MACOMB MEDICAL SOCIETY - October/November/December 2024

Medicus Macomb

Journal of the Macomb County Medical Society

October, November,December 2024 | Vol. 32 | No.4

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

Free

| E-Mail HLeach@macombcms.org , macombcms@gmail.com Web www.macombcms.org

October/November/December 2024 | Vol. 32 | No. 4

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.

Medicare Payment Reform Must be a Priority

By: Daniel M. Ryan, MD MCMS Past President & MSMS Regional Director

P

hysicians continue to bear the brunt of a broken Medicare payment system that is pushing many independent practices to the brink of financial collapse and needlessly threatening access to care for millions of people, including seniors.

In a time of soaring practice costs and high inflation, physicians over the last two decades have endured a near 30% drop in payment for care delivered to our Medicare patients, with more payment cuts proposed for next year. For many of us, it means we’re being paid less today to perform common treatments and procedures than we would have made as medical students.

This is simply unconscionable. Annual Medicare payment cuts from the Centers for Medicare and Medicaid Services have put independent physicians – the backbone of our nation’s health system – in an impossible position: Either turn away patients or close their doors for good.

It's time for physicians in Macomb County and across the U.S. to speak with one voice and demand that Congress enact wholesale reforms to our antiquated Medicare payment system and put the practice of medicine on a sustainable path for the future. The stakes for our nation, and its health, could not be higher.

Fixing our broken Medicare reimbursement system is the top advocacy priority for the Macomb County Medical Society (MCMS), Michigan State Medical Society (MSMS), as well as other state and specialty societies throughout the country.

Inadequate payment is the top reason why independent physicians sell their practices to hospitals or health systems, according to the AMA Physician Practice Benchmark Survey. The lack of annual payment increases for physicians tied to the inflation rate stands in sharp contrast to the substantial boosts routinely awarded each year to hospitals, skilled nursing facilities, and others who serve Medicare patients. The experience for physicians is just the opposite, as we must fight to reduce or delay round after round of payment cuts, year after year.

The MSMS continues to press Congress to reform its Medicare payment model based on bipartisan solutions already in play. Physician organizations strongly support H.R. 2474, the Strengthening Medicare for Patients and Providers Act.

This bipartisan measure would provide a permanent, annual update equal to the increase in the Medicare Economic Index (MEI), which measures practice cost inflation.

More recently, the MSMS threw its support behind a bipartisan bill introduced in the U.S. Senate that would substantially increase financial support for physicians who provide Medicare and provide regular updates tied to MEI. While this new bill is imperfect, physicians view it as a critical first step in securing the long-term viability of our health system.

The AMA has released its own detailed plan to make the Merit-based Incentive Payment System more relevant to patients, outlined steps to significantly reduce the administrative and financial burdens that come with MIPS participation, and is fighting to bolster support for physician practices that wish to implement value-based payment systems. Physicians are also working to achieve an overhaul of federal budget neutrality policies to raise the threshold that triggers adjustments and prevent erroneous utilization estimates that cause inappropriate payment cuts.

We need our physician colleagues to lend your voice to the Fix Medicare Now grassroots campaign, which calls for a number of specific reform measures to create a rational Medicare payment system that safeguards patient access to high-quality care. The goal of these combined efforts is to create a Medicare system that is financially stable so that physicians can adequately care for the country’s aging population. We deserve a system that protects value-based care for patients while preserving access to care where it is needed most.

We must keep the pressure on Congress. Quick fixes are not enough. Physicians demand that Congress prioritize Medicare reform now as an investment in our nation’s health today and far into the future. F

HAVE YOU HEARD ABOUT THE MICHIGAN CARE IMPROVEMENT REGISTRY (MCIR)?

The Michigan Care Improvement Registry (MCIR) website provides resources for healthcare providers, schools, childcare centers, and the general public to access and manage immunization records in Michigan. It includes tools for providers to track vaccinations, training materials, and access to immunization records for individuals 18 and older.

If you are 18 years of age or older, save time and look up your immunization record online. You may be able to download your State of Michigan immunization record using a government-issued photo ID. Visit the MCIR website here. If you need a copy of a record that cannot be accessed online, then please call one of our Immunization Clinics at 586-4658537 (Warren location) or 586-469-5372 (Clinton Township location). If immunizations are needed, schedule an appointment online by visiting our Immunization Clinics webpage

FOOD SAFETY PROGRAM PREVENTS FOODBORNE

ILLNESS IN MACOMB COUNTY

We all do our best to prepare safe food at home, but how do you know food is safe when you eat out? The Macomb County Health Department’s Food Safety Program works hard to ensure food prepared and served in licensed food service establishments is wholesome and safe.

You may have heard about the Food Safety Program's regulatory inspections at licensed food service establishments. Their Restaurant Locator tool shares inspection results; search by ZIP code to see how restaurants in your area are performing!

Suspect a food safety violation or get sick when eating out? The Food Safety Program investigates consumer complaints about food service establishments and reports of foodborne illness. Contact the Food Safety Program if you have nausea, vomiting, and diarrhea lasting 24-48 hours after eating out. Reporting illnesses helps the Food Safety Program identify and address sources of contamination to prevent foodborne illness outbreaks.

E W S

For help with everything from licensing to food service plans, illness reporting, and inspections, visit the Food Safety Program’s website or contact Environmental Health Services at 586-469-5236 or environmental.health@macombgov.org

PARTNER SPOTLIGHT: CARE OF SOUTHEASTERN MICHIGAN

We are honored to highlight 2024 Macomb Business Awards Nonprofit of the Year award recipient, CARE of Southeastern Michigan. Since 1977, CARE of Southeastern Michigan has been a nonprofit deeply rooted in helping the community. Serving Macomb, Oakland, and Wayne counties, CARE provides prevention, treatment, and recovery services for all age groups, from early childhood to older adulthood. CARE’s community-oriented approach is evident in the free parenting classes and support groups offered, as well as the critical incident support they provide to first responders after traumatic incidents. CARE of Southeastern Michigan’s mission is to strengthen resilience in people and their communities through prevention, education, and services that improve the quality of life. Thank you CARE for continuing to serve your community with the utmost respect and care.

CARE of Southeastern Michigan will host its 30th Annual Parenting Conference Saturday, March 1, 2025. This extraordinary event brings together leaders, parents, educators, and social service professionals. Attendees network throughout the day and engage in applicable breakout sessions that support the development of our young people.

Learn more about CARE of Southeastern Michigan here F

Fall in Love with Macomb

Find all kinds of Fall fun in Macomb County. From apple orchards and cider mills, to breweries, festivals and family activities, our community has something for everyone.

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

October

Howard Adelson, DO

Raed Alnajjar, MD

Roberto Barretto, MD

Kenneth Cervone, MD

Randall Colvin, MD

Nicole, Dolan, DO

Jay Eastman, MD

Robert Fishman, MD

Steven Fite, MD

Amit Garg, MD

John Habicht, MD

Bijaya Hans, MD

Timothy Horrigan, MD

Syed Husain, MD

Khaled Ismail, MD

Steven Kotsonis, DO

Jeanette MarchandMateyak, MD

Robert Mendelson, MD

Mark Mishack, MD

Gerald Mullan, MD

Stephen Redding, MD

Adam Rubin, MD

Milton Simmons, MD

Graciano Singson, MD

Cheryl Sobocinski, MD

Anil Thomas, MD

Kenneth Tucker, MD

Isaac Turner, MD

Sheetal Varde, DO

November

Wassim Bazzi, MD

Yousef Bishai, MD

Jeffrey Budzyn, MD

Amy Cardellio, DO

Grace Cho, DO

David Coviak, DDS, MD

Eddie El-Yussif, DO

Allison Engel, MD

Nicole Faulkner, DO

Frank Fenton, DO

Michael Fozo, MD

Gunateet Goswami, MD

Mouhammed Joumaa, MD

Joseph Kaiser, DO

Stacy Ker, DO

Akhila Lattupally, MD

Candice Mansoor, MD

Shiva Maralani, MD

Gregory Oldford, MD

Thomas O'Neil, DO

Heather Orkwis, DO

Malati Patel, MD

Susan Radtke, MD

Chada Reddy, MD

Dumitru Sandulescu, MD

Jerome Seid, MD

Brian Seifman, MD

Jack Shartsis, MD

Gail Soo Hoo-Williams, MD

Sevak Valijan, MD

Kenneth Weinberger, MD

Stanley Wolfe, MD

December

Kootaybah Al Sheikhly, MD

David Altman, MD

Lenise Banse, MD

James Bookout, MD

Terrence Brennan, MD

Bruce Carl, MD

Adrian Christie, MD

Aaron Cloutier, DO

Matthew Edwards, DO

Eileen Hopman, MD

A. Joseph Hoski, MD

Syed Husain, MD

Ernesto Lao, MD

Christina Leo, DO

Nada Macaron, MD

Daniel Macek, MD

Daniel Malach, MD

Vittorio Morreale, MD

Rajika Munasinghe, MD

Andrew Ogawa, MD

Alan Parent, MD

Vijay Patel, MD

Benedict Pellerito, MD

S. Bhimsen Rao, MD

Mouhamad Rihawi, MD

Adam Rourke, DO

Sima Salman, DO

Paul Sweda, MD

Ethel Villanueva, MD

David Weingarden, MD

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.

Thank you to the everyone who joined us at Ike’s Restaurant on October 15th for our Annual Dinner Meeting. It was a great evening with good conversation and a relaxed convivial atmosphere. It was nice to see some new faces like Farah Salem, MD and Scott Sircus, MD as well as new MCMS Board members Kal Ismail, MD and Carolann Kinner, DO. It was also good to see some familiar members like Terrence Brennan, MD, Adrian Christie, MD, Narendra Gohel, MD, Dr. & Mrs. Golden and Dan Ryan, MD. MCMS President Lawrence Handler, MD made everyone feel welcome.

Tom George, MD, CEO of the Michigan State Medical Society gave a fantastic and informative presentation covering a wide range of topics. Some highlights include:

Advocacy and Election Update, stressing the importance of this year’s Supreme Court election in preserving MI’s current liability climate. MDPAC is endorsing Patrick O’Grady and Andrew Fink.

MI’s Corporate Practice of Medicine Laws, and the need for physicians experiencing issues with management service organizations/private equity groups dictating patient care to report them to the MI Attorney General and/or the MI Board of Medicine.

MI’s Tort Reform and Liability Laws, MSMS expects the introduction of legislation that would negate existing provisions in MI law that help to maintain the stability of our current liability climate.

Membership Perks for 2025, MSMS plans to offer FREE, unlimited CME for all members! F

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

Macomb County Medical Society Foundation ’s 2024 Holiday Sharing Card Project

Dear Macomb County Medical Society Members,

For this year’s Holiday Sharing Card Project we are giving you the option of contributing to either or both of the following local charities. We know that you receive several donation requests but the need in Macomb County has never been greater and we hope that you will help those in need in your community. The MCMS Foundation is a 501(c)(3) non -profit charitable organization , as it pays for all costs associated with this project, your donation is 100% tax deductible. The MCMS Foundation’s Tax ID number is 38-3180176.

Macomb Food Program serves people in need of food through its 50 plus pantry distribution sites and its “Fresh to You” Mobile Pantry Last year the Macomb Food Program served 127,148 households, an increase of 28%, and the need continues to grow. Every dollar donated stays in Macomb County and is used to feed hungry families, children, veterans, the elderly, and the disabled throughout the County.

Turning Point Shelter assists victims/survivors of domestic violence, sexual assault, and homeless ness. They provide a 24-hour crisis hotline, emergency shelter, Forensic Nurse Examiner Program, legal advocacy, prevention education, support groups and counseling services that help thousands of women and their children.

We will be sending holiday cards to all MCMS members with a list of this year’s Holiday Sharing Card donors inside. If you would like to have your name included as a donor, please complete the form below and return it along with your check to the MCMS office no later than December 5, 2024.

If you have any questions, please contact the MCMS office at HLeach@macombcms.org or call 810-712-2546.

Form and payment must be returned by December 5th

Name(s) to appear on holiday card

Address

Phone Email

The MCMS Foundation is a 501(c)(3) non-profit charitable organization sponsored by the Macomb County Medical Society. As the MCMS Foundation pays for all costs associated with this project, your donation is 100% tax deductible. The MCMS Foundation Tax ID # 38-3180176. $ Contribution to Food Program $ Contribution to Turning Point

Please make checks payable to: Macomb County Medical Society FDN Return form to: MCMS Foundation, PO Box 551, Lexington, MI 48450 -0551

We would like to welcome the following New Members!

Wassim M. Bazzi, MD

Urology – Board Certified

Medical School: Wayne State University School of Medicine, 2006. Post Graduate Education: University of California San Diego, completed in 2012; Memorial Sloan Kettering Cancer Center (NY), completed in 2014. Hospital Affiliations: Beaumont Dearborn, Beaumont Trenton. Currently practicing at MI Institute of Urology, 18100 Oakwood Blvd., Ste. 315, Dearborn, MI 48124, ph. 313-271-0066, fx. 313-271-1047, www.michiganurology.com.

Jeffrey D. Budzyn, MD

Urology – Board Certified

Medical School: Wayne State University School of Medicine, 2017. Post Graduate Education: Henry Ford Hospital, completed in 2022; University of Southern California Keck School of Medicine, completed in 2023. Hospital

Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Grosse Pointe, Henry Ford Macomb. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com.

Genevieve J. Crandall, MD

Family Medicine – Board Certified Medical School: MI State University College of Human Medicine, 1997. Post Graduate Education: Beaumont Troy, completed in 2000. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Robert L. Elgin, DO

Urology – Board Certified

Medical School: Philadelphia College of Osteopathic Medicine, 2012. Post Graduate Education: Botsford Hospital Farmington Hills, completed in 2013; Michigan State University College of Osteopathic Medicine –McLaren Regional Medical Center, completed in 2017. Hospital Affiliations: Ascension St. John, Beaumont Grosse Pointe, Henry Ford Macomb, McLaren Macomb. Currently practicing at MI Institute of Urology, 19991 Hall Rd., Ste. 201, Macomb, MI 48044, ph. 586-228-0150, fx. 586-228-0154, www.michiganurology.com

Melissa C. Fischer, MD

Urogynecology – Board Certified, Urology –Board Certified Medical School: Wayne State University School of Medicine, 1999. Post Graduate Education: Henry Ford Hospital, completed in 2005; New York University, completed in 2006. Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com.

Juan Rene Frontera, MD

Urology – Board Certified Medical School: University of Puerto Rico - Cayey School of Medicine, 1985. Post Graduate Education: Medical College of Pennsylvania, completed in 1988; Detroit Medical Center, completed in 1991. Hospital Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Grosse Pointe. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com

Marko R. Gudziak, MD

Urology – Board Certified Medical School: New York University School of Medicine, 1987. Post Graduate Education: Thomas Jefferson Hospital, (PA), completed in 1990; University of New Mexico Hospital, completed in 1993; University of Texas Health Science Center Houston, completed in 1994. Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy, Trinity Health. Currently practicing at MI Institute of Urology, 44200 Woodward Ave., Ste. 207, Pontiac, MI 4834, ph. 248-322-6103, fx. 248-322-6108, www.michiganurology.com

Tristan Guevara, DO

Family Medicine – Board Certified Medical School: MI State University College of Osteopathic Medicine, 1998. Post Graduate Education: St. John Riverview Hospital, completed in 1999; Ascension Providence Hospital, completed in 2002. Hospital Affiliations: Ascension St. John, Beaumont Grosse Pointe, Beaumont Troy, Henry Ford Macomb, McLaren Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Brian V. Guz, MD

Urology – Board Certified

Medical School: University of Michigan School of Medicine, 1985. Post Graduate Education: Cleveland Clinic (OH), completed in 1990; UCLA Kaiser Foundation Hospital (CA), completed in 1990. Hospital Affiliations: Ascension St. John, Beaumont Grosse Pointe, Henry Ford Macomb. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com

John J. Habicht, MD

Family Medicine – Board Certified Medical School: MI State University College of Human Medicine, 2002. Post Graduate Education: Genesys Regional Medical Center, completed in 2005. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Jason M. Hafron, MD

Urology – Board Certified

Medical School: Loyola University of Chicago Stritch School of Medicine, 2000. Post Graduate Education: Loyola University Medical Center (IL), completed in 2001; Albert Einstein College of Medicine - Montefiore Medical Center (NY), completed in 2006; Cleveland Clinic (OH), completed in 2007. Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com

Antwan L. Hall, MD

Family Medicine – Board Certified Medical School: St. Matthew's University School of Medicine (Cayman Islands), 2012. Post Graduate Education: Henry Ford Hospital, completed in 2015. Hospital Affiliations: Beaumont Troy, McLaren Macomb. Currently practicing at Silver Pine Medical Group, 31225 23 Mile Rd., Chesterfield, MI 48047, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Jennifer L. Hichme, MD

Family Medicine – Board Certified Medical School: Wayne State University School of Medicine, 1996. Post Graduate Education: Beaumont Troy Hospital, completed in 1999. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Michael S. Hoff, DO

Urology – Board Certified Medical School: University of Osteopathic Medicine and Health Sciences (IA), 1998. Post Graduate Education: Botsford Hospital Farmington Hills, completed in 1999; Bi-County Hospital, completed in 2004. Hospital Affiliations: Ascension Macomb-Oakland, Beaumont Farmington Hills, McLaren Macomb. Currently practicing at MI Institute of Urology, 19991 Hall Rd., Ste. 201, Macomb, MI 48044, ph. 586-228-0150, fx. 586-228-0154, www.michiganurology.com.

Mitchell B. Hollander, MD

Urology – Board Certified Medical School: University of Michigan School of Medicine, 1986. Post Graduate Education: Cleveland Clinic (OH), completed in 1991. Currently serving as CEO of the MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com

Cynthia A. Housel, DO

Internal Medicine – Board Certified Medical School: Des Moines University College of Osteopathic Medicine (IA), 1988. Post Graduate Education: Detroit Osteopathic Hospital, completed in 1992. Hospital Affiliations: Ascension Macomb-Oakland, Ascension Providence. Currently practicing at Silver Pine Medical Group, 57850 Van Dyke Ave., Ste. 100, Washington, MI 48094,

Kenneth M. Kernen, MD

Urology – Board Certified Medical School: Wayne State University School of Medicine, 1993. Post Graduate Education: Beaumont Royal Oak Hospital, completed in 1999; Baylor College of Medicine (TX), completed in 2000. Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy, Trinity Health Oakland. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com.

Steven G. Kotsonis, DO

Family Medicine – Board Certified

Medical School: Des Moines University College of Osteopathic Medicine (IA), 1995. Post Graduate Education: Mt. Clemens General Hospital, completed in 1996; Bon Secours Hospital, completed in 1998. Hospital Affiliations: Ascension Providence, Beaumont Troy, Henry Ford Macomb, McLaren Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

David W. Law, DO

Urology – Board Certified Medical School: Philadelphia College of Osteopathic Medicine (PA), 1976. Post Graduate Education: Kennedy Memorial Hospital-University Medical Center Stratford (NJ), completed in 1977; Detroit Osteopathic Hospital. Hospital Affiliations: Beaumont Dearborn, Beaumont Trenton. Currently practicing at MI Institute of Urology, 19117 Allen Rd., Ste. A, Brownstown Twp., MI 48183, ph. 734-676-4040, fx. 734-676-9897, www.michiganurology.com.

Zachary J. Liss, MD

Pediatric Urology – Board Certified, Urology –Board Certified

Medical School: Wayne State University School of Medicine, 2008. Post Graduate Education: Wayne State University, completed in 2013; Cincinnati Children's Hospital Medical Center (OH), completed in 2015. Hospital Affiliations: Ascension St. John, Beaumont Royal Oak, Beaumont Troy, DMC Children’s Hospital. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com.

Shiva J. Maralani, MD

Urology – Board Certified, Urogynecology –Board Certified

Medical School: Loyola University of Chicago Stritch School of Medicine (IL), 1992. Post Graduate Education: Wayne State University School of Medicine, completed in 1998. Hospital Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Royal Oak, Beaumont Troy, Henry Ford Macomb. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com

George T. Maristela, MD

Family Medicine – Board Certified

Medical School: Ross University School of Medicine (FL), 2003. Post Graduate Education: St. John Hospital, completed in 2008. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb, McLaren Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Gregory V. McIntosh, DO

Urology – Board Certified

Medical School: MI State University College of Osteopathic Medicine, 1992. Post Graduate Education: University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine - Kennedy Memorial Hospital, completed in 1998. Hospital Affiliations: Ascension Macomb-Oakland, Beaumont Farmington Hills, Henry Ford Macomb, McLaren Macomb. Currently practicing at MI Institute of Urology, 19991 Hall Rd., Ste. 201, Macomb, MI 48044, ph. 586-228-0150, fx. 586-228-0154, www.michiganurology.com.

Kristen M. Miller-Unger, MD

Pediatrics – Board Certified

Medical School: Wayne State University School of Medicine, 2001. Post Graduate Education: Children’s Hospital of MI, completed in 2005. Hospital Affiliations: Beaumont Troy. Currently practicing at Shelby Pediatric Associates, 36555 26 Mile Rd., Ste. 2100, Lenox, MI 48048, ph. 586-532-0599, fx. 586-566-8967, www.shelbypediatricassociates.com

Pradeep Nagaraju, MD

Urology – Board Certified, Urogynecology –Board Certified

Medical School: Loyola University of Chicago Stritch School of Medicine (IL), 1995. Post Graduate Education: Medical College of Wisconsin; Emory University Hospitals (GA). Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 11051 Hall Rd., Ste. 200, Utica, MI 48317, ph. 586-254-5759, fx. 586-254-5793, www.michiganurology.com

Ryan J. Nelson, DO

Urology – Board Certified Medical School: Touro University College of Osteopathic Medicine (CA), 2009. Post Graduate Education: St. John Macomb-Oakland Hospital, completed in 2011; McLaren Macomb Hospital, completed in 2015; Cleveland Clinic, completed in 2017. Hospital Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Royal Oak, Beaumont Troy, Henry Ford Macomb, McLaren Macomb. Currently practicing at MI Institute of Urology, 11051 Hall Rd., Ste. 200, Utica, MI 48317, ph. 586-254-5759, fx. 586-254-5793, www.michiganurology.com.

Gideon O. Nyakundi, MD

Pediatrics – First Year Practice

Medical School: American University of the Caribbean School of Medicine, 2021. Post Graduate Education: Children’s Hospital of MI, completed in 2024. Hospital Affiliations: Beaumont Troy. Currently practicing at Shelby Pediatric Associates, 15125 22 Mile Rd., Shelby Township, MI 48315, ph. 586-532-0599, fx. 586-566-8967, www.shelbypediatricassociates.com

Gregory Mark Oldford, MD

Urology – Board Certified Medical School: Wayne State University School of Medicine, 1987. Post Graduate Education: Detroit Medical Center, completed in 1992. Hospital Affiliations: DMC Huron Valley-Sinai, Trinity Health. Currently practicing at MI Institute of Urology, 2300 Haggerty Rd., Ste. 2000, West Bloomfield, MI 48323, ph. 248-896-5450, www.michiganurology.com

Nicole T. Omell, MD

Family Medicine – Board Certified Medical School: Wayne State University School of Medicine, 2018. Post Graduate Education: Beaumont Troy Hospital, completed in 2021. Hospital Affiliations: Beaumont Troy. Currently practicing at Silver Pine Medical Group, 31225 23 Mile Rd., Chesterfield, MI 48047, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Parag P. Patel, MD

Family Medicine – Board Certified Medical School: Wayne State University School of Medicine, 2002. Post Graduate Education: Beaumont Troy Hospital, completed in 2005. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb, McLaren Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Prameela N. Patel, MD

Family Medicine – Board Certified Medical School: American University of the Caribbean School of Medicine, 2001. Post Graduate Education: Ascension Providence Hospital, completed in 2004. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 57850 Van Dyke Ave., Ste. 100, Washington, MI 48094, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Michael J. Raad, DO

Internal Medicine – Board Certified Medical School: Des Moines University College of Osteopathic Medicine (IA), 1984. Post Graduate Education: Bi-County Community Hospital, completed in 1988. Hospital Affiliations: Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Ashok Y. Reddy, MD

Urology – Board Certified

Medical School: Wayne State University School of Medicine, 1994. Post Graduate Education: Detroit Medical Center, completed in 2001. Hospital Affiliations: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 19991 Hall Rd., Ste. 201, Macomb, MI 48044, ph. 586-228-0150, fx. 586-228-0154, www.michiganurology.com

James D. Relle, MD

Urology – Board Certified Medical School: Queens University School of Medicine (Canada), 1988. Post Graduate Education: University of Toronto, completed in 1994. Hospital Affiliation: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com

Katie M. Rosen, DO

Urology – Board Certified

Medical School: MI State University College of Osteopathic Medicine, 2013. Post Graduate Education: McLaren Macomb, completed in 2018. Hospital Affiliations: Ascension Macomb-Oakland, Beaumont Farmington Hills, McLaren Macomb, Trinity Health. Currently practicing at MI Institute of Urology, 19991 Hall Rd., Ste. 201, Macomb, MI 48044, ph. 586-228-0150, fx. 586-228-0154, www.michiganurology.com.

Janel M. Salem, MD

Family Medicine – Board Certified Medical School: Trinity School of Medicine (Caribbean), 2018. Post Graduate Education: Corewell Health Butterworth Hospital, completed in 2021. Hospital Affiliations: Beaumont Troy. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Jason M. Sandberg, MD

Urology – Board Certified Medical School: Northwestern University’s Feinberg School of Medicine (IL), 2013. Post Graduate Education: Wake Forest Baptist Medical Center (NC), completed in 2019; University of Iowa Hospitals, completed in 2020. Hospital Affiliation: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com.

Brian D. Seifman, MD

Urology – Board Certified Medical School: Wayne State University School of Medicine, 1996. Post Graduate Education: University of MI Health System, completed in 2003. Hospital Affiliation: Beaumont Royal Oak, Beaumont Troy. Currently practicing at MI Institute of Urology, 1701 E. South Blvd., Ste. 340, Rochester Hills, MI 48307, ph. 248-293-1000, fx. 248-293-1001, www.michiganurology.com.

Scott I. Sircus, MD

Urology – Board Certified

Medical School: University of Miami Miller School of Medicine (FL),1983. Post Graduate Education: St. Elizabeth's Medical Center (MA), completed in 1985; Tufts New England Medical Center (MA), completed in 1989. Hospital Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Royal Oak, Henry Ford Macomb, McLaren Macomb. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com.

Jennifer L. Sobol, DO

Urology – Board Certified Medical School: Philadelphia College of Osteopathic Medicine (PA), 1999. Post Graduate Education: Botsford Hospital Farmington Hills, completed in 2000; Albert Einstein Medical Center (PA), completed in 2005; University of MI Health System, completed in 2006. Hospital Affiliation: Beaumont Royal Oak, Beaumont Troy, DMC Huron Valley-Sinai, Trinity Health. Currently practicing at MI Institute of Urology, 130 Town Center Dr., Ste. 101, Troy, MI 48084, ph. 248-740-0670, fx. 248-740-0688, www.michiganurology.com.

Philip A. Tangalos, DO

Family Medicine – Board Certified Medical School: MI State University College of Osteopathic Medicine, 2018. Post Graduate Education: Detroit Medical Center Hospitals, completed in 2022. Hospital Affiliations: Ascension Providence, Beaumont Farmington Hills. Currently practicing at Silver Pine Medical Group, 57850 Van Dyke Ave., Ste. 100, Washington, MI 48094, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Theodore L. Tangalos, MD

Family Medicine – Board Certified Medical School: Wayne State University School of Medicine, 1994. Post Graduate Education: Oakwood Hospital Dearborn, completed in 1995; Henry Ford Hospital, completed in 1996; Beaumont Troy Hospital, completed in 1998. Hospital Affiliations: Ascension Providence, Beaumont Troy, Henry Ford Macomb. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com.

Alexander D. Tapper, MD

Urology – Board Certified Medical School: Wayne State University School of Medicine, 2015. Post Graduate Education: Beaumont Royal Oak, completed in 2020. Hospital Affiliations: Ascension Providence, Beaumont Royal Oak, Beaumont Troy, Trinity Health. Currently practicing at MI Institute of Urology, 44200 Woodward Ave., Ste. 207, Pontiac, MI 4834, ph. 248-322-6103, fx. 248-322-6108, www.michiganurology.com.

Adrianna M. Thibault, MD

Family Medicine

Medical School: University of Medicine and Health Sciences (St. Kitts), 2019. Post Graduate Education: Munson Hospital (Traverse City), completed in 2023. Hospital Affiliations: Munson Hospital. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Steven J. Thibault, MD

Family Medicine – Board Certified Medical School: American University of the Caribbean School of Medicine, 1985. Post Graduate Education: Detroit Medical Center/Children's Hospital, completed in 1991; Bon Secours Hospital, completed in 1994. Hospital Affiliations: Henry Ford Macomb, Beaumont Grosse Pointe, Beaumont Troy. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Jack A. Trebelhorn, MD

Urology – Board Certified Medical School: Medical College of Wisconsin, 2016. Post Graduate Education: Detroit Medical Center, completed in 2021. Hospital Affiliations: Ascension St. John, Beaumont Grosse Pointe. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com.

Naysha M. Varghese, MD

Family Medicine – Board Certified Medical School: American University of the Caribbean School of Medicine, 1998. Post Graduate Education: North Oakland Medical Centers/Pontiac General, completed in 2002. Hospital Affiliations: Beaumont Troy. Currently practicing at Silver Pine Medical Group, 43455 Schoenherr Rd., Ste. 2, Sterling Heights, MI 48313, p. 586-726-4823, f. 586-276-8365, www.silverpinedocs.com

Scott M. Wilkinson, DO

Urology – Board Certified Medical School: MI State University College of Osteopathic Medicine, 2004. Post Graduate Education: Henry Ford Macomb Hospital, completed in 2006; Ascension Macomb-Oakland Hospital, completed in 2010. Hospital Affiliations: Ascension Macomb-Oakland, Ascension St. John, Beaumont Grosse Pointe, McLaren Macomb. Currently practicing at MI Institute of Urology, 20952 12 Mile Rd., Ste. 200, St. Clair Shores, MI 48081, ph. 586-771-4820, fx. 586-771-6620, www.michiganurology.com

November 4 ~ MSMS History of Medicine – A History of Forensic Medicine in America

FREE Live Virtual presentation by Dr. Jeffrey Jentzen, 7 – 8 pm via Zoom. Dr. Jentzen is the Director of Autopsy at the University of Michigan Department of Pathology. Registration is required. Click here to register and receive the Zoom link.

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 Pain Management, 1-hr. Controlled Substances, 3-hrs DEA MATE Act, 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 9 ~ MSMS 28th Annual Conference on Bioethics

Hybrid (In-Person and Virtual) Meeting, 8:30 am – 3:30 pm, Double Tree by Hilton in Ann Arbor. 5.75 AMA/PRA Category 1 CME Credits. Cost: $50 members, $100 non-members, free for student/resident members.

November 13 ~ Common Anorectal Conditions: It’s Not Always Hemorrhoids

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

Alec E. Wilson, MD

Urology – Board Certified Medical School: Wayne State University School of Medicine, 2015. Post Graduate Education: Beaumont Royal Oak, completed in 2020. Hospital Affiliations: Ascension Providence, Beaumont Royal Oak, Beaumont Troy, DMC Huron Valley-Sinai, Trinity Health. Currently practicing at MI Institute of Urology, 44200 Woodward Ave., Ste. 207, Pontiac, MI 4834, ph. 248-322-6103, fx. 248-322-6108, www.michiganurology.com

Maria K. Yaldo, MD

Dermatology – Board Certified Medical School: Wayne State University School of Medicine, 2015. Post Graduate Education: Oakwood Hospital, completed in 2016; Cook County Hospital (Chicago), completed in 2019. Currently practicing at Dermatology Specialists of Shelby Township, 50505 Schoenherr Rd., Ste. 325, Shelby Township, MI 48315, ph. 586-580-1001, www.dermatologyspecialistsofshelby.com.

MEDICAL RECORDS OF RETIRED PHYSICIANS

Patients looking for their medical records from retired physicians frequently contact the MCMS. 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 so we can note our database accordingly. Thank you!

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.

November 22 ~ A Day of Board of Medicine Renewal Requirements

MSMS In-Person Meeting, 8:30 am – 4:45 pm, Holiday & Suites in Troy. Conference fulfills: 3-hrs Pain Management, 1-hr. Controlled Substances, 3-hrs DEA MATE Act, 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.

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 3-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.

December 11 ~ Best Practices for Working with Interpreters MSMS Practice Management Series, FREE Live Webinar, 1 pm – 2 pm, 1 AMA/PRA Category 1 CME Credit.

Keeping Work and Life Balanced

By: Brooke Buckley, MD, MBA, FACS, Chief Medical Officer at Henry Ford Wyandotte Hospital & Chair of the AMPAC Board of Directors

Wellness is a 4 trillion-dollar global industry. In America, we work more than 10 hours longer per week than Europeans This may be why worklife balance is high in our collective conscious. The AMA reports that 57% of physicians are working more than 71 hours each week. Increased demands of work and less balance between work and ‘life’ tie directly to the burnout epidemic (Berg, 2019).

As physicians and care providers, we expect work to be a significant part of our life. Simultaneously, we want to have time with people we care about and hobbies and rest. Increasingly, we find ourselves in conflict between work and life; so-called worklife balance. When balance is lost in a car engine, the check engine light comes on. Thoughtful owners go to the shop and make repairs (i.e. restore balance). When balance is lost in a person, burnout happens.

Burnout has been extensively researched. It is disruptive, unhealthy, and rampant. Shanafelt and his colleagues have outlined everything from behavioral irregularities, addiction, reduction in commitment to work, and turnover as elements related to burnout. In other words, it’s hard to cure burnout with an ongoing mismatch of work and our expectations of life (Shanafelt, 2017).

As it relates to balance, most can relate to the discomfort felt when there is mismatch between expectations and realities. Cognitive dissonance is the name for this mismatch. For example, if you stub your toe and it hurts, your brain wants your toe to not hurt, so you feel strong motivation to soothe your foot to go back to the expected state of ‘no pain’. In fact, we are hard-wired to try to close that gap. We have to actively try not to soothe ourselves when we are in a state of mismatch.

Work-life balance has been characterized as a goal. Popular media describes balance as some euphoric place we are all trying to reach. If it is so wonderful, why are so many of us struggling to get there? I would suggest that this balance we seek is so elusive because it is really a daily practice and not a goal at all. In reality, finding work-life balance is mastering the practice of closing related cognitive dissonance gaps.

To go back to the car reference, balance can be static or dynamic. Static balance is a steady state where gravity is the only acting force, much like matched weights on a scale.

LOOKING TO LESSON THE BURDEN OF MISMATCHED EXPECTATIONS CAN BECOME A DAILY PRACTICE TO REALIGN WORK AND LIFE.

The Mechanical Power Transmission Association (MPTA) states “A rotating body is said to be in static balance when it’s center of gravity coincides with the axis upon which it revolves.” (Sullivan, 2010) Dynamic balance, is harder to understand and is most felt when it is out of balance. The MPTA definition essentially describes opposing forces vibrating against each other in opposite directions causing a lack of balance. It can be much easier to identify than it is to restore.

I don’t have the answers, but I would offer that paying attention to the forces that pull against you and looking to close the gaps is a great place to start. Looking to lessen the burden of mismatched expectations can become a daily practice to realign work and life. Remove a calendar appointment, prioritize a family event, limit your patient schedule, limit expenses, make an appointment with yourself (for walking, reading, thinking, having dinner with a friend), prioritize yourself and your balance. Without balance, our engine can only drive so far. Taking a moment to rebalance will keep you on the “road” for many years to come. F

Works Cited

Sara Berg, MS (2019, March 22), AMA. Retrieved from “As Work Hours Rise so does Physician Burnout”

Taia D. Shanafelt, MD (2017, Jan), Mayo Clinic Proceedings. Retrieved from “Executive Leadership and Physician Well-being”

Don R. Sullivan (2010, April 19), the News. Retrieved from “Explaining Static vs. Dynamic Sheave Balancing”

Henry Ford Macomb Hospital

‘AN INCREDIBLE PRIVILEGE’: HENRY FORD HEALTH & ASCENSION MICHIGAN LAUNCH NEW ORGANIZATION

On October 1st, Henry Ford Health and Ascension Michigan officially launched their newly combined organization, solidifying their shared commitment to Detroiters, Michiganders and everyone seeking the very best in compassionate, results-focused healthcare. The joint venture will dramatically impact the health and wellness of the communities it serves –improving outcomes, access to care and experience; prioritizing population health and value-based care; advancing innovation, academic medicine, and complex care; fostering economic mobility and unparalleled career opportunities; and championing equity for all.

Under the leadership of President and CEO Bob Riney, Henry Ford Health now employs approximately 50,000 team members at more than 550 sites across Michigan – with 13 acute care hospitals; three behavioral health facilities including two world-class addiction treatment centers; a state-of-the-art orthopedics and sports medicine facility; multiple cancer care destinations including the Brigitte Harris Cancer Pavilion, Henry Ford Health’s premier location in Detroit; and more options than ever for primary care for patients and families across the region.

The acute care hospitals that are now part of Henry Ford Health are: Ascension Genesys Hospital; Ascension MacombOakland Hospital, Warren and Madison Heights Campuses; Ascension Providence Hospital, Novi and Southfield Campuses; Ascension Providence Rochester Hospital; Ascension River District Hospital; and Ascension St. John Hospital. These hospitals’ related sites of care, as well as Ascension Brighton Center for Recovery, are also included. Sites will be renamed and rebranded to Henry Ford Health, with patients and team members seeing the brand on temporary interior and exterior signage as early as Oct. 1, and on permanent signage over the next few years.

Henry Ford Health plans to invest in and fully integrate its now-expanded healthcare delivery network, creating greater opportunities to coordinate, grow, and adapt services and care settings to meet consumer needs – expanding access to care, lowering costs, and improving health outcomes, as well as delivering exceptional performance in quality, safety, and customer service. Among the most significant investments Henry Ford Health will make is to upgrade the electronic medical record platform at the Ascension Michigan facilities included in the joint venture, which is expected to benefit patients and care providers alike.

As Henry Ford Health works diligently to integrate its technology – from electronic heath records to its consumer facing website, henryford.com – the health system will provide ongoing resources to help patients and families navigate changes to features including ‘Find A Doctor,’ online scheduling, and questions about pricing and billing, and how to take advantage of Henry Ford MyChart.

Consistent with the commitment to maintaining the Catholic identity of the former Ascension Michigan hospitals and healthcare facilities included in the joint venture, sites that are currently Catholic will continue to provide faith-based care, and the Providence, St. John and Genesys hospital names will be maintained, in conjunction with Henry Ford Health. All existing Henry Ford Health facilities will continue to operate as they have – offering the same services patients have come to expect.

By coming together, the combined organization will provide expanded career pathways and increased opportunities for career development and advancement across more sites, and in more areas, as well as amplifying Henry Ford Health’s capabilities to attract, train, and grow top talent.

Already among Michigan’s top funded academic institutions, Henry Ford Health is also poised to expand its academic enterprise – focused on complex care and research with immediate clinical applications, particularly in cancer care; growing population health learnings and capabilities; and expanding health equity and health disparities research in multiple areas including maternal and fetal health.

ARTIFICIAL INTELLIGENCE ENHANCES RADIOTHERAPY FOR HENRY FORD HEALTH PATIENTS WITH CANCER: PATIENTS AT HENRY FORD MACOMB HOSPITAL HAVE ACCESS TO NEW TREATMENT SYSTEM

Patients undergoing radiation therapy for certain types of cancer at Henry Ford Macomb Hospital have access to a cutting-edge treatment system that increases accuracy and precision, enhances patient comfort, and minimizes side effects.

In September, Henry Ford Macomb Hospital began offering treatment with the Varian Ethos™ system equipped with

HyperSight, which leverages artificial intelligence and the fastest on-table imaging in the field to enhance precision and increase the likelihood of effectively treating tumors.

"This is not just a step, but a giant leap forward in cancer treatment,” said Ben Movsas, MD, Chair of the Department of Radiation Oncology and Medical Director at Henry Ford Cancer. “Utilizing this new system, treatments can be adjusted and tailored in real-time based on an individual patient’s needs and anatomy, as well as the specific changes observed during their therapy.”

In traditional radiotherapy, a plan is established at the beginning of treatment and followed through the treatment course. Adaptive radiotherapy allows for real-time modifications to the plan based on periodic assessments while the patient is on the table.

Human anatomy changes quickly through normal bodily processes such as a bladder filling or intestines moving during digestion. In the context of radiation therapy, even slight shifts or alterations in the body during the course of treatment can significantly impact effectiveness.

“This advancement will allow us to deliver personalized treatments, enabling our radiation oncologists to make necessary treatment decisions even more quickly and accurately,” said Ibrahim Aref, MD, Medical Director of Cancer at Henry Ford Macomb Hospital. “This will offer clinically meaningful benefits for many of our patients who require radiotherapy for a wide range of cancers, including prostate, lung, breast and others.”

Leveraging the power of artificial intelligence to capture and analyze rapid images in real time, the Varian Ethos system with HyperSight quickly detects changes in the patient’s anatomy

Pictured are: Jadranka Dragovic, MD, Ibrahim Aref, MD and David Bergman, MD from Henry Ford Macomb Hospital’s Radiation Oncology department.

and tumor size, shape or position. Using real-time imaging data, the system automatically adjusts the treatment plan to account for these changes, which is key to achieving better patient outcomes.

The Ethos system with HyperSight also utilizes artificial intelligence when determining the distribution of the radiation dose, which ensures the tumor receives the optimal amount of radiation, as well as streamlining workflow, which makes the entire process of adaptive radiotherapy more efficient.

The new HyperSight technology enables real-time imaging on the radiation table to be completed in seconds, rather than minutes, a game changing advantage for both targeting accuracy and patient comfort.

The addition of this revolutionary treatment option builds upon the first Halcyon-Ethos radiation unit in Michigan, which arrived at Henry Ford Jackson Hospital in 2020. Henry Ford West Bloomfield Hospital also adopted the technology in 2023. Henry Ford continues to solidify its position at the forefront of cancer care in Michigan and beyond, underscoring its commitment to improving patient outcomes and quality of life.

The Henry Ford Health Radiation Oncology department is a national leader in cutting edge and adaptive radiation therapy. F

UPDATED COVID-19 VACCINE AVAILABLE AND RECOMMENDED FOR MICHIGAN RESIDENTS SIX MONTHS AND OLDER

Seasonal Vaccinations for COVID-19, Influenza and RSV Urged Ahead of Upcoming Respiratory Season

The Michigan Department of Health and Human Services (MDHHS) is recommending residents get flu, COVID-19 and RSV vaccines to protect themselves and their communities against respiratory viruses during this upcoming fall and winter season.

This recommendation follows the recent Food and Drug Administration (FDA) authorization and U.S. Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation for the 2024-2025 COVID-19 vaccines. The updated vaccines are expected to provide protection against severe COVID-19 disease from currently circulating variants. The COVID-19 vaccine can be given with other vaccines, including flu and RSV vaccines.

Respiratory infections are projected to cause millions of illnesses and thousands of hospitalizations and deaths throughout the United States and Michigan this year. During the past two flu seasons,16 Michigan children died from influenza – the most recorded in any two-year span over the last 20 years.

“Our best protection against severe illness from these infections are annual vaccinations for flu and COVID-19 and a single dose of RSV for older adults or pregnant individuals,” said Dr. Natasha Bagdasarian, chief medical executive.

According to data from the Michigan Care Improvement Registry, seasonal flu vaccine coverage in Michiganders has decreased each year since the 2020-21 flu season. Coverage for the 2023-24 season was 26% overall, down from 34% in 2020-21. This combined with low COVID-19 vaccine coverage in Michiganders for the 2023-24 season (12.5%) is cause for concern. Getting vaccinated against these viruses helps contain the spread of respiratory viruses in communities and reduces severe illness and hospitalizations.

Learn more about 2024-2025 Influenza Vaccine Updates for health professionals

MICHIGAN’S

OLDER RESIDENTS HAVE TAKEN 1.5 MILLION GETSETUP CLASSES

The Michigan Department of Health and Human Services (MDHHS) is observing four years of partnership with GetSetUp, an online learning platform tailored for older adults to support active aging and independence. This collab -

oration aims to enhance mental, physical and social well-being in older Michigan residents to combat social isolation and provide opportunities for lifelong learning.

Through this partnership, Michigan residents aged 60 and older have free access to a catalog of more than 5,000 classes across 40 different categories. Over 1.5 million classes have been attended by Michiganders since the partnership began in 2020.

“We are proud to partner with GetSetUp to offer a wide array of classes that enrich the lives of older Michigan residents,” said Elizabeth Hertel, MDHHS director. “This initiative is part of our ongoing commitment to support the health and wellbeing of our senior community and create opportunities for our residents to connect and engage.”

GetSetUp offers a number of benefits, including:

• Digital Literacy: Classes on digital skills needed to thrive in today’s tech-driven world to meet older adults where they are.

• Health Equity: Virtual education options on aging benefits, demonstrating how to use websites and apps, and offering health and wellness classes.

• Mental Health: Classes on mindfulness, meditation and cognitive exercises help enhance mental clarity and reduce stress.

• Physical Health: Fitness sessions promote physical well-being with low-impact exercises and modified exercises like chair yoga and yoga for arthritis.

• Social Health: Interactive and live classes create opportunities for social engagement, reducing feelings of loneliness and isolation.

• Equity and Accessibility: Combat social isolation and provide equitable access to services. GetSetUp ensures that older adults in Michigan's rural and socio-economically diverse areas can benefit from these resources.

Many of these classes are also available embedded on websites such as area agencies on aging (AAAs) and libraries through GetSetUp Anywhere.

“Michigan was our first statewide partner, and we are incredibly proud to positively impact Michiganders as we move into our fourth year of a thriving partnership that benefits hundreds of thousands of older adults,” said Lawrence Kosick, GetSetUp president and co-founder. “The success and engagement we’ve seen in Michigan exemplify the power of lifelong learning and community connection. Our partnership highlights the practical impact that MDHHS has on its older residents daily to show a shift and change to offer this growing aging demographic empowering opportunities.”

continued on page 19

MDHHS PARTNERING WITH BEHAVIORAL HEALTH AGENCIES TO EXPAND ACCESS THROUGH ADULT CRISIS STABILIZATION UNITS

As part of an effort to increase access to behavioral health services, the MDHHS is partnering with 10 agencies across the state to create Adult Crisis Stabilization Units (CSUs). A $32 million investment to establish CSUs was included in the FY2023 budget.

Adult CSUs provide immediate crisis support to anyone in a behavioral health crisis with services ranging from a couple hours to up to 72 hours. Programs will be focused on stabilizing individuals 18 and older with CSU staff providing support until the individual is actively engaged in their next level of care. These units will also be equipped to manage and treat minor medical conditions so that individuals in a behavioral health crisis aren’t sent to the emergency room for basic medical care.

Two agencies began providing CSU services to their communities earlier this year. Network180’s Behavioral Health Crisis Center in Grand Rapids began operations in May, while Detroit Wayne Integrated Health Network Crisis Care Center (DWIHN) opened its doors in June. Network180 is collaborating with Trinity Health Grand Rapids to ensure the needs of the community are met at its CSU. As of Aug. 31, Network 180 has provided 581 interventions for individuals in crisis and admitted 268 adults to its crisis center, while DWIHN has provided 486 interventions and admitted 368 adults to its crisis unit.

“These units provide increased access to immediate crisis services to anyone struggling with mental health or substance

use, which will reduce emergency room boarding, improve jail diversion and allow for better utilization of inpatient psychiatric hospital beds,” said Elizabeth Hertel, MDHHS director. “While these programs are not intended to replace ongoing treatment, they will offer fast and easy access to individuals when they need it most.”

According to a KFF report, 665,980 Michiganders report having unmet mental health needs. Additionally, one in five adults in the state have a mental health condition and one in 18 adults are diagnosed with a serious mental illness.

MDHHS is partnering with eight additional agencies across the state to develop CSUs including:

• Arab Community Center for Economic and Social Services

• Community Mental Health Authority of Clinton, Eaton and Ingham Counties

• Common Ground

• Genesee Health System

• Hegira Health

• Macomb County Community Mental Health

• Pine Rest Christian Mental Health Services (in partnership with Integrated Services of Kalamazoo)

• Team Wellness Center

Several of these agencies are developing multiple CSUs in multiple counties to ensure adequate access across their communities. Adult CSUs are being developed throughout nine counties including Clinton, Eaton, Genesee, Ingham, Kalamazoo, Kent, Macomb, Oakland and Wayne, which are home to 5.7 million individuals. Once all sites are up and running, they will provide in-county access to behavioral health crisis for 57% of Michigan’s population. F

We appreciate your continued membership and want to remind you that members who pay their dues by November 30th will receive a free CME coupon worth $100. This coupon can be used for MSMS programs including “A Day of Board of Medicine Renewal Requirements”.

Why Membership Matters

Whether you’re a solo practitioner, member of a group practice, or employed by a health care system, the Macomb County Medical Society is focused exclusively on advocating for our local physician members, across a wide-range of specialties. From federal legislative and regulatory issues, to state and local ordinances, to payor relations and public health concerns, external forces are continuously impacting your practice and your patients. We recognize there is strength in numbers and we provide a unified voice for physicians.

There are three easy ways to renew:

1. Online at www.msms.org/renew

2. Call your MSMS Account Specialist, Christina Spitzley, at 517-336-5762

3. Print the invoice from your account record and fax it to 517-336-5716

Make a Strong Flu Vaccine Recommendation

CDC recommends everyone six months and older get an influenza vaccine every year. Influenza vaccine has been shown to prevent millions of influenza illnesses, tens of thousands of hospitalizations, and thousands of deaths each year.

How to Make a Strong Flu Vaccine Recommendation

Based on years of research into vaccine motivators, CDC has developed a mnemonic device to help HCPs make a strong vaccine recommendation. This method known as “SHARE” can help you to m ake a strong vaccine recommendation and provide important information to help patients make informed decisions about vaccinations.

S- SHARE why an influenza vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.

“This vaccine can protect you and your family from getting sick from flu. By getting the vaccine today, you’ll be protecting yourself and the people around you, like your children and parents, who may be more vulnerable to serious flu illness.”

H- HIGHLIGHT positive experiences with influenza vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in influenza vaccination.

“In addition to recommending a yearly flu vaccine to my patients, I get one each year to protect myself and my family from flu.”

A- ADDRESS patient questions and any concerns about influenza vaccines, including for example, side effects, safety, and vaccine effectiveness, in plain and understandable language. Acknowledge that while people who get an influenza vaccine may still get sick, there are studies to show that their illness may be less severe.

“A flu vaccine cannot cause flu infection. The most common side effects of an influenza vaccine are mild, like redness, swelling, soreness, or a low -grade fever for a flu shot. This should go away within a few days.”

“Flu vaccines protect against flu illness but aren’t 100% effective, so even if you get vaccinated you might still become sick with flu. It’s important to get your flu vaccine because studies show that even if you do get sick, vaccination may make your flu illness less severe.”

R- REMIND patients that influenza vaccines help protect them and their l oves ones from serious influenza illness and complications that can result in hospitalization or even death for some people.

“Flu activity is going to start to pick up, and CDC says to expect more cases in the coming months. That is why I want to make sure I help protect you and your loved ones against flu and its potentially serious complications.”

E- EXPLAIN the potential costs of getting influenza, including potential serious health effects for the patient, time lost (such as missing work or family obligations), financial costs, and potentially spreading flu to more vulnerable family and friends.

“It’s important to get vaccinated this season because flu vaccination can reduce potential flu illnesses, doctor visits, and missed work and school due to flu, and can protect those around you who are more vulnerable to potentially serious flu complications.”

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

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

Gravity of Licensing Disciplinary Actions

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 MI - Legal Insights in a Scrutinized Landscape

Surviving Litigation

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

Trauma Informed Leadership

What Does "Value" Mean for Health Equity?

Practice Management Webinar Series:

Ask the Experts – Legal Panel

Basics of Diagnosis Coding - Do You Really Know It?

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

Telehealth Update

TORT TUTORIAL – WHAT PHYSICIANS NEED TO KNOW

Michigan's tort reforms and professional liability laws, which have played a crucial role in maintaining a stable practice environment for physicians across the state. With looming threats of legislative changes, it's vital for today’s physicians—many of whom were not practicing during the last reforms—to understand the potential destabilizing impact on patient care and the workforce. As Michigan faces an existing physician shortage, these discussions will serve as both an education and a call to action to defend the laws that protect the future of healthcare in the state.

Part One: Michigan's Practice Environment Before Tort Reform

Before Michigan enacted comprehensive tort reform legislation in the 1980s and 1990s, physicians faced an overwhelming number of medical malpractice lawsuits and escalating malpractice premiums, contributing to a growing medical liability crisis. Patients could easily file medical malpractice claims, forcing physicians to practice "defensive medicine"—ordering unnecessary tests and treatments to protect themselves from potential liability and excessive jury awards. This environment not only altered the way physicians practiced but also contributed to rising healthcare costs.

The pre-reform legal landscape in Michigan had far-reaching consequences, including a significant physician shortage, as many left the state due to the burdensome liability risks and soaring malpractice insurance premiums. Defensive medicine further inflated healthcare costs, adding an estimated 10 to 20 percent to expenses nationwide. Tort reform was a critical intervention to stabilize Michigan's healthcare system, curb unnecessary costs, and retain physicians.

Part Two: The Legislative History of Tort Reform in Michigan

Michigan has implemented four significant waves of tort reform legislation, beginning in 1986. These initial reforms addressed legal venue modifications, set stricter criteria for medical expert witnesses, and tackled issues related to joint and several liability.

In 1993, further reforms targeted medical malpractice cases filed after April 1, 1994. These included limits on non-economic damages, reduced statutes of limitations for minors, stricter affidavit of merit requirements, expert witness standards, and a mandatory 182-day notice period before filing a lawsuit.

A comprehensive overhaul in 1995 abolished joint and several liability, imposed caps on non-economic damages, adjusted venue rules, and tightened standards for expert testimony. The most recent reform occurred in 2013, when two MSMSbacked bills clarified that loss of society or companionship falls

continued on page 22

under non-economic damages, subject to Michigan’s existing damage caps.

Part Three: The Current Standards

Michigan's medical liability laws underwent significant reforms in the 1990s, introducing lasting changes in three key areas: joint and several liability, non-economic damage caps, and expert witness requirements.

Joint and Several Liability

Prior to the reforms, Michigan law followed the principle of "joint and several liability," meaning an injured party could sue any one of the responsible parties for the full amount of damages, regardless of the individual defendant’s level of fault. This placed a heavy burden on one defendant, even if they were minimally at fault.

In 1995, Michigan introduced "fair share liability," which eliminated joint and several liability for most personal injury, property damage, and wrongful death cases. Now, each defendant is responsible for paying damages proportional to their level of fault. However, joint and several liability still applies in medical malpractice cases and for other cases involving gross negligence or crimes involving alcohol or controlled substances where the defendant was convicted.

Non-Economic Damage Caps

Caps on non-economic damages, which compensate for pain and suffering or emotional distress, were introduced for medical malpractice and product liability cases.

For medical malpractice, a 1993 reform set a cap of $280,000 for non-economic damages. This cap increases to $500,000 if the plaintiff suffers severe injuries, such as hemiplegia, paraplegia, or quadriplegia. These caps are adjusted annually based on inflation. As of 2024, the higher cap had risen to $1,016,000, and the lower cap to $569,000.

Expert Witness Requirements

Prior to reform, expert witnesses could testify in medical malpractice cases as long as the court found them competent, based on their ability to help the jury understand the facts.

The 1993 reform imposed stricter requirements for expert witnesses in medical malpractice cases. Experts must specialize in the same field as the defendant and have been practicing or teaching in that specialty for at least a year before the alleged malpractice occurred. The 1995 reforms added further rules, requiring courts to evaluate the reliability of expert testimony using seven criteria, including whether the expert’s opinion had been tested, published, and accepted by peers in the relevant field, among other factors.

These reforms aimed to ensure fairer allocation of liability, limit excessive damage awards, and improve the quality and credibility of expert testimony in medical malpractice cases.

Part Four: Court Cases

Michigan Supreme Court Rulings Offer Relief and Raise Concerns for Physicians

Although legislative action over the past forty years has shaped Michigan’s current liability environment, one cannot ignore the influence of Michigan’s judicial branch in determining how the laws are applied. Recent decisions by the Michigan Supreme Court highlight their impact.

Clarifying Future Earnings Awards

Michigan physicians and healthcare providers recently secured a major legal victory thanks to a unanimous Michigan Supreme Court ruling on July 30, 2024, that directly impacts the state's medical liability landscape. The ruling, which prohibits the inclusion of lost future earnings in damages awarded under Michigan’s Wrongful Death Act, is expected to help curb rising medical liability costs, which have been a growing concern for physicians and healthcare systems alike.

In Daher v. Prime Healthcare Services-Garden City, LLC, the Court struck down the precedent set by a 2016 Michigan Court of Appeals decision, Denney v. Kent County Road Commission

The Denney ruling had expanded recoverable damages in wrongful death cases to include speculative calculations of a decedent’s lost future earnings, a move that had significantly increased liability awards in malpractice suits. These so-called "Denney Damages" were no longer subject to the loss of “financial support” standard, adding millions to settlements and driving up healthcare costs.

The unanimous ruling in Daher clarifies that Michigan's current statute does not allow for ”loss of earning capacity” damages, only “loss of financial support.” Physicians and healthcare providers, including those represented by the Michigan Health & Hospital Association (MHA), the Michigan State Medical Society, the Michigan Osteopathic Association, and the American Medical Association, welcomed the decision as a long-overdue correction.

Changes in Expert Witness Requirements

Another recent Michigan Supreme Court decision affects the expert testimony requirements in medical malpractice cases, which could have broader implications for future litigation.

In a 4-3 ruling, the Court overturned part of the 2006 Woodard v. Custer decision, allowing for greater flexibility in who can testify as an expert witness in medical malpractice cases.

The ruling distinguishes between "specialties" and "subspecialties" when it comes to expert qualifications. Under the new decision, expert witnesses are only required to have the same medical specialty as the defendant, not the same subspecialty. For example, in Stokes v. Swofford, a diagnostic radiologist is now permitted to testify about a brain shunt procedure, despite not being a subspecialist in that area. Similarly, in

Selliman v. Colton, an expert in rhinoplasty can testify, even though they may not spend much time on cosmetic procedures.

While this expansion makes it easier for plaintiffs to find expert witnesses, it may also lead to a rise in malpractice claims, adding to the pressures already faced by healthcare providers.

Looking Ahead

The Daher ruling provides important relief for physicians by limiting damages in wrongful death cases, but the possibility of legislative action to reverse this decision and/or roll back other tort reforms of the 1990s during the upcoming lameduck session remains a real concern. Meanwhile, the expanded criteria for expert witnesses could complicate malpractice cases moving forward. The healthcare community will need to remain vigilant in monitoring these developments as they unfold.

Physicians should be prepared for the legislation to be introduced that would negate existing provisions in Michigan law that help to maintain the stability of Michigan’s current liability climate, prevent runaway liability costs, and enable physicians to deliver high-quality care without fear of excessive litigation. Ongoing political dynamics and rumored legislative efforts could alter this balance, making physician engagement and advocacy more important than ever. 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

Separate from 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

Aurea Montoya-Vinluan, MD, FACOG

Dr. Aurea Cabigting Montoya-Vinluan peacefully departed this life on October 3, 2024, returning to the Lord's embrace at age 84. She was born on October 4, 1939, in Sta. Ana, Pampanga, Philippines, and began a significant journey when she moved to the United States on September 17, 1967.

Throughout her life, Aurea was a nurturing soul whose warmth and kindness made everyone feel truly blessed and valued. Deeply anchored in faith, she gracefully embodied the virtues of love, compassion, and selfless service to others. As a devoted wife, mother, daughter, sister, aunt, and grandmother, she generously shared her gifts, leaving an indelible mark on the hearts of all who were fortunate enough to know her.

Aurea earned her Doctor of Medicine degree from the University of Santo Tomas in 1965. She then completed her internship and residency at Deaconess Hospital, gaining recognition as an Outstanding Intern in 1968 and as an Outstanding Resident in 1969. Following her training, Aurea specialized in Obstetrics and Gynecology at Detroit Medical Center/Wayne State University. She practiced her specialty at Ascension St. John Hospital, where her colleagues regarded her as an exceptional and dedicated member of the staff.

Beyond her professional accomplishments, Aurea’s meticulous and organized nature became evident in every aspect of her work. Her colleagues knew when she was on duty – the doctors' lounge was always impeccably clean. She was always thoughtful, bringing food to share with everyone, a reflection of her love for fine cuisine and her kind-hearted spirit.

Aurea was keen on collecting miniature items. She also enjoyed crocheting while studying and crafting intricate beaded ornaments while waiting for newborns to arrive. Her dedication to these crafts showcased her creativity, precision, and productive spirit. She always found beauty and purpose in life's simplest moments, leaving a lasting impression on those around her.

She is now reunited with her beloved husband, Dr. Nuromeo O. Vinluan, her parents, Juan M. Montoya, Sr. and Maria M. Cabigting-Montoya, and her siblings Florsefina, Fredesvinda, Pedro, Juan, Belarmino, Conrado, and Primo.

Aurea is survived by her cherished stepchildren, Lara Vinluan, Jason Vinluan, and Leah Vinluan, and her loving siblings, Anna Maria C. Montoya-Maranan, Jose Basilides C. Montoya, Sr., and Hannah Lilian C. Montoya-Vicente.

The family is deeply grateful to Dr. Lokesh Nagori, Dr. Paul Chuba, Dr. Banda Reddy, and the attending doctors at Corewell Health (Beaumont) Royal Oak for their exceptional care. They are also thankful for the compassionate staff at Macomb Woodside Senior Living and Elara Caring Hospice for their unwavering support. Their kindness and dedication have meant the world to the family during this difficult journey.

In lieu of flowers, donations may be made to St. Anastasia Catholic Church, Troy, MI, in honor of her spirit of generosity and faith. F

OVER 80% OF PRIOR AUTH APPEALS SUCCEED. WHY AREN’T THERE MORE?

By: Tanya Albert Henry, Contributing AMA News Writer

When an insurance company denies a request for prior authorization, it’s highly likely that physicians and patients won’t appeal the denial.

Just one in 10 prior authorization requests that were denied in 2022 were appealed, according to a recently released KFF analysis of data that Medicare Advantage insurers submitted to the Centers for Medicare & Medicaid Services (CMS) between 2019 and 2022.

The statistic is particularly alarming when one considers that the overwhelming majority of appeals – 83.2% – resulted in the insurance company either partially or fully overturning the initial prior authorization denial in 2022. That figure is similar to what the overturn rate was between 2019 and 2021.

Denials and delays in care that result when physicians and patients must go through an appeals process to ultimately get care result in real patient harm. According to data from the most recent AMA prior authorization survey of 1,000 practicing physicians, among the doctors surveyed:

• 94% said that the prior authorization process always, often or sometimes delays patients’ accessing necessary care.

• 19% said prior auth resulted in a serious adverse event leading to a patient being hospitalized.

• 13% said prior auth resulted in a serious adverse event leading to a life-threatening event or requiring intervention to prevent permanent impairment or damage.

• 7% said prior auth resulted in a serious adverse event leading to a patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death.

The AMA is fixing prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles. As part of that effort, the AMA provided a statement to a Labor Department advisory committee last month further detailing the implications of the KFF analysis of prior authorization in Medicare Advantage.

Why aren’t there more appeals?

The AMA prior authorization survey found that fewer than one in five physicians that they surveyed – 18% – reported that they always appeal a prior authorization denial. Among the reasons that physicians said they did not appeal adverse decisions:

• 62% said they do not believe the appeal will be successful based on past experience.

• 48% said that patient care cannot wait for the health plan to approve the prior authorization.

• 48% said that they have insufficient practice staff time or resources.

Mississippi internist and addiction-medicine specialist Daniel P. Edney, MD, explained that he has patients who drive two hours to see him and that prior authorization may take two or three days, forcing the patient to go home and come back. In these situations, denials can lead to patients abandoning care.

“For working class families, it’s very typical that they can’t come back,” Dr. Edney said in a moving video that is part of a collection of AMA member physicians sharing their awful experiences with prior authorization in practice.

Testimonials and data from the AMA prior authorization survey help explain why so many physicians said they have insufficient practice staff resources and time to file appeals. The AMA survey found that physicians and their staff on average spend 12 hours each week completing prior authorization requests, with 35% of physicians surveyed saying they have staff who exclusively work on prior authorization—something that not every practice can afford.

The KFF analysis noted that few patients may appeal their denials because Medicare Advantage enrollees may not know that they can appeal or that they may find the appeal process intimidating. This is based on an earlier KFF survey of adults with health insurance that found that “claims denials appear to be connected to the complexity of insurance for consumers.”

Half of all insured adults surveyed said they find some aspect of insurance difficult to understand, but that number jumped to eight in 10 among those who experienced a claim denial.

Prior authorization must change

The AMA is advocating for critical changes to prior authorization, including insurers reducing the volume of prior authorization and becoming more transparent about what information is required for prior authorization and when.

The AMA says critical national and state-level reforms must be made to improve prior authorization, including gold-carding programs, making prior authorization valid for the length of treatment for those with chronic conditions, and requiring that new health plans honor a previous payer’s prior authorization for a minimum of 90 days.

Among the measures the AMA supports is the Improving Seniors’ Timely Access to Care Act of 2024 (H.R. 8702; S. 4532), which is bipartisan and bicameral federal legislation that would reform prior authorization procedures in Medicare Advantage. F

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!

MSMS Physicians Insurance Agency’s licensed agents can help physicians with all their insurance needs – for business, employees and families. We are ready to assist you in protecting your profession.

Protecting You & Your Team

INDIVIDUAL AND GROUP

COVERAGES

• Dental Insurance

• Vision Insurance

• Short Term and Long-Term Disability Insurance

• Life Insurance

• Accidental Death and Dismemberment

MEDICAL COVERAGE OPTIONS

• HMO/PPO/POS Health Plans

• Health Savings Accounts (HSAs)

• Health Reimbursement Arrangements (HRAs)

• Wellness Reward Promoting Healthy Living

• Medicare Supplemental

• GeoBlue Travel Medical and International Health

• COBRA related services for groups over 20 at no cost to the group

Protecting your Professional Advice

MEDICAL MALPRACTICE

• Exclusive benefits for MSMS members

• Program discount of 5% for qualified members

• Claims free credit up to 25%

• Tribute Plan recognizes doctors for their loyalty and commitment to the practice of good medicine

Protecting You

PERSONAL LINES

• Auto Insurance

• Homeowners Insurance

• Renters insurance

• Umbrella

• Motorcycle

• Recreational Vehicles

PROTECTING YOUR PRACTICE

• Cyber Liability Insurance

• Workers Compensation Insurance

• Business Owners Insurance (BOP)

• Directors and Officers Liability Insurance

• Employment Practices Liability Insurance (EPLI)

• Commercial General Liability

• Errors and Ommissions (E&O)

Tri-County Virtual Candidate Forum

On October 21st the Macomb, Oakland, and Wayne County Medical Societies hosted a Virtual Candidate Forum. The event was well attended with eight candidates participating including Congresswoman Debbie Dingell. There were great discussions between the physicians and candidates, particularly those that are current state legislators, regarding Scope of Practice legislation, expansion of programs like MIdocs to help keep physicians in Michigan, and insurance company’s use of AI to replace physicians.

The Tri-County Legislative Committee meets quarterly with legislators. These meetings provide an open forum for physicians to engage directly with legislators who often come seeking physician input and education on healthcare related legislation.

Anyone interested in joining the Committee please contact Heidi Leach at HLeach@macombcms.org.

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

SB 279 seeks to undermine and threaten the physician-led care team by 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.

Medicus

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 MSMS and MCMS is that health care decisions should be made between physicians and patients. The insurance companies' practice of step therapy not only delays necessary treatment but can also exacerbate health conditions. 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 Bills 5554 & 5555 – Oppose Efforts to Weaken Michigan's Smoke Free Air Laws

HB 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 secondor third-hand smoke. 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 4472 – Protect Patients Access to Physician-Led Care Teams

HB 4472 would require advanced practice registered nurses (APRNs) to practice as part of physician-led, patient-centered 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.

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

SHARE YOUR NEWSWORTHY ITEMS!

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.

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

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. FREE Hotlink to Your Website & Free Advertising Design! For advertising rates and information, please contact:

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

County Medical Society

Macomb