Michigan Medicine, Volume 115, No. 1

Page 1

A W A R D - W I N N I N G








January / February 2016 • Volume 115 • No. 1

It’s Time for Change!




• Is Maintenance of Certification a Violation of the Antitrust Laws? (page 6)

• E-cigarettes: A Physician’s Dilemma (page 8) • Five Ways to Get Your Finances in Order in the New year (page 30)

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Chief Executive Officer JULIE L. NOVAK

Managing Editor January / February 2016 • Volume 115 • No. 1


12 It’s Time for Change! Conversations About Maintenance of Certification FEATURES

22 Overcoming the Stress of Malpractice Litigation: Solutions to Help Physicians Stay Healthy and Engaged By David P. Michelin, MD, MPH (Contributed by The Doctors Company)


4 President’s Perspective By Rose M. Ramirez, MD A Unified Voice Is Needed to Affect Change: Maintenance of Certification in Michigan

6 Ask Our Lawyer By Daniel J. Schulte, JD Is Maintenance of Certification A Violation of the Antitrust Laws?



Publication Office Michigan State Medical Society PO Box 950, East Lansing, MI 48826-0950 517-337-1351 www.msms.org All communications on articles, news, exchanges and classified advertising should be sent to the above address, attn: Kevin McFatridge.

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Postmaster: Address Changes Michigan Medicine Hannah Dingwell PO Box 950, East Lansing, MI 48826-0950 Michigan Medicine, the official magazine of the Michigan

MDHHS Update

State Medical Society (MSMS), is dedicated to providing

By Eden V. Wells, MD, MPH, FACPM E-cigarettes: A Physician’s Dilemma

of the Michigan State Medical Society and contemporary

10 HIT Corner By Dara J. Barrera, MSMS Manager of Practice Management and Health Information Technology, and Stacey P. Hettiger, Director of Medical and Regulatory Policy What Recourse Do Physicians Have to Express Their Concerns Regarding Meaningful Use?


20 Obituaries

21 New MSMS Members

24 MSMS Foundation Education Course Offerings

26 The Marketplace

30 WealthCare Advisors

useful information to Michigan physicians about actions 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 2016 it is published in January/February, March/April, May/June, July/August, September/October and November/December. Second class postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA.

The mission of the Michigan State Medical Society is to promote a health care environment which supports physicians in caring for and enhancing the health of Michigan citizens through science, quality and ethics in the practice of medicine.

©2016 Michigan State Medical Society


P R E S I D E N T ’ S


A Unified Voice Is Needed To Affect Change: Maintenance of Certification in Michigan BY ROSE M. RAMIREZ, MD

Maintenance of Certification This issue of Michigan Medicine is highlighting issues related to Maintenance of Certification (MOC); however, secondarily, I would also like to share a brief update on Advance Care Planning (ACP) in Michigan.

I hope your holidays were full of thankfulness and joy! Based on some recent studies, people who experience gratitude and happiness live longer and are healthier!

First, a little history…The American Board of Medical Specialties (ABMS) is the parent organization of the 24 core boards and their subspecialties. Board certification began in 1917 with the American Board of Ophthalmology as the first specialty board. The American Board of Internal Medicine (ABIM) was incorporated in 1936. Forty-two years ago, the ABIM officially endorsed the principle of recertification, but decided to implement it on a voluntary, rather than mandatory basis. By 2002, the core group of the 24 member boards of the ABMS had a firm set of shared guidelines and requirements for board certification. Over time, MOC has become a mandate rather than a recommendation. In the April 15, 2010 issue of The New England Journal of Medicine, an article discussing the results of a poll of members regarding board recertification was published. Specifically, many readers felt that the cost of MOC far outweighed the educational benefit and that the MOC program was essentially a money-generating activity for the ABIM. Others felt that the exercise was only marginally relevant to their day-to-day practice and that it took their time away from patients and other learning activities. In January 2014, the ABIM substantially increased the requirements and fees for its MOC program. Internists will now incur an average of $23,607 in MOC costs over



10 years, ranging from $16,725 for general internists to $40,495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. In 2014, when the ABIM issued the new requirements for maintaining certification, Paul Teirstein, MD, (chief of cardiology at Scripps Clinic in San Diego) and his colleagues declared “enough.” They formed a new recertification organization called the National Board of Physicians and Surgeons (NBPAS). The NBPAS fees are much, much lower than those charged by the ABIM and its board and management—all top names in medicine—work for free. The goal is to break the monopoly the ABMS has on MOC and put leadership back into the hands of practicing physicians. Here in Michigan, another approach to the onerous and expensive requirements of MOC includes legislative proposals by Senator Peter MacGregor and Representative Edward Canfield, DO, to remove the requirement by insurers of board recertification as a prerequisite to payment for health care services. The bills are currently in the Senate and House Health Policy committees. Please visit http:// right2care.org for the latest information. The Pennsylvania Medical Society held a forum on MOC at the American Medical Association Interim meeting in November. It was well attended by practicing physicians and by leadership from many of the Specialty boards. I think ABMS January / February 2016

“We will need the unified physician voice to make a change in the deeply entrenched powers that want to maintain the MOC status quo. That’s why MSMS developed it’s campaign, ‘Right2Care’. I encourage each of you to visit http://right2care.org, where you may contact your lawmakers and contribute to fight this bureaucratic nightmare.”

and its core members are finally getting the message that MOC needs to change. One big challenge is that The Affordable Care Act (ACA) modified Sections 1848(k) and 1848(m) of the Social Security Act which defines how CMS pays physicians for their services. For 2013 and 2014, the “Quality Reporting System’ portions included requirements of MOC in the registry reporting section and gave payment incentives. In 2015, reporting on MOC was still required, but incentive payments were no longer included. And even though the mantra from the ABMS attempts to sell MOC as a “Trusted Credential”, the ABMS uses empirical evidence to make its claim of the value MOC brings to health care and has yet to prove that the value is greater than the cost. However, because hospitals and payers want a way to show that their physicians are high quality, this is one surrogate they use. Various quality organizations and health care purchasers also use this ‘credential’ to show value. At the recent Interim meeting, the AMA House of Delegates approved the Report 2 from the Council on Medical Education which includes the AMA principles on MOC. This report reviews and consolidates existing American Medical Association (AMA) policy on MOC, Osteopathic Continuous Certification (OCC) and Maintenance of Licensure (MOL) to ensure that these policies are current and coherent. We will need the unified physician voice to make a change in the deeply entrenched powers that want to maintain the MOC status quo. That’s why MSMS developed it’s campaign, ‘Right2Care’. I encourage Volume 115 • No. 1

each of you to visit http://right2care.org, where you may contact your lawmakers and contribute to fight this bureaucratic nightmare.”

Advanced Care Planning (ACP) Before I conclude, I want to briefly discuss some of the Advance Care Planning (ACP) work going on in our state. ‘End of Life Care’ is one of our current Michigan State Medical Society (MSMS) strategic objectives and we have an opportunity to collaborate with a number of communities in our state already working on ACP and essentially following the Gunderson Lutheran Respecting Choices model. This ACP model provides an evidence-based process with a standardized approach to conversations with patients and their families about end of life care.

First Steps: Introduce ACP and basic documentation. Next Steps: Discuss ACP again when chronic illnesses become more advanced. Final Steps: Discussions with frail, elderly or when a patient may die within next 12 months. More complete documentation such as Physician Orders for Life Sustaining Treatment (POLST or MI-POST). As these documents are completed, they will be uploaded to a statewide registry. While community volunteers, clergy and others can participate in First Steps, medical professionals are needed for the Final Steps. Medicare will begin to reimburse for time spent counseling patients on end of life care beginning in 2016. MICHIGAN MEDICINE

Some of the components that make this program successful are the community approach, the availability of information as standard practice and education of healthcare professionals. Other components include the careful scripting of the conversations and the training of physician and other non-physician advance care planning facilitators. Other states have used their state medical societies to promote ACP programs. The two organizations in our state working on this are “makingchoicesmichigan. org” and “honoringhealthcarechoicesmi. org”. John McKeigan, MD, was one of the founding members of RespectingChoicesMichigan, which has been mostly focused in West Michigan. At the October 7, 2015 MSMS Board meeting, a motion was approved to “request more comprehensive information on the Gunderson Respecting Choices model and an analysis of the feasibility of our MSMS leading this initiative statewide.” The motion was passed unanimously. More information will be forthcoming!

Doctor Ramirez, a Kent County family physician, is president of the Michigan State Medical Society





Is Maintenance of Certification A Violation of the Antitrust Laws? BY DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL QUESTION:

It was reported a year or two ago that a lawsuit alleging that Maintenance of Certification (“MOC”) violated the anti-trust laws. Was this lawsuit filed by the government or a private party? Can you explain what this lawsuit alleged specifically regarding antitrust law violations? I assume the case was either unsuccessful or has not been decided because if MOC was illegal we would not still talking about it. Can you update us on this? ANSWER: You must be referring to the Association of American Physicians & Surgeons’ (“AAPS”) lawsuit against the American Board of Medical Specialties (“ABMS”). The AAPS filed its Complaint against ABMS back on April 23, 2013. Neither the Federal Trade Commission nor the U.S. Department of Justice are involved in the case nor is any state antitrust enforcement agency. In its Complaint, AAPS seeks: 1. a declaratory judgment that the ABMS has violated the antitrust laws (specifically Section 1 2. an injunction against ABMS prohibiting it from continuing to engage in its restraint of trade (i.e. the MOC Program); 3. a refund of fees paid by AAPS members who have complied with the ABMS MOC program; 4. an injunction prohibiting ABMS from continuing to make certain false statements in connection with the MOC program; and 5. reimbursement of its attorney fees. Daniel Schulte, JD, MSMS Legal Counsel, is a member of Kerr Russell Attorneys and Counselors


AAPS alleges the existence of several agreements entered into by ABMS and at least two dozen other entities to impose on physicians the recertification program known as ABMS MOC®. The other entities include health plan administrators, health insurers, hospitals and other health facilities. The Complaint further alleges that ABMS is acting in concert with The Joint Commission so that the more than 20,000 healthcare organizations and hospitals accredited by The Joint Commission will require MOC compliance by those physicians on their medical staffs as a condition of renewal of their privileges. According to AAPS, ABMS together with the other entities and The Joint Commission have formed a conspiracy to illegally restrain competition in the market for physician services by excluding physicians who do not comply with the MOC program from continuing to practice in hospitals and other health facilities and terminating their participation in health plan/health insurer networks. AAPS alleges that the effect of this conspiracy to illegally restrain competition is a limitation on patient’s access to their physician of choice. The injunction sought to prohibit ABMS from continuing to make certain false statements relates to ABMS’ use of “Not MICHIGAN MEDICINE

Meeting MOC Requirements” to describe physicians who chose not to comply with MOC. AAPS alleges that this statement creates the false impression that MOC is a “requirement” that is indicative of the medical skills of these physicians and that physicians that do not comply with the MOC “requirement” are somehow less competent than those that do. AAPS also seeks to prohibit ABMS from continued use of its website named “certification matters” which, AAPS alleges, invites the public to search on specific physicians and falsely implies that physicians who do not comply with MOC are somehow less competent physicians. AAPS alleges that these are all false representations since ABMS has no support for and cannot demonstrate a significant correlation between MOC compliance and superior medical skills. The procedural history of this case is a bit out of the ordinary. The Complaint was filed on April 23, 2013. AMBS moved to dismiss the case in May of 2014. This motion to dismiss was fully briefed as of July of 2014 but the court (Federal District Court for the Northern District of Illinois) has not yet ruled. MSM legal counsel will continue to monitor the case and report on developments when they occur. January / February 2016

Volume 115 • No. 1





E-cigarettes: A Physician’s Dilemma



was visiting my family during a reunion a few months ago, and came face-to-face with what I now refer to as the “e-cigarette dilemma”. A family member, who is in his mid50’s and has smoked since his teens, was using an e-cigarette, and stated he has been doing so over the last year. He uses a cinnamon flavor. I certainly was glad to see the “vaping” (the term used for e-cigarette use) family member cutting down (in fact, he has not smoked a regular cigarette in a long time), and complimented him on his efforts. But suddenly, the questions about e-cigarettes that have come to me as matters of policy became quite personal. Do I think that use of an e-cigarette is healthier than that of a traditional cigarette? Can I say that the use of an e-cigarette is healthy? What do we know about e-cigarettes effects on others exposed to the vapor? What is known is that use of tobacco products are the source of morbidity preventable deaths in the US and across the globe. 1,2 Smoking causes more than 480,000 deaths each year in the United States.2,3 Nearly 18 of every 100 U.S. adults aged 18 years or older (17.8%), or 42.1 million adults currently smoke cigarettes; current smoking has declined from 20.9% in 2005.3 Yet, while traditional cigarette smoking has decreased, other uses of tobacco/nicotine products are on the rise. In fact, e-cigarettes are marketed as smoking cessation devices or alternatives to traditional cigarettes.4 A 2014 study showed that e-cigarette use was especially

prominent among current and former cigarette smokers.5 In 2014, 12.6% of adults had ever tried an e-cigarette even one time, and the majority were young adults aged 18-24 years of age.6 What is particularly worrisome is the increased use of e-cigarettes utilized by adolescents, who are smoking traditional cigarettes less, but from 2011 to 2014 substantial increases were observed in e-cigarette and hookah use among middle and high school students (an estimated 2.4 million e-cigarette youth users).7 Per the Centers for Disease Control and Prevention, use of tobacco in any form, whether combustible, noncombustible, or electronic, is unsafe; further, nicotine exposure during adolescence, might have lasting adverse consequences for brain development and causes addiction, which may lead to sustained use of tobacco products.7 Currently, the U.S. Food and Drug Administration (FDA) Center for Tobacco Products regulates cigarettes, cigarette tobacco, rollyour-own tobacco, and smokeless tobacco. In 2015 FDA issued a proposed rule that will extend its authority to cover additional tobacco products such as e-cigarettes.8 The recommendation to have e-cigarettes regulated as a tobacco product is strongly supported by the American Thoracic Society, the American College of Physicians, and the American Academy of Pediatrics, among others.9,10,11

THESE RECOMMENDATIONS ARE BASED UPON THE FOLLOWING: E-cigarettes are NOT an FDA-approved quit tobacco device.12 E-cigarettes are NOT a safe alternative to other forms of

tobacco.12 E-cigarettes may be particularly attractive to youth due to their

novelty.12 Recent studies show that use of e-cigarettes may encourage

traditional cigarette use by adolescents.13 The number of calls to poison centers involving e-cigarette

nicotine liquids rose from one per month in September 2010 to 215 per month in February 2014.14 Yet, while e-cigarette use has skyrocketed over the last few years, much remains unknown about the effects on individual or population health, as no data exists yet regarding long-term neoplastic, respiratory, or cardiac risks.15 So while I applaud my family member and others for looking for ways to cut back or quit tobacco use, long-term studies are needed to determine the safety and efficacy of e-cigarettes. Studies such as those are vital to informing public health and healthcare providers about the health effects of aerosolized substances comprising flavored nicotine liquids, and whether use of e-cigarettes definitively decreases the use of traditional cigarettes.15 8


January / February 2016

REFERENCES 1. Bartter T. Electronic Cigarettes: Aggregate Harm. Annals of Internal Med. 2015; 163(1):59-60. 2. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 Available at: http://www.surgeongeneral. gov/library/reports/50-years-of-progress/index.html Accessed November 23, 2015. 3. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2013. Morbidity and Mortality Weekly Report 2014;63(47):1108–12. 4. Grana RA, Ling PM. “Smoking revolution”: A content analysis of electronic cigarette retail websites. Am J Prev Med 46(4):395–403. 2014. 5. King BA, Patel R, Nguyen K, et al. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010-2013. Nicot & Tob Res. 2015; 17 (2): 219-227 6. Schoenborn CA and Gindi RM. NCHS Data Brief. Electronic Cigarette Use Among Adults: United States, 2014. October 2015, Number 217, Available at: http://www.cdc.gov/nchs/data/databriefs/db217. htm. Accessed November 23, 2015. 7. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students — United States, 2011–2014. MMWR 2015; 64(14);381-385. 8. US Federal Drug Administration. E-Cigarettes. Available at: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm. Accessed November 23, 2015. 9. Leone FT, Douglas IS. The emergence of e-cigarettes: a triumph of wishful thinking over science [Editorial]. Ann Am Thorac Soc. 2014; 11:216-9. 10. Crowley RA, for the Health and Public Policy Committee of the American College of Physicians. Electronic nicotine delivery systems: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015;162:583-4 11. The American Academy of Pediatrics. The American Academy of Pediatrics Issues Sweeping Recommendations on Tobacco and E-Cigarettes - See more at: https://www.aap.org/en-us/about-the-aap/ aap-press-room/pages/Tobacco-and-E-Cigarettes, October 25, 3015. Available at: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Tobacco-and-E-Cigarettes.aspx. Accessed November 23, 2015. 12. Michigan Department of Health and Humans Services. A Primer on Emerging Tobacco Products, Available at: http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2973-340369--,00.html. Accessed November 23, 2015. 13. Lauren M. Dutra LM, Glantz SA.Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents, A Cross-sectional Study. JAMA Pediatr. 2014;168 (7):610-617 14. Centers of Disease Control and Prevention. Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014. 2014; 63(13);292-293. 15. Drummond MB. Electronic Cigarettes: Perhaps the Devil Unknown Is Better Than the Devil Known. Annals of Internal Med. 2015; 163(1): 61-62

Serving healthcare providers for over 30 years

Volume 115 • No. 1







t feels like the federal government is rushing physicians to adopt EHRs that don’t provide physicians with the support they need to provide quality physician-patient care. Instead, compliance with government-imposed “Meaningful Use” objectives creates a costly burden and impractical expectations. It prevents physicians from providing the highest level of care for their patients. What recourse do physicians have to express their concerns?

The federal government’s Meaningful Use (MU) program requires that physicians adopt electronic health records (EHRs) or receive lowered Medicare payments. However, physicians want assurances that they are investing in the right EHR systems that will help them improve patient care in an efficient and thoughtful manner. Although initial MU incentives have helped to spur adoption, more than 80 percent of physicians have EHRs in their practices, only 12 percent of physicians have been able to successfully participate in Stage 2 of MU. This statistic highlights the need to adopt policies that help physicians embrace new technology while eliminating regulations that hold back progress. Over the past several years, physicians have been bringing to the forefront problems with the program and asking for remedies that would support physicians in providing the best care possible for patients. These remedies need to include the development of innovative EHR technologies that meet the needs of physicians and their practices and that advance the sharing of patient data among the professionals who are providing their care.

“Break the Red Tape” Campaign In response to the physician outcry against the Meaningful Use requirements, the American Medical Association (AMA) launched it’s “Break the Red Tape” cam10

paign. It includes a website (BreaktheRedTape.org), and other initiatives designed to help inform and include physicians in the discussion about making changes to the program. As part of that effort, the AMA is encouraging physicians to visit BreaktheRedTape.org to tell Congress and relevant agencies how rushing MU Stage 3 creates a costly burden and limits innovation. The premise is that forcing physicians to adopt costly and complicated EHRs on an unrealistic timeline entangles both patients and physicians in problematic red tape. The outcry against EHR adoption and use has lead to myth that physicians don’t want to use technology. This is actually false. Surveys show that physicians and care teams actually embrace new technology that helps to prevent disease, and diagnose and treat patients. Most physicians use tablets, personal and desktop computers and smart phones to streamline their day-to-day work. However, current versions of EHRs and the MU regulations can make their daily jobs more complicated and can lead to issues that decrease satisfaction for both the physician and the patient, such as increased wait time for patients, decreased time spent with patient/physician, and inconsistency in information. AMA President Steven Stack, MD, stated, “We want to promote interoperability of EHRs, improve usability and increase patient engagement.” MICHIGAN MEDICINE

ONC Complaint Online Form The Office of the National Coordinator (ONC) has developed an online complaint form to assist physicians with issues related to their EHR. The complaint tool is designed to ensure your issue or concern gets to the appropriate person at the ONC or other department within the federal government. As challenges and changes arise, physicians are encouraged to contact their vendor as a first step towards resolving any issues. If your issue is related to the products certified capabilities, then you should contact the ONC – Authorized Certification Bodies, who should be able to work with you to find a resolution. If the issue remains unresolved, submit your complaint to the ONC via the online complaint form. Keep in mind that logging your complaint may not resolve your complaint, but will allow for further conversation between you, your vendor, and the ONC to address the issue and make changes. It is the goal of the ONC to provide a more centralized and streamlined customer service process that will not only aid the physician’s complaint reporting process, but help find ways to address information blocking and improve security, safety and usability of EHRs. For more information or to view the complaint form, visit HealthIT.gov/ healthitcomplaints.

MSMS and organized medicine ongoing activity MSMS, along with the AMA and over 100 other medical societies, recently sent a joint letter to Congressional leaders asking Congress to take immediate action to refocus the Meaningful Use (MU) program on the goal of achieving a truly interoperable system of electronic health records. The letter stressed that the MU program has grown into a “morass of regulation,” “failed to focus on interoperability,” and “created January / February 2016

new barriers” to data exchange across care settings. Below are some excerpts from the letter highlighting the importance of program redesign, realistic and appropriate expectations, and evolving technology that truly provides the information sharing and tools necessary to improve patient care.

Steps you can take.

“Congressional action to refocus this program is urgently needed before physicians, frustrated by the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements, abandon the program completely.”

Engage with MSMS

“…as the regulatory scheme to measure “meaningful use” of this technology has evolved, the Centers for Medicare & Medicaid Services (CMS) has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”

2. Keep up on current topics and events by receiving and reading Friday’s Medigram email blast.

“We believe that the success of the program hinges on a laser-like focus on promoting interoperability and allowing innovation to flourish as vendors respond to the demands of physicians and hospitals rather than the current system where vendors must meet the ill-informed check-the-box requirements of the current program.” Also, it is important to remember that MSMS and AMA policies concerning the MU program and EHRs are driven by active delegates to each organizations respective House of Delegates (HODs). The HOD is the official legislative and policy-making body of MSMS and the AMA. During these meetings, resolutions are one of the vehicles used to debate and determine the policies, priorities, and direction of MSMS and the AMA during the ensuing 12 months and beyond. For example, at the 2015 MSMS HOD meeting, a resolution was adopted supporting efforts to advocate the Centers for Medicare & Medicaid Services suspend penalties to physicians and health care facilities for failure to meet Meaningful Use criteria. Recently, at the 2015 AMA Interim HOD meeting, new policy was adopted supporting efforts to accelerate the development and adoption of universal and enforceable EHR interoperability standards for all vendors before the implementation of Medicare’s Merit- Based Incentive Payment System (MIPs). Volume 115 • No. 1

1. Email your members of Congress via http://msms.org/engage. Via the website, it takes less than a minute to let them know that the nation’s patients and physicians need significant changes to Stage 3 of meaningful use.

3. Participate in MSMS’s House of Delegates (HOD) meeting as a delegate or as a resolution author. The MSMS HOD meets annually in the spring. The best way to get your idea or recommendation adopted as a Society policy or directive is at the grassroots level. To do so, present your suggestion and rationale at your county medical society meeting. If the county agrees, the county will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired Society policy or directive for Society action. If the county does not agree with your idea, you can ask another delegate to submit a resolution on your behalf as an individual delegate. It is also prudent to check the Society’s current Policy Manual and, if relevant, the AMA Policy Finder to determine if policy on the issue already exists.

Check-out the AMA’s “Break the Red Tape” website Through this website, you can: 1. Email your members of Congress. Via the website, it takes less than a minute to let them know that the nation’s patients and physicians need significant changes to Stage 3 of meaningful use. 2. Share your story. Join your peers in telling your story about how meaningful use regulations are affecting your patient-physician relationships.

File a Complaint. Use the ONC Online Complaint Form at HealthIT.gov/healthitcomplaints.



It’s Time for Change! Conversations About Maintenance of Certification Maintenance of Certification brings up one consistent question among Michigan physicians: Why?

Why are we paying thousands of dollars to bring zero value to our patients? Why are we subjected to redundant, non-specialized modules and procedures? Why is MOC continuing to be regulated? In this issue of Michigan Medicine, we talk to three physicians about their frustrations with MOC and how this bureaucratic requirement is affecting their practice and patients. Their stories and many others are fueling change and inspiring advocacy campaigns such as Michigan State Medical Society’s recent Right 2 Care (www.right2care.org) initiative, which aims to eliminate unnecessary requirements in Michigan.

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January January // February February 2016 2016

Patients and Physicians in Michigan have a Right 2 Care Michigan Patients have a right to high quality health care from a physician of their choice.

How does Maintenance of Certification Hurt Patients and Physicians?

Michigan Physicians have a right and a responsibility to deliver high quality care to their patients.

Physicians already maintain education requirements to keep their licenses to practice medicine and have the right to deliver high quality health care to their patients, but:

Those rights are at risk because of a bureaucratic nightmare known as “Maintenance of Certification,” and a reckless new health insurance company plan that could cut off patients’ access to the physicians they know and trust! That’s not just a hassle- that’s dangerous.

• Maintenance of Certification is an out-of-state scheme that drives up the cost of health care while limiting physicians’ time with their patients. • A new health insurance company plan may use MOC to force some patients to leave the physicians they’ve grown to know and trust.

What is Maintenance of Certification? As physicians’ careers advance, they take part in continuing medical education programs that help them keep current with advancements in medicine and patient care. The costs of this testing and training are paid by each physician, and are necessary to allow them to practice in Michigan. Here’s the problem: the American Board of Internal Medicine, or ABIM, devised a way to make huge profits through regular, additional, duplicative and unnecessary Maintenance of Certification (MOC). Now, some health plans and insurance companies in Michigan are threatening to cut off patients’ access to their highly trained, highly qualified physicians unless those physicians jump through bureaucratic hoops.

Defending Michigan Patients Right 2 Care. Patients deserve access to high quality health care. New legislation in Lansing would make sure they get it. Senate Bills 608 and 609 and House Bills 5090 and 5091 will protect and defend: • A patient’s right to the health care and support they need from the physician they choose. • A physician’s right to provide quality care to patients without costly, troublesome “pay to play” requirements. • A state’s right to create a health care system that works for everyone.

MSMS is proud to have established the R2C campaign to fight MOC. We need your financial support to be successful. It’s time to fight for Michigan’s Right 2 Care. Contribute today at http://right2care.org.

Volume 115 • No. 1



Megan M. Edison, MD Pediatrician, Brookville Pediatric and Internal Medicine

Q: When did you begin advocating against MOC and why? A: Like many pediatricians, my concerns with MOC started in 2010 when the American Board of Pediatrics again revised their program to a more expensive and ongoing MOC program, without any evidence these changes would improve patient care. Pediatricians tried to voice our concerns, but we felt alone and easily intimidated in the fight. It really wasn’t until the past two to three years when American Board of Internal Medicine tried to force these same continuous MOC programs on the internists that this issue really gained attention. Since then, we’ve all come together as physicians to speak out against this MOC scheme affecting us all. I am a young pediatrician, with 25 years left in my career. In just eight years, I’ve watched the ‘mission creep’ of MOC go from an open book every seven years, to a secure exam every seven, to the five year cycles of secure testing, online testing and practice improvement modules it is now. The American Board of Pediatrics is already starting discussion of weekly testing and direct access to our charts for research data. At a certain point, we have to get involved in the process, and say ‘enough.’

Q: Tell me about a situation when MOC clearly affected your practice and/or one of your co-workers’ practice. A: In Michigan, the issue of MOC is more pressing for our physicians than for doctors in other states because Blue Cross Blue Shield of Michigan (BCBSM) requires board certifica-

tion and MOC to participate. In other states, doctors can simply choose not to participate in MOC without consequence. In Michigan, doing so will result in loss of insurance participation. This isn’t just an idle threat by BCBSM. This year, one of my partners was a few weeks late turning in data for a ‘hand washing module’, where patients rate our hand washing and the data is sent to the American Board of Pediatrics. He was immediately notified by BCBSM that he could no longer see his BCBSM patients until he complied with MOC. This means these out-of-state board corporations with their ever-changing MOC requirements have incredible power to end relationships between doctors and patients.

Q: Tell me about your involvement in the Right 2 Care campaign and why you feel that this campaign will help bring change. A: My involvement in the Right 2 Care issue dates back to helping write the very first anti-MOC resolutions at the 2013 House of Delegates, and then sitting on committees in the 2014 and 2015 House of Delegates listening to my colleagues present their anti-MOC resolutions. The passion and unity of physicians around MOC is simply unprecedented. It’s exciting to be part of the process where physician concerns become resolutions, resolutions become MSMS policy and now hopefully MSMS policy becomes state law. If Michigan becomes the first ‘Right 2 Care’ state, meaning MOC would not be required for a medical license, insurance participation

“If Michigan becomes the first ‘Right 2 Care’ state—meaning MOC would not be required for a medical license, insurance participation or hospital privileges—many positive transformative changes would happen for doctors and our patients.”



January / February 2016

or hospital privileges, many positive transformative changes would happen for doctors and our patients. Michigan doctors would be free to choose continuing medical education that best suits our needs and our unique patient populations, rather than the limited proprietary products from the boards. We would be free to pursue relevant clinical research and novel practice improvement projects, rather than the irrelevant projects chosen by the boards. Right 2 Care legislation would improve medical access and patient choice, as doctors won’t be dropped from insurances for not participating in MOC and our more experienced doctors won’t be considering early retirement to avoid another costly and time consuming MOC cycle.

Q: If MOC were to continue being regulated, what would you change about it to make it more reasonable and relevant for doctors? A: I don’t believe the American Board of Medical Specialties and their boards will change their highly lucrative MOC program unless doctors are given a choice to stop participating or are allowed to certify through competing boards like the National Board of Physicians and Surgeons. Only when we are given freedom to choose, will change happen. Any MOC requirements must be straightforward, egalitarian, inexpensive, and physician-focused. After certifying, re-certifying and re-re-certifying through the American Board of Pediatrics, I have had enough. I am currently maintaining my pediatric board certification through the National Board of Physicians and Surgeons, because their requirements reflect my ideals of what MOC should be: Pass the board examination once, hold an active, unrestricted state medical license and demonstrate commitment to ongoing education through 50 hours of Continuing Medical Education (CME) every two years. That is more than adequate.

Volume 115 • No. 1

Megan M. Edison, MD and Srinivas K. Janardan, MD



Srinivas K. Janardan, MD Gastroenterologist, Grand River Gastroenterology

Q: When did you begin advocating against MOC and why? A: I have been involved in the certification and recertification process for the American Board of Internal Medicine for the last 20 years. I initially took my Internal Medicine boards in 1991; in 1995, I took my gastroenterology boards. I’ve elected not to recertify in Internal Medicine. I have retaken my Gastroenterology boards in 2005 and most recently in 2015. In the last two years, I have been very disappointed with the new requirements of the MOC process. The high failure rate in Gastroenterology boards has made this a very stressful test. It is this that has led me to be very active in opposing the MOC requirements. When looking at the pros and cons of the MOC, it is clear that it does not add value to me as a clinician or to my care of my patients. It has become a right of insurability and paperwork. It has become a very stressful event with no significant game. I do not find it helpful as a form of education. I do not find it helpful in improvement of my practice. The endless number of practice improvement modules are worthless for gastroenterology. There is significant overlap with multiple other agencies and requirements for us as physicians. The excessive cost, time requirements and time away from family has made these MOC requirements unreasonable.

“I believe the MOC process is an outdated method, even though it was just started in the last few years. It does not address how physicians practice. It does not take into account how physicians research information and collaborate with other physicians. It does not address how physicians learn as practicing physicians rather than as residents and fellows.”

In July 2013, I was elected Chief of Staff at Mercy Health St. Mary’s (MHSM). During the same time, I have had to recertify in Gastroenterology. As Chief of Staff, I sent out a survey and fact-finding email to all of the medical staff at MHSM. Many medical staff shared my opposition to the recertification and MOC process. I received numerous emails from the medical staff in support of my efforts to overturn this process. Recently, I have been elected to the board of MHSM. In this position, I have presented this same opposition and asked for support to oppose requiring the MOC for the medical staff. It is my hope that we will get MHSM bylaws changed in the near future. Unfortunately, insurance companies such as Blue Cross Blue Shield have been unwilling to change or look for alternative certification. It is this reason that I believe state legislation will be necessary.

Q: Tell me about a situation when MOC clearly affected your practice and/or one of your co-workers’ practice. A: I have seen high quality physicians fail the test and then be dropped from insurance reimbursement. In addition, I have seen physicians who came from abroad that are not allowed to take these tests. As such they have been excluded for participating in insurance company reimbursement. These are world experts that are excluded from practicing here in Grand Rapids. Again, for no specific reason apart from rigid requirements. In the end, our patients are losing high quality care.

Q: If MOC were to continue being regulated, what would you change about it to make it more reasonable and relevant for doctors? A: I believe the MOC process is an outdated method, even though it was just started in the last few years. It does not address how physicians practice. It does not take into account how physicians research information and collaborate with other physicians. It does not address how physicians learn as practicing physicians rather than as residents and fellows. The Gastroenterology associations are starting a process of continuing education that would be far superior to the MOC methodology. Our Gastrointestinal (GI) societies are going to be very active in overriding the American Board of Internal Medicine MOC. It is my hope that this will become a reality within the next one to two years. Certainly, I hope I will not have to go through the recertification and MOC process for last 15 years of my career!



January / February 2016

Josephine P. Dhar, MD Chief and Program Director, Internal Medicine, Central Michigan University School of Medicine; Adjunct, Internal Medicine, Wayne State University School of Medicine

Q: When did you begin advocating against MOC and why? A: It was through the Michigan State Medical Society

(MSMS) that I originally became involved. I’m on the editorial board and I very clearly started to express my opinion on MOC and that it’s a burden on the practice. I’ve been in an academic setting, and so I appreciate the difference between an academic setting and a private office or community setting. We have the advantage of having training programs [at Central Michigan University School of Medicine] and so for us, it’s not as difficult. But for people that practice to start implementing these type of educational activities in their office, it’s just overly burdensome. When I did the MOC modules, there were no modules for Rheumatology, which I thought was silly. So in my busy academic practice, I was doing modules on cardiovascular disease and hypertension which did nothing to improve my patient care. I’m a rheumatologist and there were no rheumatology MOC modules.

Q: Tell me about a situation when MOC clearly affected your practice and/or one of your co-workers’ practice. A: I just remember walking in to a patient’s room and say-

ing ‘do you mind doing this questionnaire for me because I need to do it for my certification.’ It was just odd to ask them to help me get my certification. And then after that, I would still have to extract data from their chart into my questionnaire because it requires certain information. I just remember patients saying ‘Why are you doing this Doctor Dhar?’ and they always said, ‘Okay, I’ll help you.’ The patients were really nice, I think the patients are just wonderful trying to help their doctor. It was an imposition on the visit, and then I had to explain to the patient it wasn’t research, I had to do it for my course. It’s just awful the way you have to insert it into your practice. Not only did it not help my practice, but it interfered with the patient.

Q: If MOC were to continue being regulated, what would you change about it to make it more reasonable and relevant for doctors? A: I don’t understand what the purpose of MOC is. We’re required to get continued education and credits every year and most of us are attending specialized meetings and so we’re already learning about our field. How is MOC different than that? Josephine P. Dhar, MD

To learn more about MOC and the Right 2 Care initiative, visit www.right2care.org and join the fight.




Overcoming the Stress of Malpractice Litigation: Solutions to Help Physicians Stay Healthy and Engaged BY DAVID P. MICHELIN, MD, MPH (Contributed by The Doctors Company)


magine the scene: You’re in your busy office on a typical day

when a letter arrives— a patient is suing you for malpractice...

If the lawsuit proceeds to trial, the process can be lengthy, dominating your personal and professional life for a year, two years, or more. But as I learned during my own litigation experience, there are steps you can take to ease the strain you’re under, allowing you to continue to serve your patients and maintain healthy relationships with those around you.

Prepare Thoroughly First, take a deep breath—and then prepare. Approach the lawsuit simply as an unfortunate consequence of practicing medicine, the price of being a physician. In today’s medical climate, a lawsuit is essentially inevitable, especially if you conduct procedures. Treat the litigation as another necessary part of your career, and take the same approach as you would toward other hurdles like a board exam. Be meticulous. Go over your chart. Familiarize yourself with every aspect of the case. Be ready for your meetings with your attorney, and take an active role in your defense. Above all, prepare for the witness chair by taking part in litigation education, especially a mock deposition.

Reach Out Although you can’t divulge the clinical details of a current claim to family members, you can talk with them about how it is affecting you. By opening up to your spouse, children, and other family members, you can help prepare them and ease your own burden. Seek their input and advice. This can help you overcome the feelings of isolation that often accompany a malpractice claim. Doctors often have a tough, go-it-alone mentality. But this is the bottom line: Don’t go into a shell. Talk to somebody.

Make Yourself a Priority Every profession has its stresses, but doctors’ stresses are unique. Overwhelmed patients share with us their innermost thoughts and concerns. To the everyday stresses of our profession, add the stress of fighting a lawsuit to defend your reputation—more than ever, it becomes imperative that you take care of yourself. Don’t hesitate to make yourself your first priority. Do whatever you need to do to unwind. This might be physical exercise like running or biking, or it might simply involve becoming more engaged in other personal interests. If you’re not blocking out time to decompress, you’re doing a disservice to yourself, your case, and your patients. David P. Michelin, MD, MPH, is a gynecologic oncologist in Traverse City, Michigan. 18

Rising Above the Challenge Ultimately, after two trials spanning two-and-a-half years, I was completely exonerated by the jury. By adopting certain strategies, I was able to mitigate many of the negative effects so many doctors experience. You can still maintain your self-assurance, keep your relationships intact, and continue to provide the vital medical care on which your community relies. MICHIGAN MEDICINE

January / February 2016

Volume 115 • No. 1



Winter 2016 Education Course Offerings FREE “LUNCH AND LEARN” SERIES Grab a lunch, click the link, and join us! These FREE short and interactive

 MSMS On-Demand Webinars: Education When You Want It!  Physician Executive Development Programs:  Health Care Law for Physicians in ACO’s

monthly online updates are designed

 Medicaid Issues and Trends: Outlook for 2014 and Beyond

to explore key policy issues impacting

 In Search of Joy in Practice: Innovations in Patient Centered Care

physicians in the state of Michigan.

 From Physician to Physician Leader

It’s more than a presentation…

 Inter-Professionalism: Cultivating Collaboration

insights are solicited from participants

 Financial Information Analysis, Budget Development, and Monitoring

and encouraged interaction with our

 Choosing Wisely

experts. To find out more information and register for one of our upcoming

 Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction

webinars, follow this link:

 CDL-Medical Examiner Course


 Legalities and Practicalities of HIT including:


 Cyber Security: Issues and Liability Coverage  Engaging Patients on Their Own Turf: Using Websites and Social Media  Summary of the Affordable Care Act  HIPAA Security Rule  End of Life Concerns and Considerations  What’s New in Labor and Employment Law  Preparing for the Medicare Physician Value-Based Payment Modifier  Understanding and Preventing Identity Theft in Your Practice  Stepping Up to Stage 2  Physician On-line Rating and Reviews: Do’s and Don’ts  Patient Portals as a Tool for Patient Engagement

Please visit www.msms.org/eo for complete listing.



January / February 2016

Questions? Phone MSMS Registrar at 517-336-7581




1 CLICK online at

Date: Wednesday, March 16, 2016 Location: MSMS Headquarters, East Lansing Intended for: Physicians, nurses, residents, students, and all health care professionals. Note: Continental breakfast and lunch will be provided. Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org


Date: Thursday, May 19 Location: Somerset Inn, Troy Note: Continental breakfast and lunch will be provided Intended for: Physicians, nurses, residents, students, and all health care professionals working with women and their infants. Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org


2 CALL (517) 336-7581 3 FAX registration

form (517) 336-5797

4 MAIL form: MSMS Foundation 120 W. Saginaw St. East Lansing, MI 48823


Morning, afternoon and evening clinical courses available Date: Thursday, May 19 and Friday, May 20 Location: Somerset Inn, Troy Contact: Marianne Ben-Hamza 517-336-7581or mbenhamza@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians and all other health care professionals

 151ST MSMS ANNUAL SCIENTIFIC MEETING Morning, afternoon and evening clinical courses available Date: Tuesday, October 25 through Saturday, October 29 Location: Sheraton, Novi Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org Note: Continental breakfast and lunch will be provided. Intended for: Physicians and all other health care professionals


Details coming soon on this June 2016 conference.

For more information or to register on-line please visit www.msms.org/eo Volume 115 • No. 1



OBITUARIES The members of the Michigan State Medical Society remember with respect their colleagues who have died. Gali Subbareddy, MD Genesee County Medical Society | Died September 6, 2015 Henry Krystal, MD Oakland County Medical Society | Died September 8, 2015 Hernan Lescay, MD Muskegon County Medical Society | Died September 11, 2015 Joseph Schirle, MD Oakland County Medical Society | Died September 23, 2015 Joseph Weiss, MD Wayne County Medical Society | Died September 25, 2015

∫ IN MEMORY ¢ If you would like to recognize a colleague by making a gift or bequest to the MSMS Foundation in their memory, please contact: Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw St., East Lansing, MI 48823 phone: 517-336-5729 email: rblake@msms.org

Patients trust you. You can trust Kerr Russell. A successful practice requires more than talented individuals and a desire to heal. Let Kerr Russell provide the legal insight needed to manage and grow your business. ENTITY FORMATION • BUSINESS MATTERS • EMPLOYMENT CONTRACTS • PURCHASE / SALE OF OWNERSHIP INTERESTS • MALPRACTICE AND ALL OTHER COMMERCIAL LITIGATION • APPEALS • MEDICAL STAFF PRIVILEGE DISPUTES HOSPITAL RELATIONS MATTERS • HEALTHCARE FRAUD DEFENSE • LICENSING AND OTHER REGULATORY MATTERS



For more information, please contact: Daniel J. Schulte dschulte@kerr-russell.com Patrick J. Haddad phaddad@kerr-russell.com

500 Woodward Avenue, Suite 2500 Detroit, Michigan 48226 T: 313.961.0200 / F: 313.961.0388


Established 1874



January / February 2016



Would You Like To Place A Classified Ad? The rate for classified advertising in Michigan Medicine, including both print and online versions, is $1.60 per word, with a minimum of $65.00. All ads must be prepaid. Text for classified advertisements and advertising fee should be received no later than the first of the month proceeding the month of publication. All submitted ads must be typed. No handwritten or dictated ads will be accepted. To place an ad call Carl Mischka at 888-666-1491 or email carl@mischka.us.

Office Condominium For Sale in Battle Creek, MI 2,250 sq ft, $90,000, OBO. Great view of Kalamazoo River. Email earlee13@sbcglobal.net for details.

» Email earlee13@sbcglobal.net for details

Orthopedic Surgeon and/or Neuro Surgeon to lease office space in a very busy Interventional Pain Practice with two locations.

Call Amy at 586-757-4000

Looking for a DME Supplier to lease 1100 sq ft of

office space in a very busy Interventional Pain Practice with two locations.

DON’T RENT – Own Your Own office

Call Amy at 586-757-4000

Why pay rent to someone else? Own your office! 1079 sq. ft. suite in Farmington Hills medical/dental building. EZ access to all X-ways. Price slashed!! $110K.

Anesthesiologist to give conscious sedation 2-3 days a

» Call 248-637-9700

week for a Pain Center in Warren. Generous compensation.

Call Amy at 586-757-4000

Actively Seeking Physicians

Family Medical Practice For Sale

We are actively looking for the following Physicians

Manistee, MI practice located on Lake Michigan, just 60 miles southwest of Traverse City

(With or Without Building)

to work in Southwest Michigan: Family Practice (Outpatient and/or both Out/Inpatient Internal Medicine • Orthopedic Surgeon General Surgeon • OB/GYN and GYNs Gastroenterology • Urology Non-invasive Cardiology Mid-level (NP and/or PA) for Orthopedics Must be either Board Certified or Eligible, a team player, have good communication skills, and enjoy rural areas. Employed with possible sign on bonus, relocation, benefits, malpractice, etc. Rural area, located near Indiana border, not far from Kalamazoo, Chicago and Detroit. Good schools, churches, downhill skiing, hunting, and fishing at numerous lakes in the service area. Contact: If interested, forward CV and contact information to Cindy Dilley at WhitneyRecLLC@aol.com or call 269-506-4464.


• • •

Practice has been in business for 15 years; licensed as a Rural Health Care Clinic for 11 years. Owner retiring in 2016; business arrangements with new owner are flexible. Located in stand-alone building in Manistee Historical District. Renovated in 2006. 2 BR apartment upstairs.

Contact: If interesteed contact Bill Sawhill, Manistee Family Health Care, 110 Washington Street, Manistee, MI. Call 231-633-7417 or email wsawhill@gmail.com.


January / February 2016

EMPLOYMENT OPPORTUNITIES Open Positions: [ MD/ DO/ DPM ] Primary Care • Pain Management • Psychiatry Podiatry • Ophthalmology • Wound Care

Residential Home Care, Inc.

Corporate Office: 11477 E. 12 Mile Road, Warren, MI 48093 Telephone: (586) 751-0200 • Fax: (586) 751-0414

Dr. Metropoulos, Medical Director Multiple providers needed for our growing practice. No Nights. No Weekends. No On-Call. Full-time or Part-time. Compassionate and skilled practitioners for providing quality care to elderly and disabled patients in their homes. Transportation provided for you, driven by medical assistant in company-owned vehicle. In-home diagnostics are available to assist you with the evaluation, diagnosis, and management of our patients. Clinic opportunities available. If you are interested in more information, please call (586) 751-0200. Please mail, fax, or email us your CV today. Fax: (586) 751-0414 • Email: HealthNetWeb@aol.com

Serving Southeastern Michigan for 55 Years

Working Together With You to Maximize the Financial Health of Your Practice Services Tailored to Your Specific Needs: • Full Billing Services • Credentialing Services • Business Planning • Electronic Health Records

• Accounts Receivable Recovery Services • New Practice Start-Up • Flexible Practice Management Software Options

All Medical Specialties Welcome PH: 248-478-5234 • FAX: 248-478-5307 www.elitemedicalbill.com We Are Your Medical Reimbursement Specialists 24


January / February 2016

Family Practices n Allen Park: Retired Orthopedic Surgeon offering turn key operation. Full PT Lab, receive patient files, lots of potential for a very low price asking $50,000. n East Pointe Primary Care: Near I94 and Kelly Road. 3 Exam rooms, 2 year old practice. Asking $60,000 includes equipment/goodwill and transition. Real estate available. n Farmington Hills: Long established Internal Medicine Practice, 10 Mile/Middlebelt area. Free standing building, 5 exam rooms, lab, x-ray. Very close to Botsford, St. Mary’s, and Providence Novi. Asking $175,000 for practice. n Garden City Internal Med Practice: Long established, majority of patients Medicare. Fully equipped, grossing in excess of $200,000 annually. Asking $70,000. n Mexican Town Detroit: 20 year old Primary Care Clinic. Staff is fluent in multiple languages. Seller financing available, priced to sell, work as you pay terms. Never in 25 years have I had the opportunity to offer more flexible terms. Price reduced to $589,000 for everything including real estate. n Lincoln Park: Walk-in clinic. Very visible, long established, seeing approximately 40 patients daily. Approx. gross income $800,000. Asking $250,000 for practice and $350,000 for real estate.

The first mental health assessment tool that immediately delivers test results Improve Patient Care: GreenLight tests serve as a first line of defense, an early warning system for the detection of mental illness.

Decrease Risk: GreenLight provides a permanent detailed record of testing.

Generate Revenue: GreenLight tests are typically covered by insurance.

n Podiatry Practices Detroit: 2 locations, very successful, grossing in excess of 600,000 annually. Fully equipped. Asking $300,000 for both locations. Real estate available. n Westside Detroit, Primary Care Practice: Established 2005, grossing in excess of $500,000 annually. Fully equipped. Asking $200,000 owner wants to retire.

Medical Buildings For Sale or Lease n Pontiac: Large professional medical building. Three story, suites 5005,000 sq. ft. Across from hospital, acres of parking. VERY REASONABLE rates/terms or buy building for $250,000. n West Side Detroit: 8,000 square feet, multi suites, fully leased. $60,000 pos. cash flow excellent. Brick, single story asking $500,000 or lease for $1.00 square foot plus utilities.

The new measure of mental health GreenLight, a division of StratMedical Inc.

(866) 602-1778 • info@greenlight.md www.greenlight.md GreenLight is an MSMS Practice Solutions Partner, and we proudly offer MSMS members a discount on our services.

For more details contact our practice specialist at Union Reality:

Joe Zrenchik, Broker 248-240-2141 (cell) joezrenchik@yahoo.com 248-919-0037 (office)

A free iPad and training are included when you sign up.

Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices.

Volume 115 • No. 1


To get started, please visit www.greenlight.md. It’s a GO with GreenLight


Five Ways to Get Your Finances In Order In the New Year BY NICOLE GOPOIAN, JD, CFP®


aking the time to organize your finances is a great way to start the year off right. Going through this exercise will provide peace of mind and empower you to make good financial decisions in the year to come. Here are five things you can do to gain insight into your financial position:

1. Know What You Have

Step One: Make a list of what you own (your assets).

Step Two: Make a list of what you owe (your liabilities). The difference between what you own and what you owe is your net worth.

Step Three: Examine your outflows. How much do you spend on an annual basis? Write down the real version. Not the pie in the sky number you keep telling yourself.

2. Find Out Where Important Documents Are Located

Having the proper documents and statements is important, but if you don’t know where they are, they won’t do you much good. Be sure to know your logins, passwords and how to access electronic accounts. Consolidate all paper documents in one place so that you don’t have to go on a scavenger hunt when you need to find them.

3. Know What to Keep and For How Long

Keeping important documents is vital to organizing your financial life. However, if you don’t know what to keep and how long to keep it, you may find yourself drowning in a sea of paperwork. Having a well organized document retention system in place is key to understanding your financial position.

4. Plan for the Unexpected Nicole Gopoian, JD, CFP® is an advisor at WealthCare Advisors, LLC – an MSMS joint venture.

Life is messy. Bad things can happen to good people. Consider what would happen in the case of job loss, illness, divorce or death of a spouse. Evaluate how one of these events could alter your financial position. Determine how it could affect your cash flow and impact your financial goals.

5. Protect Yourself


It’s important to protect yourself against the risk of the unknown. Develop a financial plan and stress test it for the following “What-if?” scenarios: illness, divorce, and death of a spouse. After you review these risks, create an action plan to protect yourself: draft the appropriate legal and estate planning documents, make sure you have adequate cash reserves, invest in portfolio strategy aligned with your risk tolerance, and review your insurance coverage. The only person in charge of making sure you’re ok is you.

A successful journey requires planning, commitment and preparation for the unexpected. Contact WealthCare Advisors today if you need help developing a financial game plan. Our Financial Empowerment Workbook is a great tool to help you get organized and on the right track. Please ask for a copy, we’d love to share! Taking time to invest in your financial well-being is time well spent. MICHIGAN MEDICINE

January / February 2016

INTRODUCING The Michigan State Medical Society’s Medical Opportunities msms.medopps.org Whether you’re just getting started or looking for a change, we have hundreds of opportunities located in a community where you want to live and work.


Volume 115 • No. 1



DOES YOUR MEDICAL MALPRACTICE INSURER KNOW WHICH PROCEDURES ARE MOST FREQUENTLY LINKED TO CARDIOLOGY CLAIMS? THE DOCTORS COMPANY DOES. As the nation’s largest physician-owned medical malpractice insurer, we have an unparalleled understanding of



liability claims against cardiologists. This gives us a significant advantage in the courtroom. It also accounts for our ability to anticipate emerging trends and



provide innovative patient safety tools to help physicians reduce risk. When your reputation and livelihood are on the line, only one medical malpractice insurer



can give you the assurance that today’s challenging practice environment demands—The Doctors Company.



To learn more, call our East Lansing office at 888.896.1868 or visit WWW.THEDOCTORS.COM.


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