately 2.80 percent from $33.2875 to $32.3562. Similarly, the anesthesia conversion factor would be reduced from $20.7739 to $20.3340. This cut is largely the result of the expiration of a 2.93 percent temporary update to the conversion factor at the end of 2024 and a 0 percent baseline update for 2025 under the Medicare Access and CHIP Reauthorization Act (MACRA). Unfortunately, these cuts coincide with ongoing growth in the cost to practice medicine as CMS projects the increase in the Medicare Economic Index (MEI) for 2025 will be 3.6 percent.

Physician practices cannot continue to absorb increasing costs while their payment rates dwindle. Both the Medicare Physician Payment Advisory Commission (MedPAC) and the Medicare Trustees have issued warnings about access to care problems for America’s seniors and persons with disabilities if the gap between what Medicare pays physicians and what it costs to provide high-quality care continue to grow. This is why the AMA and our partners in organized medicine strongly support H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would provide a permanent, annual update equal to the increase in the MEI and allow physician practices to invest in their practices and implement new strategies to provide high-value care. Visit the AMA’s Fix Medicare Now site and join the fight for financial stability for physician practices to preserve access to care for Medicare beneficiaries.

In addition, following ongoing advocacy by the AMA not to increase the Merit-based Incentive Payment System (MIPS) performance threshold due to significant disruptions caused by the COVID-19 pandemic and Change Healthcare cyberattack, CMS proposed to maintain the threshold to avoid a MIPS penalty of up to 9 percent at 75 points for the CY 2025 performance year/2027 MIPS payment year. Research continues to show that MIPS is unduly burdensome; disproportionately harmful to small, rural, and independent practices; exacerbating health inequities; and divorced from meaningful clinical outcomes. The AMA is strongly urging Congress to make statutory changes to improve MIPS and address fundamental problems with the program by replacing steep penalties that disproportionately hurt small and rural practices, prioritizing access to timely and actionable data, reducing burden, aligning MIPS

with facility quality programs, and incentivizing the development and reporting of new clinically relevant quality and cost measures.

The text of the proposed rule can be accessed at: https://public-inspection.federalregister.gov/2024-14828.pdf

Additional links include:

• CMS Press Release

• Physician Payment Schedule Fact Sheet

• Medicare Shared Savings Program Fact Sheet

• Quality Payment Program (QPP) Fact Sheet

INFORMATION BLOCKING DISINCENTIVES REGULATION FINALIZED

With CMS and ONC releasing a Final Rule in late June implementing disincentives for physicians and other health care providers participating in specific Medicare programs that HHS has determined have committed information blocking, the AMA created a summary brief about the new final regulation. It is important to note that physicians and other health care providers will be subject to CMS and ONC’s disincentive regulations starting July 31, 2024

HHS has defined "information blocking" as any practice that is likely to interfere with the access, exchange, or use of electronic health information (EHI), unless covered by an exception. Disincentives apply to Medicare-enrolled physicians and other providers found to have committed information blocking, but do not extend to all health care providers. Hospitals and critical access hospitals (CAHs) face disincentives through the Medicare Promoting Interoperability (PI) Program, such as losing their status as meaningful EHR users and receiving reduced payment adjustments. Similarly, physicians participating in the Merit-based Incentive Payment System (MIPS) will receive a zero score for the Promoting Interoperability performance category if found guilty of information blocking. For the Medicare Shared Savings Program (MSSP), health care providers, including Accountable Care Organizations (ACOs), may be barred from participation for at least one year if found to have committed information blocking. In this final rule, CMS offers MSSP participants more discretion and will consider the nature of the violation, the provider's efforts to correct the issue, and other relevant factors before applying disincentives.

Physicians and other providers must “know” that a practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of EHI, in order to be in violation of information blocking regulations. The rule also includes a transparency requirement, mandating that information about physicians and other provider actors determined to have committed information blocking be publicly posted on ONC’s website. This includes the physician or other provider’s name, address, the nature of the information blocking practice, and the applied disincentive. F

hysician engagement is essential to the success of a pro-medicine legislature. Join us in fighting for legislation that helps physicians practice medicine without interference from over regulation and protects patients with decisions made by doctors not politicians. Lawmakers want and need to hear from professionals in the field of medicine!

Current State Legislation

Senate Bill 279 – Oppose Dangerous Scope of Practice Expansion

The patient-centered care model, led by physicians and supported by the best trained and most qualified care team members is the proven, time-tested approach that ensures all Michigan patients receive the kind of quality care they expect and deserve.

SB 279 seeks to undermine and threaten that approach by removing physicians from patient care teams and allowing the full independent practice of Nurse Practitioners. It’s dangerous legislation that could have severe consequences for patient outcomes and access to quality care.

Please contact your lawmakers today and urge them to vote NO on Senate Bill 279

House Bills 5554 & 5555 – Oppose Efforts to Weaken Michigan's Smoke Free Air Laws

Efforts are underway to weaken Michigan's Smoke Free Air laws and legislators need to hear from you! House Bills 5554 and 5555 would exempt hookah bars from the public smoking prohibition. Currently, hookah lounges have to operate separate LLCs to accommodate guests that want to smoke hookah and eat or drink. Combining these businesses into one would mean more employees are subject to second or third-hand smoke when previously they were protected due to a physical barrier between the lounge and the restaurant. These bills would undermine public health efforts and expose more people to the dangers of secondhand smoke.

Take action now and tell your Representative to protect public health and vote NO on HB 5554 & HB 5555.

House Bill 5339 – Call on the House Insurance Committee to Schedule a Hearing on Step Therapy Reform!

One of the most important tenets of the work of the Michigan State Medical Society and Macomb County Medical Society is that health care decisions should be made between physicians and patients. Unfortunately, insurance companies' practice of step therapy forces patients to try and fail on one or more prescription medications before they can access the treatment originally prescribed by their healthcare provider. This practice not only delays necessary treatment but can also exacerbate health conditions and lead to increased healthcare costs in the long run. HB 5339 would reform the pressing issue of "fail first" policies, which have a detrimental impact on patients across Michigan.

Securing a hearing on HB 5339 is pivotal in advancing this legislation and protecting Michiganders from the harms of step therapy tactics.

Please reach out to the members of the House Insurance Committee and urge them to schedule a hearing on HB 5339 as soon as possible

House

Bill 4472 – Protect Patients Access to Physician-Led

Care Teams

When it comes to restoring a patient’s health, no one is more capable, better trained, and more likely to deliver safe and effective outcomes than physicians. That’s something we all need to work to protect, and House Bill 4472 is an excellent start.

House Bill 4472 would require advanced practice registered nurses (APRNs) to practice as part of physician-led, patientcentered care teams, where they would practice within the scope of their usual professional activities, creating a care model that ensures rural and underserved communities have access to physician-led care.

Medicine is just too complex and unforgiving to not have the most experienced and highly trained health care providers involved in diagnosis and treatment decisions, leading the way to the best and safest outcomes.

Please contact your lawmakers today and urge them to vote YES on HB 4472 F

Have you or a MCMS colleague been elected to a position (specialty society, hospital, community based program, etc.) or honored for your volunteer service within the community or abroad? Let us know. We would like to recognize MCMS members in the“Member News” section of the Medicus. Contact Heidi Leach at HLeach@macombcms.org with newsworthy information. Publication is subject to availability of space and the discretion of the Editor. SHARE YOUR NEWSWORTHY ITEMS!

Macomb Journal of the Macomb County Medical Society

MICHIGAN SENATE

Senate District 3

Sen. Stephanie Chang (D) SenSChang@senate.michigan.gov (517) 373-7346

Senate District 9

Sen. Michael Webber (R) SenMWebber@senate.michigan.gov (517) 373-0994

Senate District 10

Sen. Paul Wojno (D) SenPWojno@senate.michigan.gov (517) 373-8360

Senate District 11

Sen. Veronica Klinefelt (D) SenVKlinefelt@senate.michigan.gov (517) 373-7670

Senate District 12

Sen. Kevin Hertel (D) SenKHertel@senate.michigan.gov (517) 373-7315

Senate District 24

Sen. Ruth Johnson (R) SenRJohnson@senate.michigan.gov (517) 373-1636

Senate District 25

Sen. Daniel Lauwers (R) SenDLauwers@senate.michigan.gov (517) 373-7708

COMMITTEES

House – Appropriations

Thomas Kuhn (R), District 57

Donavan McKinney (D), District 14

Denise Mentzer (D), District 61

House – Family, Children & Seniors

Kimberly Edwards (D), District 12

Doug Wozniak (R), District 59

2024 Macomb County Legislator Contact Guide

MICHIGAN HOUSE

House District 10

Rep. Joe Tate (D) Speaker of the House JoeTate@house.mi.gov (517) 373-085, (855) 737-2882

House District 11

Rep. Veronica Paiz (D) VeronicaPaiz@house.mi.gov (517) 373-0849

House District 12

Rep. Kimberly Edwards (D) KimberlyEdwards@house.mi.gov (517) 373-0852

House District 13

Rep. Mai Xiong (D) MaiXiong@house.mi.gov (517) 373-0845

House – Insurance

Joseph Aragona (R), District 60

House – Regulatory Reform

Joseph Aragona (R), District 60

Senate – Appropriations

Kevin Hertel (D), District 12

Veronica Klinefelt (D), District 11

House District 14

Rep. Donavan McKinney (D) DonavanMcKinney@house. mi.gov (517) 373-0140

House District 57

Rep. Thomas Kuhn (R) TomKuhn@house.mi.gov (517) 373-1706

House District 58

Rep. Nate Shannon (D) NateShannon@house.mi.gov (517) 373-1794, (855) 926-3925

House District 59

Rep. Douglas Wozniak (R) DouglasWozniak@house.mi.gov (517) 373-0832

House District 60

Rep. Joseph Aragona (R) JosephAragona@house.mi.gov (517) 373-1785

House District 61

Rep. Denise Mentzer (D) DeniseMentzer@house.mi.gov (517) 373-1774

House District 62

Rep. Alicia St. Germaine (R) AliciaStGermaine@house.mi.gov (517) 373-0555

House District 63

Rep. Jay DeBoyer (R) JayDeBoyer@house.mi.gov (517) 373-1787

House District 65

Rep. Jaime Greene (R) JaimeGreene@house.mi.gov (517) 373-1775

House District 66

Rep. Josh Schriver (R) JoshSchriver@house.mi.gov (517) 373-0839

Senate – Health Policy

Kevin Hertel (D), District 12

Veronica Klinefelt (D), District 11

Michael Webber (R), District 9

Paul Wojno (D), District 10

Senate – Regulatory Affairs

Kevin Hertel (D), District 12

Dan Lauwers (R), District 25

Michael Webber (R), District 9

Paul Wojno (D), District 10

Heidi Leach, Executive Director & Managing Editor Macomb County Medical Society, PO Box 551, 810-712-2546 HLeach@macombcms.org | www.macombcms.org Macomb

The Macomb Medicus is the official quarterly journal of the Macomb County Medical Society. It is a full-color glossy magazine published both electronically and in hard copy format. It is a valued news source for our 600 plus physician members of all specialties and their staff throughout Macomb County. In addition to members the Macomb Medicus is sent to hospital executives, Michigan State Medical Society staff, other county medical society staff, and healthcare related businesses/organizations in Macomb County. The Macomb Medicus is read by an impressive cross section of the healthcare community and is electronically available on our website at www.macombcms.org.

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