Michigan Medicine®, Volume 121, No. 1

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 121 / NO. 1

January / February 2022

MSMS LEGISLATIVE ADVOCACY:

What to look for and what to expect headed into 2022

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p resident 's Colleagues, Happy New Year from everyone at the Michigan State Medical Society!

The transition from December to January is always an interesting one in that it feels like the perfect opportunity for both reflection on time gone by and musings on what’s ahead. What have we accomplished in the past 12 months? What are our goals and priorities for the next 12 ahead? These are the kinds of questions we all consider on a personal level, but there’s just as much value in asking and answering those questions organizationally.

That’s the exercise that will play out in this edition of Michigan Medicine®.

PINO D. COLONE, MD (GENESSEE COUNTY) MSMS PRESIDENT

Now at the midpoint of the current legislative session, it’s the perfect time to take stock of what has been accomplished and what is yet to come in terms of our advocacy efforts in and around the state capitol.

2021 was an eventful and challenging year. COVID-19 continues to dominate headlines and the attention of those in and around state politics, and rightly so.

“Now at the midpoint of the

With vaccination rates slowing, hospitalizations rising, and billion in unspent

current legislative session,

federal relief dollars that could make a real difference in the fight against COVID

it’s the perfect time to take

sitting idle, it makes perfect sense that dealing with the global pandemic—and all the unfortunate fallout that come with it—remains top of mind for our lawmakers.

stock of what has been

The other big priority for Lansing’s elected officials: keeping their jobs. We’ve offi-

accomplished and what

cially entered an election year, and with new legislative boundaries still unclear,

is yet to come in terms of

it’s bound to be a chaotic one.

Despite all this, it’s been a successful legislative session thus far for MSMS. We’re excited to tell you about our recent legislative accomplishments and the exciting

our advocacy efforts in and around the state capitol.”

things we hope to achieve for physicians and the patients they serve in 2022.

Sincerely,

PINO D. COLONE, MD, MSMS PRESIDENT

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FEATURES & CONTENTS January / February 2022

STAY INFORMED – STAY CONNECTED!

12 MSMS Legislative Advocacy: What to look for and what to expect headed into 2022

At first glance, the exercise of examining the Michigan’s legislative “lay of the land” might seem unwarranted headed into 2022. Of course, as has been the case in recent years, 2022 will be anything but ordinary. (Story begins on page 12.)

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What Are My Rights When a Health Plan Audits My Claims?

MICHIGAN MEDICINE® VOL. 121 / NO.1

DANIEL J. SCHULTE, J.D

Chief Executive Officer JULIE L. NOVAK

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Health Care’s Digital Revolution: Are We Ready to Reimagine the Work?

DAVID L. FELDMAN, MD, MBA, FACS

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MICHIGAN STATE MEDICAL SOCIETY

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ALSO INSIDE

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan.

The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors.

Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy.

Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2022 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA.

Evaluating Performance During COVID and Staffing Shortages

Now Is the Time to Get Caught up on All Vaccines!

MICHELLE DOEBLER, MPH

23 NEW & REINSTATED MEMBERS

©2022 Michigan State Medical Society

michigan MEDICINE® 5

ASK OUR LAWYER

What Are My Rights When a Health Plan Audits My Claims?

By Daniel J. Schulte, J.D., MSMS Legal Counsel

Q:

A health plan that I participate with has sent me a notice stating that it has audited some of the claims I have submitted over the past

three years. The health plan believes that some of these claims were improper and that I owe them a refund. The amount of the refund is large and based on a statistical extrapolation. The notice states that if I do not send the health plan a check it will withhold the amount of the refund from its future payments.

Can the health plan do this? What rights do I have in this process?

“ Quote

T

he situation you describe has become common.

Physicians are frequently being audited by both governmental and private health plans with refunds claimed based on alleged failures to comply with the health plan’s technical coding, billing and documentation requirements. Many physicians wrongly believe it takes a finding of fraud to result in a refund.

This is untrue. Claims can be denied and refunds sought based on incorrect claims submission caused only by honest errors and lack of documentation.

Statistical extrapolation can greatly increase the amount of the requested refund. The refund amount resulting from the claims the health plan has actually audited is extrapolated to all similar claims paid to you over the entire audit period. Using such a method, what may be a minor refund on actual audited claims can escalate to a refund demand of a much larger amount.

You do have rights in this process.

These rights are for the most part contained in your contract with the health plan and any policies and procedures of the health plan that have been incorporated into the contract by reference.

You must familiarize yourself with these documents and evaluate the following:

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Can you dispute the health plan’s right to conduct an audit? Does the contract, directly or indirectly, specifically allow the health plan to conduct an audit?

If so, how often and under what terms and conditions, if any? Is there a limit on how far back claims may be audited and/or refunds sought?

Do you need to retain your own billing and other consultants/experts to use in disputing the audit findings?

The health plan should be required to disclose the complete audit results including an itemized list of the claims audited and the findings and the basis for the findings on a per claim basis.

Can you challenge the use of statistical extrapolation methods? Is the use of such methods specifically authorized by the contract?

“You do have rights in this process. These rights are, for the most part, contained in your contract with the health plan.

If statistical extrapolation is allowed by the contract, you have the right to challenge the validity of the sample taken and methodology used.

If any of the health plan findings based on medical necessity issues or otherwise involve information documented in medical records, were those determinations made by a physician in active practice with the same training, qualifications and experience as you?

These determinations should be made

by active practicing physicians with the same training, qualifications and experience.

Is there some type of mediation or managerial-level conference for resolving the dispute promptly and informally?

Do you have a right to dispute the health plan’s audit findings with Michigan’s Department of Insurance and Financial Services or some other governmental agency?

You do have rights but you must know what your contract says to discover what they are and how best to use them. This is a process that requires a health care attorney experienced in these matters.

Driven by results.

As counsel to the MSMS community for over 70 years, we know how to help physicians.

DETROIT

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T R OY

kerr-russell.com

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ASK HUMAN RESOURCES

Evaluating Performance During COVID and Staffing Shortages

By Jodi Schafer, SPHR, SHRM-SCP HRM Services | www.WorkWithHRM.com

Q:

I know I am supposed to conduct employee evaluations, but am struggling with whether or not to do so this year given the stress and strain my team has been under. I want to provide them with feedback, but am concerned that any areas of concern or growth I identify may lead to unhappy staff and unnecessary turnover. What are other practices doing in this area?

Are they even giving reviews this year or just giving raises to keep the staff they have from leaving?

I

think we can all agree that employees want to feel as though their contributions matter; that their boss knows what needs to be accomplished and provides the resources and

feedback to help them be successful. For that reason, carving out time to spend with each employee to discuss their performance, celebrate their ‘wins’ and identify areas for renewed emphasis or growth is an important component of employee development and retention – especially in our current environment.

I think the real question then is not ‘Should I’? but instead, ‘How should I?’. Begin with a reality check. The last two years have been a lesson in crisis management. Employees who have weathered this storm with you have experienced their own form of stress, frustration and perhaps even trauma. Emotions like this drain staff energy and negatively impact focus.

Combine that with the diversion of time away from core job responsibilities to manage the COVID crisis of the moment and you have an environment

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where previous expectations may need to be adjusted to account for current realities. I’m not suggesting that you grant a pass to all employees with performance and/or behavior issues, but you should evaluate the seriousness of the infraction(s) before deciding how best to proceed. Now is not the time to nit-pick the small stuff.

During the review, verbally acknowledge that this last year was still far from ‘normal’. Point out the high points that you noticed despite the workplace challenges and ask your employee to do the

same. Make sure your gratitude for their efforts comes through loud and clear. If this employee is a ‘lynch pin’ in keeping your practice going, decide whether or not the areas of growth or weakness you’ve identified are deal-breakers. If you feel your practice is better off with this employee than without them, consider addressing areas of growth as a future objective rather than a past mistake that can’t be undone. This allows you to keep the overall mood of the evaluation positive and forward facing, while still providing an opportunity to put a plan together to ensure that your areas of concern don’t slip further behind. Say something like, “I feel like we’ve been in a reactive state for the past few years due to COVID and it’s been all hands on deck. However, for

this upcoming year, I’d like to hit the reset button. I want all of us to shift to a more proactive stance with renewed focus in our roles. In your position, that means…” Allow the employee to provide their thoughts and create an opportunity for buy-in. Hopefully they see things the same way you do, but regardless of whether or not the employee agrees with you, you can still outline the goals you have for them in the upcoming year. Be sure to include metrics or examples of what a ‘good job’ looks like and the time frames you have in mind for each objective.

The other approach is more direct.

If the current COVID climate isn’t a factor in the employee’s poor performance/attitude or the employee’s contributions have deteriorated to the

point where it’s hurting your practice or driving others out the door, then you need to be honest about your observations and your expectations in their evaluation. Ignoring this part of the conversation or using the goal-setting approach described above will not solve the problem(s) and may lead to more serious issues down the road. It comes with a potential flight risk, but shortcomings of this caliber may be more detrimental if the employee stays than if they go.

Regardless of which strategy you use, I encourage you to make time for these one-on-one conversations. The most valuable thing you can give to your team is your time, so while a pay raise may be in order, providing it without a conversation is a missed opportunity.

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MDHHS UPDATE

Now Is the Time to Get Caught up on All Vaccines!

Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization

Over the last two years, the world has been battling COVID-19.

Public health, healthcare professionals, government entities, and more came together for one goal: end the pandemic. Vaccines were developed at a rapid pace, recommendations regarding masking, social-distancing, quarantine, and isolation were made by leaders in the field, testing for the virus was expanded upon and various treatments were developed.

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W

hile we are entering 2022 still battling the COVID-19 pandemic, great strides have been made. Now is the time to not only encourage COVID-19 vaccination, but to also encourage patients of every age to get caught up on all recommended vaccines in the new year.

According to a Morbidity and Mortality Weekly Report (MMWR) published in June 2021, after the March 2020

“Routine vaccination is an essential preventive care service for children, adolescents, and adults, including pregnant people, that should not be delayed due to the COVID-19 pandemic.”

declaration of the COVID-19 pandemic in the United States, an analysis of provider ordering data from the federally funded Vaccines for Children program found a substantial decrease in routine pediatric vaccine ordering.

Further, data from New York City and Michigan indicated sharp declines in routine childhood vaccine administration in these areas. (3) Unfortunately, this downward trend has continued into 2021. In Michigan, according to the Michigan Care Improvement Registry (MCIR), and as of November 2021, the vaccination rate for 19 to 36 month olds for the pediatric vaccine series (4313314 series: 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB, 1 Varicella, and 4 PCV) was 69.7%. In comparison, the vaccination rate for that same pediatric vaccine series (4313314) among that age group was 74.1% back in November of 2019. With reduced vaccine administration during the COVID-19 pandemic, unvaccinated or undervaccinated patients are susceptible to preventable illness, and communities are at risk for outbreaks. Therefore, it’s imperative to implement strategies to promote vaccination schedule adherence and ensure catch-up vaccination, especially for children. Healthcare personnel should identify children who have missed well-child visits and/or recommended vaccinations and contact parents to schedule in-person

appointments, starting with newborns, infants and children up to 24 months, young children, and extending through adolescence. (2) Routine vaccination is an essential preventive care service for children, adolescents, and adults, including pregnant people, that should not be delayed due to the COVID-19 pandemic. According to CDC, ensuring that routine vaccination is maintained or reinitiated during the COVID-19 pandemic is essential for protecting individuals and communities from vaccine-preventable diseases and outbreaks. Routine vaccination prevents illnesses that lead to unnecessary medical visits and hospitalizations, and further strain the healthcare system. All vaccines due or overdue should be administered according to the recommended CDC immunization schedules (1) during each visit unless there is a specific contraindication.

This will provide protection as soon as possible and minimize the number of healthcare visits needed to complete vaccination. Healthcare personnel, whether they administer vaccines or not, should take steps to ensure their patients continue to receive vaccines according to the Standards for Adult Immunization Practice. If vaccination is deferred, older adults and adults with underlying medical conditions are at increased risk for complications of vaccine-preventable diseases. (2)

Now is the time to catch your patients, at every age, up on any vaccines they may need, including COVID-19 vaccine. Healthcare providers are encouraged to utilize the MCIR to generate reminders and recall letters of patients that are overdue or coming due for recommended vaccines. It’s time to put an end to this pandemic, and to protect your patients from all vaccine-preventable diseases through timely vaccination.

REFERENCES Centers for Disease Control and Prevention (CDC). 2021, Aug 23. Immunization Schedules for Healthcare Providers.

Retrieved from https://www.cdc.gov/vaccines/schedules/ index.html.

Centers for Disease Control and Prevention (CDC). 2021, April 15. Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic. Retrieved from https://www.cdc.gov/vaccines/pandemic-guidance/ index.html.

Patel B, Murthy , Zell E, et al. Impact of the COVID-19 Pandemic on Administration of Selected Routine Childhood and Adolescent Vaccinations — 10 U.S. Jurisdictions, March–September 2020. MMWR Morb Mortal Wkly Rep 2021;70:840–845. DOI: http://dx.doi.org/10.15585/mmwr. mm7023a2.

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MSMS LEGISLATIVE ADVOCACY …

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… WHAT TO LOOK FOR AND WHAT TO EXPECT HEADED INTO 2022

A

t first glance, the exercise of examining the Michigan’s legislative “lay of the land” might seem unwarranted headed into 2022. In the middle of a legislative session where both the governorship and the makeup of both

the state House and Senate remain unchanged, one might assume a degree of steadiness and stability persists that would render a full examination of the political landscape unnecessary.

Of course, as has been the case in recent years, 2022 will be anything but ordinary.

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It starts with COVID-19.

W

ith vaccination rates plateauing, new and concerning variants continuing to emerge, and hospitalization rates seemingly always reaching new peaks, it’s safe to assume the ongoing global pandemic will continue to dominate the legislature’s attention and funding allocation decisions through 2022 and beyond—yet to be allocated federal COVID funding from the American Rescue Plan Act all but guarantees that’s a certainty.

In total, nearly $10 billion in federal relief funds have yet to be appropriated, with Michigan’s legislature having discretion over how to spend approximately $5.7 billion of that total figure.

That is not to suggest there have not been efforts to start allocating these funds. In November of 2021, Governor Whitmer’s budget office called on Michigan’s legislature to approve $2.5 billion in supplement spending, with a large portion of expenditures earmarked for specific COVID relief

measures to be financed with American Rescue Plan dollars. More specifically, Governor Whitmer has called for $300 million to bring screening and testing to Michigan’s schools, $367 million for increased testing and contract tracing measures, and an additional $97 million to bolster vaccination rates.

However, officially appropriating those funds will require cooperation from Governor Whitmer – something that’s been especially difficult to come by this legislative cycle. And with the state having until 2024 to spend much of these federal relief funds, coupled with the broad discretion lawmakers have over how the funds are ultimately allocated, there’s a good chance this will be a protracted fight through 2022 and beyond.

Complicating matters further is the fact that the skirmishes over relief funding are taking place in an election year and against the backdrop of changing and uncertain political maps in Michigan.

While election cycles always create an environment of heightened tension and uncertainty, it’s safe to assume those straining conditions will be especially heightened in 2022, the inaugural election year in freshly drawn—and still uncertain—legislative districts.

And it is possible those districts will look dramatically different than they have in years past with a new, independent, citizen-led commission now responsible for drawing Michigan’s congressional and state legislative districts.

Created in 2018 following a voter-approved constitutional amendment, the Michigan Independent Citizens Redistricting Commission is still working through the task of finalizing the political geographic boundaries that will persist for the next 10 years.

That process has been turbulent and uncertain to say the least.

What is certain is that the end result will generate a chaotic 2022 election cycle. Up to half of all seats in the state House and Senate could have new representatives headed into 2023 because of redistricting and term limits, according to analysis conducted by Bridge Magazine. Even more compelling, it’s highly likely a number of incumbent legislators will be pitted against one another in newly drawn districts.

Suffice to say, there will be a lot to contend with outside of the confines of the State House when it comes to engaging with the legislature in the coming year.

“Governor Whitmer has called for $300 million to bring screening and testing to Michigan’s schools, $367 million for increased testing and contract tracing measures, and an additional $97 million to bolster vaccination rates. However, officially appropriating those funds will require cooperation from Governor Whitmer – something that’s been especially difficult to come by this legislative cycle.”

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MSMS 2021 Accomplishments and 2022 Goals

D

espite the unique challenges associated with this legislative term outlined above, the Michigan State Medical Society made great strides on promoting legislative action that’s in the best interest of Michigan’s physicians and they patients they serve. Work continues with MSMS’ most important priorities, including prior authorization reform, scope of practice issues, and telehealth parity, with a great deal of time and effort also devoted to advocating for and against a myriad of other issues that affect Michigan physicians and patients.

Here is a recap of the work the MSMS Government Relations team has done on these issues and where things presently stand at the midpoint of this current legislative session:

Prior Authorization This past spring, MSMS made significant progress in the fight for prior authorization reform when Senate Bill 247 unanimously passed through the Senate.

If enacted, Senate Bill 247 would bring new transparency, fairness and clinical validity requirements to the prior authorization processes insurers use to bog down patient care, ensuring patients throughout the state receive timely coverage decisions and the care they need.

The bill has since moved on to the House of Representatives for consideration, and MSMS continues to fight hard for its passage. To that end, MSMS hosted a House Lobby Day in October in an effort familiarize House members with the legislation and the need for prior authorization reform. That effort was a great success, generating important support from members on both sides.

Telehealth Parity To minimize spread and exposure to COVID-19 and preserve continuity of care for the patients they serve, Michigan’s physicians were quick to adopt telehealth medicine at the start of the COVID-19 pandemic, and its widespread adoption has emerged as one of the silver linings of the global pandemic. Telemedicine has proven to be a powerful tool for maintaining safe access to care in a convenient, cost-effective manner.

That transition was made easier by payers initially agreeing to remove some of the regulatory and administrative barriers that had previously limited telehealth use. Unfortunately, those actions have proven to be only temporary, with payers now reverting to pre-pandemic rates.

MSMS and physicians across the state believe that’s the wrong approach and

have called on lawmakers to ensure telehealth services remain available and fully covered. HB5651, dictating permanent equitable rates, was introduced on December 15, 2021.

Feminine Hygiene Product Tax Exemption For far too long, Michigan women have been subjected to unnecessary and discriminatory sales and use taxes for feminine hygiene products.

Thankfully, that will be no longer the case, thanks in part to hard work from MSMS mem-bers and staff.

For years now, efforts have been made to repeal the tax on essential menstrual products including tampons. In 2021, those efforts took the form of Senate Bill 153 and House Bill 5267. Both bills were supported by the Michigan State Medical Society, with Doctor Nita CONTINUED ON PAGE 16

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Kulkarni—a Flint obstetrician—being an especially instrumental advocate in pushing for their passage. With help from the MSMS Government Affairs Team, Doctor Kulkarni crafted and delivered testimony in support of this critical legislation when the bills were being considered in committee.

“Michigan must move away from viewing these products as a luxury,” said Doctor Kulkarni. “That designation couldn’t be further from the truth. Feminine hygiene products are essential items for maintaining women’s health and wellbeing and they should be treated as such. These taxes are unfair and especially burdensome on lower-income women forced to choose between menstrual supplies and other necessities.”

Those costs are nothing to scoff at according to research conducted by the American Association of University Women of Michigan indicating that the average woman may spend more than $4,800 on menstrual products over the course of a lifetime, including nearly $288 in state sales tax alone.

Thankfully, this critical legislation passed through both chambers and was signed into law by Governor Whitmer on November 5, 2021. The new law will take effect in February 2022.

Filter First MSMS stands with a broad range of advocacy groups in calling for the passage of Senate Bills 184 and 185— bipartisan legislation first introduced in February 2021 that would provide the funds necessary for Michigan’s schools and daycare centers to install and maintain water filtration systems, ensuring children have access to safe drinking water.

“This is the kind of commonsense legislation everyone should be able to get behind and support,” said Dr. Kulkarni. “Exposure to lead can seriously hamper a child’s health and development, and the unfortunate reality is our children are particularly vulnerable to lead exposure in our schools being that water sits stagnant in pipes during weeks and vacations, diluting the effectiveness of corrosion control chemicals.”

Presently, Michigan relies on the flawed “test and tell” method to monitor for the occurrence of lead in drinking water, which only confirms the presence of lead without preventing or reducing exposure. Bypassing this slow and costly method by simply installing filtered drinking water stations will ensure children are better protected sooner and in a more cost-effective manner.

“Exposure to lead can seriously hamper a child’s health and development, and the unfortunate reality is our children are particularly vulnerable to lead exposure in our schools being that water sits stagnant in pipes during weeks and vacations, diluting the effectiveness of corrosion control chemicals.”

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Senate Bills 184 and 185 were subject to a hearing in the Committee on Environmental Quality on October 26, with testimony largely positive and in favor of the bills. MSMS has and will continue to be supportive of this legislation and urge lawmakers to take action.

Narcan/Substance Use Disorder Treatment Every year, Michigan endures thousands of needless and tragic overdose deaths. In response to this growing overdose epidemic, MSMS continues to support policies and initiatives to prevent these heartbreaking occurrences.

Introduced in June 2021, House Bill 5163 and Senate Bill 579 would expand the availability of medications for opioid use disorder in emergency departments.

While Senate Bill 579/House Bill 5166 would expand access to naloxone—a lifesaving overdose reversal drug—by allowing community-based organizations to administer it.

“These bills will expand access to care for our patients with substance use disorders. We hope that this additional access will help us to intervene and to save more lives,” said Jayne Courts, MD. “MSMS is pleased to support these bills.”

To that end, MSMS submitted a card of support regarding the Senate Bills to the Senate Health and Human Services Committee on September 9, 2021. The bills have now unanimously passe the Senate and have been sent to the House Committee on Health Policy where they presently await further action.

House Bills 5163 and 5166 have made the opposite journey, passing the

House on October 14, 2021 and now await action in the Senate Committee on Health Policy and Human Services.

MSMS will continue to support both bill packages and encourage lawmakers to press forward in the New Year.

Protections for Emergency Room Personnel Medicine—and emergency medicine in particular—has always been a highstress undertaking, and that’s okay.

That’s just the nature of the job when human lives are on the line.

What is not okay is the added stress that comes with fielding assault and threats of violence while trying to administer life-saving care, which has become a much more common occurrence in a COVID-19 world marred by heightened fear and anxiety.

To battle back against that reality—and protect the brave, hard-working health care providers working to provide critical, quality care—the Michigan Statement Medical Society supports House Bill 5084—legislation that expands the crime of assaulting a person performing certain job-related duties to include emergency room personnel.

and streamlines the administrative burden associated with the state’s mental health system by creating one single oversight entity.

“Our system can and must be patient-centered and outcome-based,” said Senate Majority Leader Shirkey.

“Michigan will save an estimated $300 million in administrative costs by making this change,” said Representative Whiteford. “These savings will go directly to provide more services to our neighbors, family and friends in need of behavioral health care.”

Behavioral Health Integration MSMS is always seeking ways to make life better for the patients our member physicians serve, and for decades now, there has been an obvious opportunity on the table to do just in Michigan by integrating state payments for behavioral health services with Medicaid physical health services.

MSMS has been a vocal participant in the development of these legislative packages and has played a critical role shaping and improving these bills throughout the process, stressing the key role primary care plays in the delivery of efficient, effective, and coordinated behavioral health services.

Thankfully, there is once again a fresh opportunity to achieve behavioral health integration in Michigan in the form of Senate Bills 597 and 598 and House Bills 4925-4929.

On the Senate side, the Senate Committee on Government Operations reported the bills favorably and they now await action by the full Senate.

While the House continues to gather stakeholders’ comments in an effort to improve the package. A hearing has yet to scheduled.

Introduced by Senate Majority Leader Mike Shirkey, Senate Bills 597 and 598 would formally and fully integrate Medicaid’s physical and behavioral health services.

The legislation was born out of a call coordinated by MSMS with Representative Ben Frederick and several frontline physicians during the height of the pandemic. After hearing the harrowing accounts from these physicians, Representative Frederick agreed that emergency room personnel should not face extra threat and stress while undertaking their duties and acted to introduce this legislation.

“Our system can and must be patient-centered and outcome-based, said Senate Majority Leader Shirkey.

“The trauma suffered during the COVID-19 pandemic magnified and amplified the weaknesses in our current mental health system. The science shows when mental health and physical care are addressed and evaluated together, it leads to better outcomes for both.”

House Bill 5084 has been referred to the House Committee on Government Operations where it awaits further action.

On the other side of the legislature, the House package sponsored by Representative Mary Whiteford simplifies

CME Requirements for Lead Poisoning Identification and Treatment House Bill 5414 is legislation MSMS opposes that would mandate licensed medical professionals to take Continuing Medical Education (CME) courses on lead poisoning identification and treatment as a condition of license renewal, focusing on screening and treatment needs of children six years old and under.

While there’s no question that it’s important for a particular subset of health care providers to be able identify CONTINUED ON PAGE 18

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and treat lead poisoning, compulsory continuing education for all licensed medical professional is not the way to ensure our children our kept safe.

Although MSMS supports early and periodic screening and diagnosis and treatment program, the organization opposes all attempts to introduce compulsory content of mandated CME in the state of Michigan. Ultimately, the bill is a one-size-fits-all approach that would require even specialties that do not treat children to receive the training.

HB 5414 currently resides in the House Health Policy Committee.

E-Prescribing The date by which Michigan prescribers will be required to electronically transmit all prescriptions for controlled and non-controlled substances has been pushed to January 1, 2023, to align with Medicare’s extended enforcement date.

Federal and state statute allow for a waiver to be issued if a prescriber cannot meet the electronic prescribing requirements under the respective governing laws. Rules promulgated by the Michigan Department of Licensing and Regulatory Affairs (LARA) addressing the process for obtaining a waiver and the related eligibility criteria are expected to be finalized by the end of 2021. MSMS actively participated in the public comment process, submitting a letter on LARA’s proposed rules which included several suggested changes that LARA incorporated.

Medicare’s electronic prescribing waiver process was included in the 2022 Medicare Physician Fee Schedule, which was finalized in November.

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I

t has been an exciting and successful legislative session thus far for MSMS, but much like the member physicians we serve, our good work is never complete. With consistent, hard work, we are hopeful that 2022 brings more positive change for Michigan’s physicians and the patients they serve.

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MagMutual.com | 800-282-4882

JANUARY / FEBRUARY 2022 |

michigan MEDICINE® 19

Health Care’s Digital Revolution Are We Ready to Reimagine the Work?

David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group; Senior Vice President, Healthcare Risk Advisors

R

obert M. Wachter, MD, began his recent presentation for the Healthcare Risk Advisors (HRA) Virtual Conference Series by admitting to what he jokingly called “the stupidest thing

I ever said to a mentee,” many years ago: “What will you do after we’ve implemented our electronic health record?”

By now, we have all experienced how the electronic health record (EHR) rollout did not go as planned. If we have read Dr. Wachter’s book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, we may even understand why the rollout went so badly. Fortunately, Dr. Wachter feels that it is now, finally, “a time for optimism” in the digitization of healthcare. Our success along the road to digitization will depend on what he describes as “reimagining the work.”

The Four Stages of Digitization From studying the digitization process in other industries, Dr. Robert Wachter – Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF), and a member of The Doctors Company Board of Governors – has identified four stages of digitization for healthcare:

1. Digitizing the record – This is the stage we’re completing now—rather later than we would have liked.

2. Interoperability – Connecting (a) primary care providers to hospitals, as well as hospitals to hospitals, and then (b) the entire digital ecosystem (meaning thirdparty applications, patient-facing systems, and enterprise systems).

3. Gleaning meaningful insights from the data.

4. Converting insights into actions that improve value, whether measured by safety, cost, access, or equity.

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We’ve already begun stage two, but to achieve stages three and four, we need a sea change in how we think about digital data: less as something to gather, more as something to act with and upon. Dr. Wachter says leaders of organizations need to wake up thinking, “We have all this data sloshing around—let’s do something with it.”

The Productivity Paradox of IT The statisticians of baseball can predict with stunning accuracy whether a certain player can hit a curveball thrown by a left-handed pitcher in the rain just after a full moon. Meanwhile, Dr. Wachter wryly observes that our inpatient sepsis alerts, considered a triumph among clinical decision-making tools, are wrong about a quarter of the time.

At the moment, medicine is caught in the “productivity paradox of IT,” a term coined by economist and technology expert Erik Brynjolfsson, PhD, of Stanford. In other industries, the benefits of converting from paper to digital systems did not begin to accrue for two, five, even 10 years. Healthcare, which by its nature is highly regulated and cannot afford to play the entrepreneurial game of “go fast and fail,” may take between 10 and 20 years from the start of the EHR conversion to see those benefits accrue.

Contributed by The Doctors Company

thedoctors.com

Reimagining the Work

Team Two is the digital solutions shop.

Its members are tasked with thinking ahead about “big hairy problems” for which there is no off-the-shelf tool.

What needs to happen before digitization begins to pay off? Industries reap the rewards of digitization when the technology improves, yes—that’s a given. but the central challenge is to “reimagine the work.”

Consider a physician’s note: Those who created electronic notes envisioned digitizing a piece of paper in a binder. But if we were to design the electronic note from scratch today, Dr. Wachter points out, it would look more like a feed on Facebook or Twitter. It would include video and audio components. And, like Wikipedia or Google Docs, it would be more collaborative, with room for comments from nurses, social workers, and others.

Part of the reason for the productivity paradox of IT is that humans have a very hard time thinking about brand new ways of doing things. We need healthcare workers and administrators to begin asking: “Why are we doing x in this way? Why don’t we do it this other way?” to help us see fresh possibilities.

A Digitization Success Story Robert Rushakoff, MD, a diabetologist, is the linchpin of the UCSF Inpatient Glucose Management Service.

Each morning, Dr. Rushakoff uses a custom-built dashboard to review data from patients hospitalized at UCSF Medical Center who meet certain criteria. For about half of those patients, Dr. Rushakoff alerts the care team that they need to make an adjustment. His name is now a verb: Clinicians tell each other, “I got Rushakoffed.”

Dr. Wachter says that this system has brought instances of hyperglycemia and hypoglycemia down roughly 40 percent each.1 Dr. Rushakoff’s dashboard review of data on about 20 high-risk inpatients with diabetes takes him roughly one hour each morning—the time it used to take him to perform one endocrinology consult. That is, this dashboard allows Dr. Rushakoff to improve population health in an inpatient setting, facilitated by digitization.

Creating the dashboard took 10 to 15 hours of programming time. The programming is not what was hard, says Dr. Wachter. The thinking was hard. This is reimagining the work.

Divide and Conquer: How to Structure Tech Teams for Success Dr. Wachter proposes that organizations arrange their technology workforces into two teams with two profoundly different functions: Team One might be called the “traditional” digital arm of the organization.

Its members solve current clinical care and business problems, maintaining the day-to-day functions of the organization as it currently exists. They tend to focus on the EHR as the cornerstone of their work.

Dr. Wachter explains that UCSF’s technology force is organized in this way and that there is no way Team One would ever have had the bandwidth to come up with Dr. Rushakoff’s one-stopshop Inpatient Glucose Management Service dashboard—after all, they have their hands full solving EHR daily use and interoperability problems. Their current multi-year project is called the “UCSF Digital Patient Experience,” and it involves reimagining the entire experience, from scheduling to billing to back-and-forth communication with the health system.

Keep Calm and Carry On As we set off through stage two in pursuit of full interoperability, Dr. Wachter offers the encouraging thought that we are now, finally, truly, entering the post-EHR era, one in which we will take advantage of new tools and ways of thinking to improve healthcare value. Maybe now we will finally learn the answer to that question from years ago: What will we do after we’ve implemented our electronic health record?

To hear Dr. Wachter describe the digital revolution as only he can, access the recording of his presentation.

REFERENCE Rushakoff RJ, Sullivan MM, Windham MacMaster H, et al. Association between a virtual glucose management service and glycemic control in hospitalized adult patients: an observational study. Ann Intern Med. 2017;166(9):621627. doi:10.7326/M16-1413

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michigan MEDICINE® 21

Activate Your Political Voice!

Get started at mdpac.org he Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society. It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine.

Through MDPAC, you will activate your voice on issues important to Michigan physicians.

Five Reasons to

BACK the PAC The Michigan Doctors’ Political Action Committee (MDPAC) builds and maintains strong relationships with lawmakers, as well as candidates running for political office.

As the face of physicians, MDPAC

bring medical knowledge into discussions with political decision makers.

Activate your Take action now!

Visit https://MSMS.org/engage political voice!

For more than three decades, MDPAC has mounted successful lobbying efforts on behalf of physicians.

and become a “virtual lobbyist.”

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The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society.

It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

For example... MDPAC protects and strengthens tort reform, stopped the physician’s tax, and has

helped to stop the expansion of a non-physician’s scope of practice.

MDPAC has power, prestige and respect! If you wake your sleeping giant, MDPAC could make rapid, positive change for physicians and patients. It could ease administrative pressures with the current prior authorization process, save you money

and time on your Maintenance of Certification, and advance public health issues.

Top 150 M

Janu

NEW & REINSTATED MEMBERS ALLEGAN COUNTY

JACKSON COUNTY

Michelle Kim, MD

Janak Bhavsar, MD

ALPENA-ALCONAPRESQUE ISLE COUNTY

KENT COUNTY

Stephanie Annor, MD

Abdul-Rahman Albeiruti, MD Jorge Alchammas, MD Jonathan Alterie, DO

Dane Brown, MD

Timothy Alves, MD

Christina Endress, MD Christopher Haltigin, MD Jennifer Hoffman, MD

Adam Asarch, MD Polya Baghelai, MD Jonathan Chapman, MD

Scott Huffaker, DO

John Cochrane, DO

Jason McMaster, MD

Diego Covarrubias, MD

Michael Nicholson, MD Denise Schiebout, DO

Ben Eggleston, MD

BAY COUNTY

Nitin Jain, MD

William Fabricius, DO Jeffrey Knake, MD

David Oberlin, MD

Kelly Krcmarik, MD

Alexander Lopyan, MD Noelle Whyte, MD

Esther Lehmann, MD

CLINTON COUNTY

Sarah Marino, DO

Wael Marashdeh, MD Alex Martin, DO

Roger Annis, MD

John Mettler, MD Michael Mills, MD

GENESEE COUNTY

Gregory Mlacker, DO

Shafi Ahmed, MD

Aris Musabji, MD

Paul Lazar, MD M. Anas Moughrabieh, MD

GRATIOT COUNTY Leonard Farber, MD

Christopher Swenson, MD Nadia Yusaf, MD

Michael Green, MD Anisha Kapoor, MD

MACOMB COUNTY

Dejhara Wellons, DO

Usman Ashraf, MD Nada Macaron, MD

INGHAM COUNTY

Daniel Macek, MD

Kirsten Dickinson, MD

Karolina Skrzypek, MD

Monica Van Acker, DO

ISABELLA-CLARE COUNTY Mark Jacob, MD

Britni Souther Mashni, DO Ibrahim Syed, MD

Stephanie Goggin, MD

Raymond Greaser, MD

Ashok Ramachandra, MD Mohamad Saab, DO

Matthew Augsburger, DO

Erin DeCloux, MD

Priyanka Parekh, MD

MEDICAL (CRAWFORD-GLADWIN-KALKASKA-MONTMORENCY-OTSEGO-ROSCOMMON) Cara Crawford Bartle, MD Lisa Harrington, DO Cynthia Rubert, MD

MIDLAND COUNTY Andrew Afshar MD, DDS Omar Ali, MD Julio Benitez Lopez, MD Danielle Bennett, DO Richard Bennett, MD Amer Bleibel, DO Robert Dess, MD Travis Dice, MD Mark Dittenbir, MD, FACS Adriss Faraj, MD Jacob Frisbie, DO Tariq Hamid, MD Monica Jacobus, MD David Lyons, DO Andrew Ostosh, MD Richard Sarle, MD Gregory Strauther, MD Randy Vince, MD Gerald Whitney, MD Sandeep Yalamanchi, MD Yezi Zhang, MD

MUSKEGON COUNTY Christine Bowman, MD Patrick Couture, MD

OKLAND COUNTY Murad Bani Hani, MD Paul Bove, MD

Zenon Zarewych, MD

David Donigian MD, MBA

MARQUETTE-ALGER COUNTY

Shannon Joseph, MD

Jordan Brooks, MD Rebecca Reinertsen, MD Nelson Winkler, MD

David Hollett, MD Gerald Shiener, MD

OGEMAW-OSCODA COUNTY Raul Andino, MD, FACOG Cynthia De Meester, MD Bridget Freeman, MD Schuyler Rogg, MD Patrick Schafer, MD Tari Stull, MD

OTTAWA COUNTY Nicholas Bontumasi, MD Ethan Morrical, MD

SAGINAW COUNTY Ishan ​A​l-​S​abb​​a​g​h, MD Akram Alashari, MD Abdul Aleem, MD Ruba Allabwani, MD Taylor Gaudard, MD G​h​a​s​s​a​n​ H​a​m​a​d​e​h, MD Jay Krzewinski, MD Christina Maser, MD Matthew McRae, MD M​a​y​a​n​k​ Ohri, MD Rachel Rezmer, MD Nicholas Shokoohi, MD Monique Turner, DO

ST. CLAIR COUNTY David Bailey, DO Emily Tan, DO

WASHTENAW COUNTY Taylor Lin, MD

WAYNE COUNTY Yasser El-Abd, MD Christopher Henry, MD Eduardo Icaza, MD Xhorlina Marko, MD Isaac Powell, MD Zhen Wu, MD Omer Zaman, MD

Lisa Soranno, DO Adam Weiner, MD Syamasundera Zampani, MD

Thank you for your ongoing support of organized medicine in Michigan.

JULY / AUGUST 2021 | michigan MEDICINE® 23

MSMS ON-DEMAND WEBINARS The MSMS Foundation has a library of on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs.

Webinars that Meet Board of Medicine Requirements: A Day of Board of Medicine Renewal Requirements Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Decision Making Capability Medical Ethics – Eliminating Disparities in Health Care What Can You Do? Medical Ethics – Just Caring: Physicians and Non-Adherent Patients

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Medical Ethics – Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Pain and Symptom Management – Naloxone Prescribing Pain and Symptom Management – Balancing Pain Treatment and Legal Responsibilities

To register or to view full course details, please visit: msms.org/OnDemandWebinars

Grand Rounds Series

Other Webinars:

A Review of COVID-19 Variants

2021 ASM – Cardio-Oncology: Enhancing the Cardiac Care of the Cancer Patient

Changes to Michigan’s Auto No-Fault Act for Physicians

2021 ASM – Updates in Endocrinology

Coronavirus Relief – Overview and Updates

2021 ASM – Update in Infectious Disease

CURES Act – What is Information Blocking and How Do I Comply?

2021 ASM – Updates in Otolaryngology

Cyber Preparedness & Response for Medical Practices

2021 SSM – Contemporary Management of Nephrolithiasis

Domestic Violence and Sexual Assault (Intimate Partner Violence)

2021 SSM – Neuroscience: Central Nervous System and Neuromuscular Junction Inflammatory Disorders

Federal Information Blocking Rules Harm Reduction in Practice and Policy Strategies Henry Ford Health System COVID-19 Requirement for Employees MDHHS Update from New Director Elizabeth Hertel Navigating the No Surprises Act Recovery Audit Contractor (RAC) Region 1 Sharing Clinical Notes With Patients – A New Era of Transparency in Medicine Update on COVID-19 from Joneigh Khaldun, MD, Chief Medical Executive

Monday Night Medicine Series Creating a Manageable Cockpit for Clinicians

2021 SSM – Updates in Allergy, Asthma and Immunology 2021 SSM – Updates in Dermatology 25th Annual Conference on Bioethics Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

100% Virtual Collaborative Care for Behavioral Health Outcomes

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media

Practicing Wisely – Save 2 Hours Each Day

Medical Marijuana Law

AMA Strategic Plan to Advance Health Equity

Medical Necessity Tips on Documentation to Prove it

Implicit Bias and Racial Disparities

Non-Pharmacologic Management of Musculoskeletal Pain Syndromes

“Then when you know better, do better.” Next Steps in the Journey of Dismantling Systemic Racism Within Health Care and Beyond

Section 1557: Anti-Discrimination Obligations

A Team Based Approach Training Modules – • Module 1: How to Develop a Pharmacist-Physician Collaboration • Module 2: Medication Therapy Management Reimbursement and ROI • Module 3: Best Practices for Addressing Workflows, Resources, Challenges

Sexual Misconduct – Prevention and Reporting Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

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2022 EDUCATION EVENTS

Spring Scientific Meeting April 7 - 8, 9:00 – 11:00 am (Virtual) May 12 - 13, 9:00 – 11:00 am (DoubleTree in Dearborn) June 9 - 10, 9:00 – 11:00 am (Virtual)

Implicit Bias Series May 13, June 10, July 8, August 12, September 9, October 14, November 11, and December 9, 12:00 – 1:00 pm (Virtual)

Board of Medicine September 23, 9:00 am – 4:00 pm (Marriott in East Lansing) November 4, 9:00 am – 4:00 pm (Sheraton in Ann Arbor)

Annual Scientific Meeting Grand Rounds

September 22, 3:00 – 6:00 pm (Virtual)

February 9, March 9, April 13, May 11, June 8, September 14, October 5,

October 19 - 22, 9:00 am – 4:00 pm (Westin in Southfield)

November 9, and December 14, 12:00- 1:00 pm (Virtual)

November 17 (Virtual)

Practice Management Series

Annual Bioethics Conference

February 9, March 9, April 13, May 11, June 8, September 14, October 5,

November 5, 9:00 am – 4:00 pm (Sheraton in Ann Arbor)

November 9, and December 14, 1:00 – 2:00 pm (Virtual)

Monday Night Medicine March 7 and April 4, 6:30 – 8:00 pm (Virtual) October and November 7, 6:30 – 8:00 pm (Virtual)

For more information or to register, please visit: MSMS.org/EO Questions? Contact Beth Elliott: email belliott@msms.org or call 517/336-5789

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SAFEHAVEN™

PHYSICIAN AND PROVIDER WELL BEING PROGRAM Rediscover meaning, joy, and purpose in medicine.

SafeHaven™ ensures that physicians and health care providers can seek confidential assistance and support for burnout, career fatigue, and mental health reasons.

In-the-moment telephonic support by a licensed counselor, 24/7

Legal and financial consultations and resources, available 24/7

Peer Coaching—talk with someone who has walked in your shoes that can help you grow both personally and professionally • Six sessions per incident • Physician or provider chooses coach from a panel of coaches

Counseling, available in either face-to-face or virtual sessions; addressing stress, relationships, eldercare, grief, and more • Six sessions per incident • Available to all extended family members

WorkLife Concierge, a virtual assistant to help with every day and special occasion tasks, 24/7

VITAL WorkLife App—Mobile access to resources, well being assessments, insights, and more

RESOURCES FOR YOU AND YOUR FAMILY MEMBERS SafeHaven™ includes Well Being Resources from VITAL WorkLife—confidential and discreet resources designed to reduce stress and burnout, promote work/life integration and support well being for you and your family.

TO LEARN MORE, VISIT

www.MSMS.org/SafeHaven To support the needs of physicians and health care providers struggling with stress, burnout, and the effects of COVID-19, the Michigan State Medical Society (MSMS) and VITAL WorkLife have partnered to offer a comprehensive set of well being resources and confidential counseling services for their use, SafeHaven™.