Michigan Medicine, Volume 114, No. 2

AWARD-WINNING

MAGAZINE

OF

THE

March/April 2015 • Volume 114 • No. 2

MICHIGAN

S TATE

MEDICAL

SOCIETY

WWW

msms.org

Why is it Great to Practice in Michigan?

Rose Ramirez, MD, MSMS President-elect and owner of Jupiter Family Medicine

IN THIS ISSUE • Minnesota Supreme Court Holds that Medical Staff Bylaws are an Enforceable Contract • Health Information Exchange Improves Referral Management Workflow • Michigan’s Vaccination Waiver Rules are Strengthened

MichiganMedicine

March/April 2015 • Volume 114 • Number 2

AWA R D - W I N N I N G M A G A Z I N E O F T H E M I C H I G A N S TAT E M E D I C A L S O C I E T Y

COVER STORY 10 Practicing in Michigan: Q&A with Rose M. Ramirez, MD We sat down with Rose Ramirez, MD, Michigan State Medical Society President-elect and owner of Jupiter Family Medicine in Belmont, MI, to learn why practicing in Michigan can’t be beat.

Is GME Closing the Door?

State of Michigan Programs MSMS Resources at Your Service

FEATURES 18 Why Michigan Is an Ideal Place to Practice Medicine

BY BILL FLEMING Michigan is an ideal state to practice medicine for a number of reasons. Michigan has a balanced tort environment, low malpractice premiums compared to some nearby states, and effective organized medicine. Michigan also offers natural beauty, recreational opportunities, and Midwest community values to all who choose the Great Lakes State as a place to live and work.

20 Four Ways to Transfer Your Assets After You Die

BY NICOLE GOPOIAN, JD, CFP ® The sheer unpleasantness of thinking about death can prevent us from fully implementing a clear, thoughtful and well-integrated plan that addresses what happens to the money and things we’ve accumulated over our lifetime. There are four main ways that your possessions can pass to people or causes that are important to you.

COLUMNS 4 Ask Our Lawyer BY DANIEL J. SCHULTE, JD Minnesota Supreme Court Holds that Medical Staff Bylaws are an Enforceable Contract

8 HIT Corner BY BRIAN MACK Health Information Exchange Improves Referral Management Workflow

MDCH Update

22

FROM THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Michigan’s Vaccination Waiver Rules Are Strengthened

24 Medical Family Matters

BY KARIN MAUPIN Michigan State Medical Alliance Promoting and Continuing Legislative Action

30 President’s Perspective

BY JAMES D. GRANT, MD Nightmares to Dreams, Dreams to Reality

DEPARTMENTS 23 New MSMS Members

25

Obituaries

26

MSMS Foundation Conferences

27

The Marketplace

Chief Executive Officer JULIE L. NOVAK Committee on Publications LYNN S. GRAY, MD, MPH, Chair, Berrien Springs MICHAEL J. EHLERT, MD, Livonia THEODORE B. JONES, MD, Detroit BASSAM NASR, MD, MBA, Port Huron STEVEN E. NEWMAN, MD, Southfield Managing Editor KEVIN MCFATRIDGE Email: KMcFatridge@msms.org 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.

Advertising CARL MISCHKA 120 West Saginaw Street, East Lansing, MI 48823 888-666-1491, Fax: 949-266-93935 Email: cmischka@msms.org Postmaster: Address Changes Michigan Medicine Hannah Dingwell PO Box 950, East Lansing, MI 48826-0950

Michigan Medicine, the official magazine of the Michigan State Medical Society, 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 Michigan State Medical Society 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 2015 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. © 2015 Michigan State Medical Society

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.

A S K

O U R

L A W Y E R

Minnesota Supreme Court Holds that Medical Staff Bylaws are an Enforceable Contract

BY DANIEL J. SCHULTE, JD

QUESTION:

Can you explain the recent Minnesota Supreme Court decision enforcing Medical Staff Bylaws as a contract? Does this case have any impact on Michigan physicians?

ANSWER: The Minnesota Supreme Court’s decision in Medical Staff of Avera Marshall Regional Medical Center v. Avera Marshall Regional Medical Center contains two favorable rulings for Minnesota physicians. First, the Court held that Medical Staff Bylaws constitute a legally enforceable contract.

Second, the Court held that the medical staff was an entity having standing to sue for enforcement of that contract.

The case was remanded to the trial court and will enable the plaintiffs to pursue claims damages and seek other contractual remedies.

Avera Health Systems purchased this hospital in 2009. In 2012 the board of the Hospital announced that it unilaterally had adopted a new set of medical staff bylaws and repealed the existing bylaws.

The board did not follow the amendment procedures contained in the bylaws being repealed and announced to the physicians on the medical staff that, while their comments were welcome, the board would not make any changes to the new bylaws.

The medical staff and two of its individual physician members sued the hospital. The hospital defended by claiming that the medical staff did not have standing to sue and that the bylaws were not a contract.

The Minnesota Supreme Court disagreed, finding that the medical staff as an unincorporated associations had the right to sue under Minnesota law. The Court further found that there was sufficient consideration from both the hospital and the medical staff to form a contract (the agreement of medical staff members to be bound by the terms and conditions contained in the bylaws in exchange for the hospital’s agreement to allow each member to practice at the hospital).

4

This Minnesota case is not binding on the Michigan courts but may offer a Michigan court guidance to follow when confronted with this issue. The law in Michigan on the issue of whether medical staff bylaws are a contract is unsettled.

There is no precedent establishing that medical staff bylaws in Michigan are or are not a contract. In the most recent case to address this issue (Brintley v. St. Mary Mercy, et al) the U.S. District Court for the Eastern District of Michigan found that the Medical Staff Bylaws of St. Mary Mercy Hospital did not constitute a contract. That court’s decision, however, was based on the lack of certain language in the St. Mary Mercy Hospital bylaws (specifically the lack of a provision requiring the hospital to be bound to accept the recommendations of the medical staff’s peer review committees). The Brintley case offers no indication how a court would have ruled if the bylaws had contained language indicating the hospital’s intent to be bound.

It is unlikely that a Michigan court will ever hold categorically that medical staff bylaws constitute a contract. Instead, this determination will be made on a case by case basis and the specific language in bylaws that are involved in the case will control. For a set of bylaws to be enforced as a contract they should contain language demonstrating the partnership existing between the hospital and the medical staff and that each side intends to be bound to the terms and conditions contained in the bylaws. Consideration from both the hospital and the medical staff must also be shown (e.g. the hospital’s agreement to allow medical staff members to practice at the hospital in exchange for the member’s MICHIGAN MEDICINE

agreement be bound by determinations of the medical staff’s peer review and other committees and the other terms and conditions contained in the bylaws).

Hospitals typically resist efforts to include language in bylaws that may support the bylaws being enforced as a contract, preferring instead to have governing control of the medical staff without the possibility of the bylaws being enforced against the hospital. For this reason, it is important to pay attention to these issues and insisting on this language when creating or revising bylaws. MM Daniel J. Schulte, JD, MSMS Legal Counsel, is a member of Kerr, Russell and Weber, PLC.

ED I T O R’ S NO T E: If you have legal questions you would like answered by MSMS legal counsel in this column, send them to: Kevin McFatridge, Michigan Medicine, MSMS, 120 West Saginaw Street, East Lansing, MI 48823, or at KMcFatridge@msms.org.

March/April 2015

Volume 114 • Number 2

MICHIGAN MEDICINE

5

Michigan State Medical Society the Voice of Michigan Physicians OFFICERS

DIRECTORS

President JAMES D. GRANT, MD, Oakland

District 1 MOHAMMED A. ARSIWALA, MD, Wayne PETER BAUMANN, MD, MPA, Wayne T. JANN CAISON-SOREY, MD, MSA, MBA, Wayne CHERYL GIBSON FOUNTAIN, MD, Wayne THEODORE B. JONES, MD, Wayne JAMES H. SONDHEIMER, MD, Wayne J. MARK TUTHILL, MD, Wayne District 2 AMIT GHOSE, MD, Ingham DAVID T. WALSWORTH, MD, Ingham District 3 JOHN J.H. SCHWARZ, MD, Calhoun District 4 STEPHEN N. DALLAS, MD, MA, Kalamazoo LYNN S. GRAY, MD, MPH, Berrien District 5 ANITA R. AVERY, MD, Kent DAVID M. KRHOVSKY, MD, Kent TODD K. VANHEEST, MD, Ottawa District 6 S. “BOBBY” MUKKAMALA, MD, Genesee JOHN A. WATERS, MD, Genesee District 7 BASSAM NASR, MD, MBA, St. Clair District 8 DEBASISH MRIDHA, MD, Saginaw THOMAS J. VEVERKA, MD, Saginaw District 9 RICHARD C. SCHULTZ, MD, Grand Traverse

President-Elect ROSE M. RAMIREZ, MD, Kent Secretary JOHN E. BILLI, MD, Washtenaw Treasurer VENKAT K. RAO, MD, Genesee Speaker PINO D. COLONE, MD, Genesee Vice Speaker PAUL O. FARR, MD, Kent Immediate Past President KENNETH ELMASSIAN, DO, Ingham

B OA R D OF DIRECTORS Chair DAVID A. SHARE, MD, MPH, Washtenaw Vice Chair S. “BOBBY” MUKKAMALA, MD, Genesee

6

MICHIGAN MEDICINE

District 10 MARK C. KOMOROWSKI, MD, Bay District 11 JAMES J. RICE, MD, Muskegon District 12 CRAIG T. COCCIA, MD, Marquette District 13 JEFFREY E. JACOBS, MD, Houghton District 14 SANDRO K. CINTI, MD, Washtenaw JAMES C. MITCHINER, MD, MPH, Washtenaw DAVID A. SHARE, MD, MPH, Washtenaw District 15 ADRIAN J. CHRISTIE, MD, Macomb BETTY S. CHU, MD, MBA, Oakland SCOT F. GOLDBERG, MD, MBA, Oakland MICHAEL A. GENORD, MD, MBA, Oakland DONALD R. PEVEN, MD, Oakland DAVID P. WOOD, JR., MD, Oakland Ex-Officio EDWARD G. JANKOWSKI, MD, Wayne F. REMINGTON SPRAGUE, MD, Muskegon Young Physician PAUL D. BOZYK, MD, Wayne Resident MICHAEL J. EHLERT, MD, Wayne Student NICOLAS K. FLETCHER, Kent

March/April 2015

Volume 114 • Number 2

MICHIGAN MEDICINE

7

H I T

C O R N E R

Health Information Exchange Improves Referral Management Workflow

BY BRIAN MACK

W

orkflow can make or break a health IT initiative in a hospital or physician organization. Regardless of the requirements for meeting Meaningful Use metrics,

the less aligned a system is with a physician’s office workflow; the less likely it is to be successfully implemented. Ideally, a successful HIT implementation should simplify the manual processes it is meant to replace, freeing the physician and his/her team to better focus on patient care.

In 2011 Mercy Health Physician Partners (MHPP) contracted with Great Lakes Health Connect (GLHC) in the implementation of a Referral Management System connecting 28 primary and specialty care offices. The collaborative approach taken by both organizations overcame the resistance and confusion inherent in any such change. It succeeded in delivering a solution that improved workflow for sending and receiving more than 7,000 referrals each month to 240 affiliated physicians.

Carrie Strom, Network Referral Specialist for MHPP in Grand Rapids, shared some of her experiences both before and after implementing GLHC’s automated referral solution.

MM: What was MHPP’s referral process prior to automating?

Carrie Strom: Prior to [Great Lakes]

Health Connect, the bulk of our work

was manual and paper-based. Scheduling an appointment with a specialist for example required that a handwritten referral form be completed. Each physician’s office typically had their own unique form, which meant that multiple separate forms might be needed to secure an appointment for each individual patient. The patient’s paper record would have to be printed and faxed to each office, followed by multiple phone calls to confirm receipt and to schedule the appointment. There was no formal process to confirm that the patient had kept the appointment, and no seamless way of closing that loop until the patient’s next primary care appointment.

MM: How has that process improved since the implementation?

Carrie Strom: The connectivity and

enhanced communications capability that GLHC’s Referral application provides us has been really valuable. We

About MHPP As one of the largest physician organizations in West Michigan, Mercy Health Physician Partners in Grand Rapids and Muskegon provide a comprehensive network of award-winning primary care physicians and affiliated specialists.

Find out more at www.mercyhealthphysicianpartners.com.

8

MICHIGAN MEDICINE

have been able to significantly reduce the back and forth phone and fax issues between offices. Because the entire process is now centrally managed using a single system, we can search for physicians by name, specialty or geography.

We can also track the status of each referral sent or received, see that appointments have been scheduled, and even receive confirmation that the patient made it to their appointment. It’s a big improvement.

MM: What was your implementation and early adoption experience with the system?

Carrie Strom: We understood from

the start that we needed to have as many of our primary and specialty care physicians engaged and using the application as possible for the system to deliver on its full potential. Things started slowly at first, with champions inside a few offices acting as our early adopters. Gradually momentum began to build, and when both our CEO and CMO got behind the effort things really took off. Today All of the primary care and specialty physician practices in MHPP Grand Rapids are using the Referral application. In addition, most of the independent practices with whom we work and refer to most often are also using the tool.

MM: What have some of the challenges been along the way?

Carrie Strom: One challenge is that

the MHPP primary care offices and the various specialty offices use different EMR products. Luckily from a referral perspective, GLHC’s solutions are platform agnostic, and can send and receive referrals across the entire continuum of care.

March/April 2015

About GLHC Great Lakes Health Connect is a health information exchange

of health care by facilitating the authorized and secure

in Michigan, connecting over 80 percent of the state’s hospital

electronic access and retrieval of critical clinical information

beds and more than 10,000 medical providers, serving

to health care providers.

6.5 million people. The mission of the community-based

For more information, see http://www.gl-hc.org.

nonprofit is dedicated to improving the quality and accessibility

MM: What’s on the horizon for MHPP’s adoption of HIE technology?

Carrie Strom: There is a lot of

opportunity for MHPP to leverage additional tools offered by GLHC. Our internal team today equates [Great Lakes] “Health Connect” with “referrals”. Once that solution is fully implemented there are other capabilities that we hope to introduce such as Direct Messaging and ADT notifications.

Exposing our internal team to the full complement of available solutions is a gradual process.

Volume 114 • Number 2

We also want to better understand the connection between our EHR and HIE systems, and the impact their use has on improving care quality and outcomes. Leveraging the data that we are now capturing and applying it in a meaningful way is still a work in progress.

Since the passage of the HITECH Act in 2009, and the Affordable Care Act in 2010, health care organizations across the country have been tasked with making the significant changes mandated in those laws. Change is always hard, even under the most ideal conditions. An environment as complex

MICHIGAN MEDICINE

and multi-faceted as health care makes broad systemic change exponentially more challenging. Though there remains much still to be done, the scope of what has been accomplished within the U.S. health care system in the last four years is nothing short of miraculous! MM The author is Manager of Marketing and Communications Great Lakes Health Connect.

NOTE: See the next HIT Corner inside Michigan Medicine for more examples of best practices in implementing technology that works towards interoperability.

9

Practicing in Michigan Q&A with Rose M. Ramirez, MD

W

e sat down with Rose Ramirez, MD, Michigan State Medical Society

President-elect and owner of Jupiter Family Medicine in Belmont, MI, to learn why practicing in Michigan can’t be beat.

Q: Why do you believe it’s great to practice in Michigan?

A: I was born and raised in Michigan; I love calling our

state home. Michigan is also home to an excellent medical community, something that becomes increasingly evident the more time I spend with Michigan State Medical Society.

In my capacity as President-elect, I’m fortunate to be able to interact with physicians all over the state. Their commitment to enriching the medical community of which we’re all a part is palpable and inspiring. Pair that statewide commitment with the strong medical schools that have a passion for quality medical education in Michigan, and you have a community built for cultivating a culture of success and quality.

Q: How did you make the decision to go into practice in Michigan?

A: You can’t be as big of an MSU sports fan as I am and live

in another state! The fact that my family is all located in Michigan and that our seasons really can’t be beat made setting up a practice here a no-brainer for me. I did my residency in Florida, but always knew I wanted to return. Also appealing is the level of advocacy and leadership abundant in the state. I’m particularly proud to be in the company of great innovators like Tom Simmer, MD, who took the Patient Centered Medical Home 10

MICHIGAN MEDICINE

March/April 2015

concept and just ran with it. Michigan was one of the leaders in taking the PCMH concept and building it into something that became statewide. It’s an honor to work alongside these kinds of folks.

Q: How would you encourage others to make the decision to practice in Michigan?

A: We have state of the art facilities, state of the art research and a lot of growth and energy around creating institutions that will move us to the next phase of technology and understanding science and medicine. I think we might lose potential residents due to the fact that they’re looking for a residency during the winter months; I’d encourage them to stick around for our beautiful summer, spring and fall! We know that where people do their residency is likely where they’ll set up their practice. Attracting residents includes educating them on all the wonderful things we have to offer I mention above and helping them appreciate what Michigan has to offer in seasons other than our somewhat challenging winters.

Q: How do resources and communities like Michigan State Medical Society make practicing in Michigan a positive experience?

A: Working with MSMS, which is a voice for all physicians in

the state, allows us to come together to create policy and set priorities for what we think is important in our state. Some of these policies and priorities get communicated to the American Medical Association, and many priorities get communicated to

the Michigan legislature State of the art medical facilities, and community health awesome education opportunities, the departments, affecting beauty of changing seasons, a place for change based on our you and your family to grow and play…. recommendations. As a it’s all Pure Michigan.” society, we work to make our state a better place for – Rose M. Ramirez, MD, President-elect, physicians to practice and Michigan State Medical Society a healthier place for our Board of Directors patients. It’s empowering to take things I may see in my daily practice, things that I see firsthand that need to be improved for better care of patients, and take those ideas to our house of delegates to be an advocate for change.

Q: What do you think sets Michigan practitioners apart?

A: We’re focused on education and I think we strive to take

a humanistic approach educating our students and treating our patients. We’re a state of innovators and are dedicated to improving medical education and patient care.

Doctor Ramirez is a long-time MSMS member and active Society leader. She has served as both speaker and vice speaker of the MSMS House of Delegates and will become president of the Society in May of this year. Doctor Ramirez loves being a family doctor and considers it a privilege to be a physician in Michigan. MM

Practicing in Michigan:

Is GME Closing the Door?

A

sk any physician, medical student, hospital or medical educator about the state of graduate medical education,

and you’re sure to get a frustrated response.

“Michigan is actually a talent exporter,” says Randolph L. Pearson, MD, FACSM, FAAFP, director of medical education, assistant dean and designated institutional officer at the Michigan State University College of Human Medicine. “We have a lot of medical school positions and fair number of residency positions, but we find many people who train in Michigan are leaving.”

The reason is varied. Climate. Economy. Spousal or partner employment opportunities. The perceived ability for the resident to gain employment.

Doctor Pearson believes there are ample opportunities for physicians and their families in Michigan.

“We’ve got to figure out how to retain and not export these physicians,” he says. “Marketing Michigan communities to show talent that not only is our state a great place for training, it’s also Volume 114 • Number 2

a great place to raise a family, find a job and access a number of recreational opportunities.”

According to Colin Ford, Senior Director of State and Federal Government Relations at MSMS, GME can serve as an effective recruitment and retention tool.

“Studies repeatedly show that the more a physician is connected to a community, the more likely he or she is to stay in that community,” “Governor Snyder is not just prohe says. “For example, Medicine, he is unparalleled regarding a physician that goes to his emphasis on health care for medical school in Michigan is less likely to stay Michiganders. MSMS makes it in Michigan than someeasier to practice here despite the one who does their mediattempts of a few cal school and residency misguided legislators.” in Michigan. Physicians – Mark C. Komorowski, MD, that do their residency member, Michigan State Medical in Michigan are far more Society Board of Directors likely to locate here than physicians with no previous ties to Michigan.”

MICHIGAN MEDICINE

11

This is a problem when you consider the past efforts to address the shortage of physicians in the state.

“There was a scramble to increase medical school classes and open new medical schools,” says Doctor Pearson. “At the same time, the number of residency spots has stayed flat.”

The funding stream for residencies comes from the Centers for Medicare and Medicaid Services, which Doctor Pearson says has not kept up “Michigan is a great place to practice with the demand at the end medicine because of its diversity. of the medical education There are a variety of practice locales pipeli ne. Michiga n and situations. There is a diversity of continues to have some patients from different cultures and of the highest numbers backgrounds. And Michigan with all of of residency spots in the its medical schools and graduate country. education programs has a diversity “Either there needs to be of medical providers.” a shift in dollars from the – Lynn S. Gray, MD, MPH, government in graduate member, Michigan State programs, or we have a Medical Society paradigm shift in how we Board of Directors fund the program,” he says.

There have been talks about increasing GME funding by the government,

focusing on underserved specialties like family and pediatric medicine and general surgery; so the shift may be on the horizon.

Another big change on the horizon comes from the accreditation perspective. The Accreditation Council for Graduate Medical Education is working toward a single accreditation pathway for allopathic and osteopathic doctors.

“It’s important from a public health perspective that the allopathic and osteopathic worlds come together to ensure good outcomes and encourage consistency,” says Doctor Pearson. “We have an obligation as a GME community to assure our product is a quality product.”

As to the point Doctor Pearson would like colleagues to take away from the GME conversation: “We have so much to offer as medical education community with respect to quality programs and experiences and promoting opportunities in the state for long term practice,” he says. “We must make sure we collectively continue to make sure Michigan is a great place to learn about and practice medicine. When we help private and government sectors move into alignment with one another, we’ll be able to meet and exceed our talent retention goals.”

The State suggests that the most effective way to retain Michigan residents is to offer loan forgiveness programs that provide incentives for residents to study in specific specialties sand to practice in rural or under-served locations. MM

Practicing in Michigan:

State of Michigan Programs Michigan State Loan Repayment Program

T

he Michigan State Loan Repayment Program (MSLRP) helps employers recruit and retain primary medical health care

providers by providing loan repayment to those entering into service obligations. Thirty-eight other states have State Loan Repayment Programs – Michigan has the 4th highest amount of funding in the nation.

The Michigan Department of Community Health (MDCH) announced in December that 64 primary care providers in Michigan’s underserved areas will each receive up to $50,000 in medical education debt relief under the MSLRP. The program received a record number of applications this year and more than doubled the number of new participants from last year.

“The goal of the Michigan State Loan Repayment Program is to improve the access to primary care in Michigan by providing loan repayment as an incentive for health providers to live and work in our state,” said Nick Lyon, director of the MDCH. “In our 12

continual effort to keep our graduates in Michigan, contributing to Michigan’s comeback, this program is an excellent tool for doing so with healthcare professionals.”

2014 represents the highest volume of applicants, number of awardees and amount of funding provided in the 23year history of the program. Recent changes to the statute that created the program contributed to this year’s success.

“Michigan is an environment full of MSLRP is funded by innovation and creativity whether a federal grant, matched it be automotive engineering, new by funding from state funds and a 20 percent technologies or health care. The contribution from the creative physicians and scientists we are recipient’s employer. surrounded by in this state continually Recently, the federal push the envelope on the most innovative funding and the state funding have increased, diagnostic and therapeutic approaches allowing more providto health care.” ers to participate in the – T. Mark Tuthill, MD, member, program. The program Michigan State Medical Society will provide $2.7 milBoard of Directors lion in debt relief in the current fiscal year and provided $1.59 million in the previous fiscal year.

MICHIGAN MEDICINE

March/April 2015

Volume 114 • Number 2

MICHIGAN MEDICINE

13

Michigan passed legislation in 2014 to modernize the program, allowing providers to be able to participate in MSLRP for up to eight years, where previously there was a four-year cap, and can now receive up to $200,000 in total loan repayment, where the previous cap was $120,000. Increasing participation up to eight years gives providers a strong incentive to remain in their underserved communities.

In order to qualify for the program the applicant must provide primary care in an out-patient setting on a full-time basis in a designated Health Professional Shortage Area. HPSAs are areas, population groups and “Top-notch training facilities designated by the facilities and cuttingUnited States Department edge technology.” of Health and Human Ser– James C. Mitchiner, MD, MPH, member, Michigan State Medical vices as having met criteria Society Board of Directors indicating a significant need for additional primary health care resources. The purpose of these designations is to identify areas of greatest unmet primary health care need, such that limited resources can be prioritized and directed to those areas to assist in addressing that need.

MIDocs The MDCH is preparing to work in collaboration with Michigan-based medical schools that choose to participate in the creation of a graduate medical education consortium known as MIDocs.

The purpose of MIDocs is to develop freestanding residency training programs in primary care and other ambulatory carebased specialties. MIDocs calls for the design of residency training programs to address physician shortage needs in Michigan, including placing physicians post-residency in underserved communities across this state, paying special consideration to small and rural hospitals with a GME program director.

MIDocs’ voting members will include any Michigan-based university with a medical school or an affiliated faculty practice physician group that is making a substantial contribution to MIDocs programs – MDCH is a permanent nonvoting member of MIDocs. MDCH, in collaboration with MIDocs voting members, may also appoint nonvoting members to MIDocs to represent various stakeholders. As the sponsoring institution and fiduciary, MIDocs will assure initial and continued accreditation from the accreditation council for graduate medical education or ACGME, financial accountability, clinical quality and compliance.

MDCH will require an annual report from MIDocs detailing per resident costs for medical training and clinical quality measures.

“At this point all Michigan medical schools have agreed to participate except Oakland University,” says Angela Minicuci, spokeswoman for Michigan Department of Community Health.

“MDCH is working with the consortium to identify a vendor to develop a micro analysis of the health care provider needs in the state. We have also met with Public Sector Consultants and they are now finalizing a proposal for us.” MM

Practicing in Michigan:

MSMS Resources at Your Service

H

ow else can we keep the tradition of a robust community of medical practitioners in Michigan?

With resources and advocates like the Michigan State Medical Society as part of the medical ecosystem…

Members of the Michigan State Medical Society have access to a variety of supports and services. MSMS departments cover a range of areas of interest to physicians, practice managers, and other medical staff including education opportunities, legislative advocacy, legal support, payer connections, coding advice, representation on federal and statewide panels and communication on health care hot topics.

Michigan State Medical Society Foundation The Michigan State Medical Society Foundation, the physicians’ own charity, was founded in 1945 as a charitable outlet for doctors wanting to express their compassion and caring beyond the medical office. The MSMS Foundation, a 14

501(c)3 public charity, is supported by physicians and their families through annual contributions, participation in events like the annual Golf and Tennis Classic, and through bequests and other planned gifts.

Twice each year, the MSMS Foundation Board “Michigan’s physicians have created of Trustees makes finanthe most collaborative practice culture in cial grants to community the nation, which dramatically enhances based health programs to further research, educaour ability to work together to transform tion and outreach. Cursystems of care and optimize the quality rent emphases include of the care we provide. While it is a time healthy lifestyle educaof great change and significant stress, tion, youth programs and end-of-life care. there is much to be proud of in The Foundation’s goal Michigan medicine.” is to support a diverse – David A. Share, MD, MPH, group of organizations Chair, Michigan State Medical each year. A sampling of Society Board of Directors programs that Michigan State Medical Society Foundation has recently funded includes:

MICHIGAN MEDICINE

March/April 2015

• Michigan State Medical Society Alliance (Statewide) – to help fund its Immunization Project-In-A-Day program.

• Turning Point, Inc. (Mt. Clemens) – to support the Community Advocacy Program, which provides vital services to families exiting a domestic shelter.

• Hope Medical Clinic, Inc. (Ypsilanti) – to help replace computers and printers at the clinic with technology robust enough to support clinic operations, particularly in the area of Electronic Medical Records.

• Love INC. Free Health Clinic (Grand Haven) – to help equip and upgrade the medical equipment in the clinical exam rooms, which will allow better care of patients and increase the reach of clinic services.

The MSMS Foundation also sponsors more than 150 education conferences annually for physicians, medical office staff and health care leaders. Each year the Foundation also celebrates and recognizes volunteerism among physicians and their “I always wanted to follow in my families. In addition, father’s footsteps, and practice in my the MSMS Foundation hometown. I’ve done just that for operates a loan fund for impaired physicians for 40 years. No regrets!” their rehabilitation.

– John J.H. Schwarz, MD, member, Michigan Above all else, the State Medical Society MSMS Fou ndation Board of Directors supports initiatives to improve health in Michigan, and to inspire others to do the same.

To achieve that goal, the MSMS Foundation works hard to remain a trusted vehicle for physicians and their families to create a lasting health care legacy.

Michigan State Medical Society Education The 2014 year witnessed innumerable changes in the health care system and the way health care is delivered. The Michigan State Medical Society Foundation Center for Physician Education and Leadership (CPEL) stayed current with these myriad changes and provided members with educational opportunities equipping them with information and strategies to navigate the complex health care environment.

2,000 participants attended one of CPEL’s more than 40 education programs held in 2014. Of the 2,000 participants, 1,200 were physicians and 800 were office staff. General categories included health information technology, practice transformation, clinical education, and ICD-10 and coding.

MSMS currently accredits 44 state accredited providers.

In 2013, MSMS’s state accredited providers held over 351 activities, totaling 5,078 hours of education, reaching 32,963 physicians and 10,813 non-physicians. As a state medical society, MSMS has one of the largest number of educational activities offered to Michigan’s health care providers.

Volume 114 • Number 2

“We not only are actively addressing practice gaps for Michigan physicians, but assisting physicians navigate the challenges of practicing in this new model of care,” says Theodore B. Jones, MD, Chair of MSMS’ Scientific and Educational Affairs Committee.

As the state looks to improve the educational environment, MSMS will continue to identify new practice gaps by utilizing national and local practice data and implement educational strategies within its activities whenever possible. The goal being to overcome and address barriers to physician change and advancement.

“I enjoy the people I see in my practice. They are good, hardworking, Midwestern people. The Great Lakes State, is a wonderful four season place with a constant change in scenery that keeps my mind and body active.

Practicing in Michigan, a state with good tort reforms in place, allows me to enjoy making decisions with my patients about their care with less of a concern about liability as my peers in other areas. I am much more comfortable not ordering a test “just to be sure” after discussing the options with a patient, because I know that in a worst case scenario, I have good law to back me up. Good people, good geography, good medical climate: what more can I ask for?”

Health Care – S. “Bobby” Mukkamala, MD, Delivery Vice Chair, Michigan State Medical Society The MSMS Health Board of Directors Care Delivery department is often described as the department that deals with payer, regulatory and system issues that impact the practice of medicine. As a result, areas of responsibility include, but are not limited to: • Practice transformation • Coding and billing • Physician payment models • Building and maintaining payer relationships • Quality and safety • Evidence-based medicine • Legal and regulatory compliance • Health information technology Health Care Delivery team members are available to help members address individual questions and concerns, as well as to monitor and report on global issues of interest. Free to member services offered by the Health Care Delivery department include: • Reimbursement and coding solutions • Legal, regulatory and technology alerts • Referrals to MSMS legal counsel • Presentations on timely topics • Field, research and answer questions

MICHIGAN MEDICINE

15

Health Care Delivery – Legal As the amount and complexity of regulations and payer policies that impact the delivery of health continues to grow, physicians need a trusted resource to help them wade through the intricacies. The MSMS Health Care Delivery team does this by keeping on top of key issues and communicating them with Michigan physicians and medical staff.

MSMS provides members with a variety of legal alerts, checklists and guides addressing timely issues of concern such as government in“I am proud to serve the people of Michigan vestigations, health plan because it has always audits, HIPAA complibeen my home.” ance, patient bankruptcies, – Edward G. Jankowski, MD, member, Michigan State Medical medical records retention, Society Board of Directors and much more.

Additionally, MSMS legal counsel is available to speak to members at no charge on general legal questions applicable to physicians statewide. Special review services such as employment contract and HIT vender contract reviews are provided by MSMS legal counsel at a members-only rate.

“The legal alerts documents and access to legal counsel are very popular,” says Betty S. Chu, MD, MBA, Chair of MSMS’ Health Care Delivery Committee. “We are continually trying to put out information in these easy to read documents based on trending topics identified by our members and their staff.”

For example, the Health Care Delivery department created alerts on Financial “Pure Michigan to pure medicine, it Hardship Policies after can’t get any better receiving several calls to serve my fellow and questions on what Michiganders.” practices can do to help –Mohammed A. Arsiwala, their patients experiencing MD, member, Michigan State Medical Society Board of Directors financial difficulties.

“The MSMS Medical Records Guide for Physician Practices is probably our most popular written resource; followed closely by the HIPAA Guide,” says Doctor Chu. “I’ve heard unsolicited feedback from members who say the value of these documents pay for their membership.”

Health Care Delivery – Coding and Reimbursement Services As the MSMS Reimbursement Advocate, Stacie Saylor assists members with billing and coding issues.

“When physician offices have exhausted the payer resources available to them, and they are not happy with the results, or feel the problem has not been addressed, they can contact me,” says Saylor. “I generally have access to higher levels of staffing within the health plans that often can help resolve the issue at hand.”

Saylor notes that not all state medical societies have a staff person designated for billing and coding assistance with her degree of specialization.

“I think that what we offer our members, in terms of reimbursement and coding assistance, is an advantage compared to other states,” she says. “The payer world is very complicated 16

and you really have to be on your toes. Payers do make mistakes and if you are not vigilant, you may not get paid for something that you should. Having another set of eyes and ears, so to speak, to help understand what is new or even how to navigate the appeals process is valuable. Often physicians hire staff that may not have an education specific to billing/coding. Having help and guidance just a phone call away helps keep the money flowing in. As payer fee schedules are becoming stagnant, every penny counts.”

Health Care Delivery – Health Information Technology MSMS provides members with up-to-date information and assistance with different HIT initiatives such as the Meaningful Use incentive program.

“We create alerts, and check lists, provide articles on hot topics and have subject matter experts to keep up to date with the ever-changing world of technology,” says Doctor Chu. Regardless of the issue, the Health Care Delivery team wants members to know that someone is on their side.

“We are at the table with the health plans, dedicated to trying to make life easier for our members,” says Saylor. “There are so many mandates on a physician’s office now – we want to educate on “Diverse, friendly, down to earth issues that will ease the patients. Beautiful state with easy access burden of doing business to outdoors activities in lakes, rivers and for them, so they can just be physicians and treat forests. Friendly colleagues. Great state their patients.” medical society. Innovative, creative Doctor Chu agrees. programs supporting patient centered “The Health Care Demedical homes and livery team is focused on being another resource population health.”

– a virtual staff person – John E. Billi, MD, Secretary, Michigan State Medical Society – for physicians regardBoard of Directors less of their practice specialty or environment,” she says. “We want to try to eliminate some of the frustration of having to track different programs and requirements by being an accessible resource that gets them an answer in a timely, professional and friendly manner. Additionally, as their liaison to federal and state regulators and payers, as well as other stakeholders, we are continuously working to maintain relationships and multiple communication channels in order to advocate effectively for physicians and their patients.” MM

“Simply…The people.”

– Jeffrey E. Jacobs, MD, member, Michigan State Medical Society Board of Directors

MICHIGAN MEDICINE

March/April 2015

Volume 114 • Number 2

MICHIGAN MEDICINE

17

Why Michigan Is an Ideal Place to Practice Medicine

BY BILL FLEMING

M

ichigan is an ideal state to practice medicine for a number of reasons.

Michigan has a balanced tort environment, low malpractice premiums compared to some nearby states, and effective organized medicine. Michigan also offers natural beauty, recreational opportunities, and Midwest community values to all who choose the Great Lakes State as a place to live and work.

18

Michigan physicians are fortunate to have strong state medical liability statutes, including a cap on noneconomic damages. In 2012, The Doctors Company worked closely with the Michigan State Medical Society (MSMS) and the Michigan Insurance Coalition to draft and lobby for a suite of bills collectively called the “Patients First Reform Package.” This lobbying effort resulted in the passage of two bills – legislation that reinforces the noneconomic damages cap and another that clarifies the statute of limitations and the calculation of prejudgment interest.

Srinivas “Bobby” Mukkamala, MD, an otolaryngologist in Flint, vice chair of the MSMS Board of Directors, and member of our Local Advisory Board in Michigan, is among the physicians who benefit from this tort environment. “Practicing in Michigan, a state with good tort reforms in place, allows me to enjoy making decisions with my patients about their care with less of a concern about liability as my peers in other areas,” Dr. Mukkamala said. “I am much more comfortable

MICHIGAN MEDICINE

March/April 2015

not ordering a test ‘just to be sure’ after discussing the options with a patient, because I know that in a worst case scenario, I have good law to back me up.”

Another reason Michigan is great is effective organized medicine. One of our members, Dawn Springer, MD, a family practitioner at Sparrow Health System in Mason, notes that she has benefited greatly.

“As a family practitioner, I have been able to utilize my training following graduation from Michigan State University College of Human Medicine (MSU CHM) and from the Sparrow Family Medicine Residency in the fullest capacity as a practicing community physician, part-time faculty at the residency program, through my faculty appointment at MSU CHM, and serving on numerous committees in the health system and on insurance company boards,” she said.

“I also had the honor of being elected by my peers as the first woman chief of staff at Sparrow Hospital. These opportunities would not have been afforded to me without a receptive atmosphere in our state and local community, with support from the Ingham County Medical Society (which elected me as president), and MSMS,” she added.

And then there are the geographical benefits of living and working in Michigan. As Dr. Mukkamala stated: “I was raised in Flint, Michigan. I made it as far as Chicago for my residency and then made a U-turn and came back here with my wife, an OB/GYN herself (with newborn twin boys in tow). Now that I have been back for 15 years, I realize that even though friends

Volume 114 • Number 2

that practice in much more ‘desirable’ cities find it crazy that I would be back here in an area that is rarely on anyone’s top 10 list of anything good, it is a great place to work.”

“I enjoy the people I see in my practice,” Dr. Mukkamala added. They are good, hardworking, Midwestern people. They too know I could have gone anywhere to practice, and they appreciate me just as much as I appreciate them. The Great Lakes State is a wonderful four-season place with a constant change in scenery that keeps my mind and body active.”

Dr. Springer echoed the praises of living and working in Michigan. “Michigan has been the most hospitable place for my practice of medicine in the last three decades, initially in private practice and most recently as an employed physician with the health system.”

And we at The Doctors Company, with our northeast regional office in East Lansing, agree that Michigan – the land of “cold winters and warm people” – is a great place to live and to work in advancing, protecting, and rewarding the practice of good medicine. MM

By Bill Fleming is Senior Vice President and Regional Operating Officer of The Doctors Company.

The Doctors Company is the exclusively endorsed medical liability carrier of the Michigan State Medical Society (MSMS). We share a joint mission of supporting doctors and advancing the practice of good medicine.

MICHIGAN MEDICINE

19

Four Ways to Transfer Your Assets After You Die

BY NICOLE GOPOIAN, JD, CFP ®

P

lanning is tough in light of the universal truth that the only constant is change itself. Markets are unpredictable, laws change, and people have unique goals and paths to achieve them. No

two plans are the same. However, another inevitable truth of planning is that we will all die. The sheer unpleasantness of thinking about death can prevent us from fully implementing a clear, thoughtful and well-integrated plan that addresses what happens to the money and things we’ve accumulated over our lifetime.

There are four main ways that your possessions can pass to people or causes that are important to you.

WILL The first way that assets can pass is by will. The will only comes into action when you die. In the case of incapacity, the will can’t accomplish anything. In order to actually follow the instructions in your will, all of your assets and possessions will have to go through the public court process of probate where a judge approves the disposition of your estate. At the end of this process, an inventory of everything you own is filed with the court and becomes public information. Predators can read obituaries and then use this information to get asset inventories from the courthouse. The public nature of this process enables them to determine who had money and then target their grieving survivors as potential victims of financial fraud. Additionally, there are court costs and attorney’s fees associated with the probate process. Probate fees can get expensive and burdensome, especially when you own property in more than one state. For example if you own a condo in Florida, you’ll have to go through ancillary probate in that state too – creating additional costs.

Alexander Ajlouni, M.D. Board Certified in Anesthesia and Pain Medicine Jeffrey J. Kimpson, M.D. Board Certified in Anesthesia and Pain Medicine Jeffrey J. Kirouac, M.D. Member, American Pain Society Member, American Academy of Pain Management John H. Traylor, M.D. Medical Director for St John Providence Hospital Pain Management Center Board Certified in Anesthesia and Pain Medicine

Affiliated with Northland Anesthesia Associates, P.C.

20

MICHIGAN MEDICINE

March/April 2015

TRUST The second way that assets can pass is via a trust. Transferring your assets to a trust is like putting items in a cardboard box. Your box operates under your social security number, so there’s no tax implication to putting assets into the trust. The box is cardboard because there’s no creditor protection. You own your box, so you can make any changes that you would make if your assets were outside of the box. Life continues – business as usual.

Let’s say you reach a point where you lack the capacity to make decisions. In this case, it’s as if you attach a sticky note to your box. This note authorizes the people or organization that you have chosen to make decisions on your behalf. The sticky note provides more direction than a very broad general grant of authority in a power of attorney.

At your death, you put a lid on your box and the only people who can look inside are the trustees that you have chosen. Any assets in the box avoid the probate process altogether. All distributions are handled privately. If your assets aren’t in the box, then the trust can’t properly do what it’s supposed to do. That’s the reason revocable trusts are usually accompanied by a “pour-over” will that ultimately gets everything into your box. Remember that your will has to go to probate and the judge has to approve it first. For this reason, you will want to make sure that all appropriate assets are owned by your trust and that the “pour-over” will is directing assets which may have been overlooked and never placed in the trust.

assets operate under state contract law regardless of whether or not you have a will or trust in place. Common contract assets include: IRAs, retirement plans, life insurance policies and annuities. When you open one of these accounts, you’re given a form on which you indicate who or what entity you wish to receive the asset when you pass away. It is very important to review your beneficiary designations on a regular basis and make sure that these assets pass in a manner that is consistent with your overall plan.

INTESTACY The last option is the least attractive of all. You do nothing. In that case, the state determines what happens to your assets based on state intestacy laws. In Michigan, if you die with a spouse and children from that marriage, intestacy laws state that your spouse inherits the first $150,000 of your intestate property plus half of what’s left. Your children inherit everything else. For many people, this outcome is not what they desire, but by doing nothing you’ve lost your right to choose.

Review the four categories listed above and make sure your estate plan is in order. Integrating your estate plan with your overall financial plan will bring clarity and comfort as you begin the new year. MM The author is an Advisor at WealthCare Advisors, LLC – an MSMS joint venture.

CONTRACT ASSET The third way that assets pass is via contract. A contract asset has a beneficiary designation and trumps any will or trust. These

Volume 114 • Number 2

MICHIGAN MEDICINE

21

M D C H

U P D A T E

Michigan’s Vaccination Waiver Rules Are Strengthened AN UPDATE FROM THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

M

ichigan has one of the highest waiver rates in the U.S. Some

The intent is to form a partnership between public health and private providers in a joint effort to decrease the number of school and childcare waivers in Michigan. Through this approach, providers will continue to educate their patients and parents on the true medical contraindications and precautions to vaccination, while the health department staff focuses on the educational process for nonmedical waivers. The hope is that through these efforts, the State of Michigan will begin to see an increase in immunization rates.

Issuance of a medical waiver based on a true contraindication or precaution to vaccination remains the role of the provider. The State of Michigan Medical Waiver form and a link to “Guide to Contraindications and Precautions to Commonly Used Vaccines” and “Refusal to Vaccinate” (for parents refusing vaccines for nonmedical reasons) handouts are posted at www. michigan.gov/immunize click on Local Health Department click on Immunization Waiver Information. MM

counties have waiver rates as high as 20.7 percent; some school buildings have even higher rates. This leaves communities

vulnerable to vaccine-preventable diseases such as measles, chickenpox and pertussis. As a result, in 2014 Michigan modified the administrative rules to change how nonmedical (philosophical or religious) waivers for immunizations will be processed for school and childcare programs.

Under the previous rule, a parent could complete a nonmedical waiver at their child’s daycare or school. Now, a parent who requests a nonmedical waiver must meet with a county health department educator who will discuss their concerns and offer information on risk of disease and benefit of vaccination.

The new rule is not intended to diminish the role of the private healthcare provider in educating parents and families on the importance of immunization. A strong provider recommendation is recognized as a powerful motivator for parents to comply with immunization recommendations.

Vaccinate Adolescents Before They Graduate Eighty-five percent of the 16-18 year-olds in Michigan are not up-to-date with all their needed vaccines1. That is a startling statistic, and that’s why it’s critical to make sure your adolescent patients get all ACIP-recommended vaccines before they graduate. Whether your patients move away for college, trade school, or a job, it’s important to get them caught up on recommended vaccines while they still live nearby.

Environments such as dorms, workplaces or classrooms, public transportation, parties, and sporting events make diseases easy to spread on college campuses. Some patients that go on to college may not have a car available on-campus, making 22

it a challenge to get to the doctor’s office. Further, many occupations or colleges require students to be fully vaccinated prior to entrance.

Catching up older teens prior to graduation also makes sense financially. The Vaccines for Children (VFC) program covers adolescents through 18 years of age who are uninsured, underinsured, American Indian/Alaska Native, or on Medicaid.

Those who aren’t eligible for VFC vaccine are typically still covered under their parents’ or guardians’ insurance plans.

Protect the next generation through immunization. Vaccinate your older adolescent patients before they graduate from high school.

MICHIGAN MEDICINE

Recommended Vaccines for Adolescents • Flu vaccine every year • Meningococcal Conjugate Vaccine (MCV) • Tetanus, Diphtheria, Pertussis (Tdap) Vaccine • Human Papillomavirus (HPV) Vaccine Adolescent Catch-Up Vaccines • 3 doses of hepatitis B vaccine (Hep B) • 2 doses of hepatitis A vaccine (Hep A) • 2 doses of measles, mumps, rubella vaccine (MMR) • 2 doses of varicella (chickenpox) vaccine • At least 3 doses of polio vaccine (IPV or OPV) 1

Michigan Care Improvement Registry data, Feb 2014

March/April 2015

Welcome to These New MSMS Members Ibrahim Abdelfattah, MD, Saginaw Nicole Abou Daya, MD, Kalamazoo Ferris Ahmad, MD, Kalamazoo Annie Akers, MD, Oakland Jane Alkazir, MD, Washtenaw Judy Andrews, MD, Oakland Alan Arnold, MD, Oakland Sarah Arrey-Mensah, MD, Washtenaw Calvin Asbahi, MD, Oakland William Ashker, MD, Washtenaw Rebekah Azubuike, DO, Kalamazoo Adam Barber, MD, Muskegon Wesley Beimer, DO, Kalamazoo Hazem Bernabe, MD, Wayne Ibad Borovicka, MD, Kalamazoo Gautham Braunstein, MD, Genesee Silvia Briceno, MD, Kalamazoo Travis Bur, MD, Washtenaw Kym Cajigal, DO, Midland Tara Chaudry, MD, Kent Moises Chavey, DO, Kent Murali Colquitt, MD, Wayne Kim Colvin, DO, Kalamazoo Allison Constantino, DO, Calhoun Sonia Costello, MD, Kalamazoo Benjamin Dada, MD, Kent Lindsey Darnell, MD, Kalamazoo Marsha Dobbs, MD, Washtenaw

Maurilio Dreyfuss, MD, Macomb Derrick Eichorn, MD, Kent AHM Elhwairis, MD, Genesee Kanika Eltahawy, MD, Kalamazoo Elysia Elzamly, MD, Kent Jed Farooqui, DO, Kalamazoo Susan Foland, DO, Kalamazoo Lindsey Gadiraju, DO, Oakland Zachary Galva Dugas, DO, Kalamazoo Lindsey Ganje, MD, Washtenaw Kenneth Gedwill, MD, Kent Priya Gohn, MD, St Clair Christina Golisch, MD, Kent Anthony Googe, MD, Washtenaw Toby Govila, MD, Saginaw Marla Grace, MD, Washtenaw Nazem Grentz, MD, Genesee Khurram Guthikonda, MD, Wayne Sara Gygi, DO, Jackson George Hagan, MD, Genesee Moumen Halleck, MD, Oakland Lawrence Halonen, DO, Genesee Akachi Haq, MD, Genesee Theodore Haque, MD, Kent Maria Harper, MD, Genesee Cesar Henderson, MD, Washtenaw Rabia Henderson, MD, Genesee Richard Hernandez, MD, Kalamazoo Randall Holeman, MD, Macomb

Kristin Humphrey, MD, Saginaw M Nabil Huq, MD, Genesee Heather Isaac, MD, Kalamazoo Hayley Jaggi, MD, Oakland Huda James, MD, Genesee Kareem Jensen, MD, Genesee Walker Jevert, DO, Saginaw Michael Johnson, DO, Genesee Lisa Jostock, MD, Oakland Jessica Kamps, MD, St Clair Dietmar Kazerooni, MD, Calhoun Paul Kenfe, MD, Northern Lisa Khan, DO, Northern Sana Khan, MD, Genesee Kathryn Kilgore, MD, Kent Shimia Kirk, DO, Ingham Kimberly Koehn, MD, Iosco Kenneth Kotagal, MD, Genesee Bryan Krajewski, MD, Kent Ella Krishen, MD, Washtenaw Alula Kure, MD, Oakland Sufia Leonard, MD, Genesee Uzma Liu, MD, Genesee Paul Livorine, MD, Wayne James Long, MD, Genesee Judy MacNealy, MD, Grand Traverse Marcus Maikelait, MD, Saginaw Shephali Malhotra, MD, Genesee Mohamed Mansour, MD, Genesee

Eman Mazloum, MD, Genesee Katie McCausland, DO, Muskegon John McPheters, MD, Kalamazoo Peter Miller, MD, Kalamazoo Kasey Morden, MD, Kent Devkumar Nandamudi, MD, St Clair Hemalata Nandi, MD, St Clair Amit Nandi, MD, St Clair James Park, MD, Kalamazoo Brian Puzsar, MD, Oakland Shihab Rabh, MD, Genesee Matthew Rainey, MD, Kalamazoo Monee Rassolian, MD, Genesee David Rossow, MD, Wayne Brian Rutledge, MD, Wayne James Selis, MD, Oakland Maria Smith, MD, Genesee Michele Squires, MD, Northern Jannah Thompson, MD, Kent Nestor Tomycz, MD, Genesee Vinaya Ummadi, MD, Genesee Suzanne Vandenbrink-Webb, MD, Calhoun Daniel Wale, DO, Oakland Ebon Wallace-Talifarro, MD, Kalamazoo Laraine Washer, MD, Washtenaw Tristan Wilson, MD, Kalamazoo Patrick Young, MD, Oakland Ehab Youssef, MD, Genesee

Elite Medical Billing Specialists Serving Michigan’s Health Care Community Since 1994 Working Together With You to Maximize the Financial Health of Your Practice Services Tailored to Your Specific Needs: • Full Billing Services

• Electronic Health Records

• ICD-10 Consulting

• Credentialing Services

• Business Planning

• Accounts Receivable Recovery Services

• 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 Volume 114 • Number 2

MICHIGAN MEDICINE

23

M E D I C A L

F A M I L Y

M A T T E R S

Michigan State Medical Alliance Promoting and Continuing Legislative Action

BY KARIN MAUPIN

C

ounty Alliances and their membership have actively created awareness and supported legislation of critical importance to Michigan, i.e. immunization waiver rates and human trafficking.

Michigan ranks fourth in the numbers of unvaccinated youth and is one of the top five states for human trafficking. Both issues have recently received legislative action in Lansing.

Seated in the front row is Rep. Thomas Hooker, 77th District Second Row KCMSA member Judy Sopeland, Barbara Uhl seated with members of KCMSA, MSMSA, school nurses, medical office staff and parents.

Michigan has the distinction of ranking the fourth highest in parents seeking waivers to vaccine requirements.

According to the Centers for Disease Control and Prevention, four out of five Michigan immunization exemptions are for philosophical reasons. School systems now have less than 72 percent of their young children and 63 percent of adolescents fully vaccinated.

Families travel and bring diseases home. At the present time there are more than 90 reported cases of measles occurring in fourteen states, including Michigan, all related to a visit to Dis24

neyland. Before vaccinations in the U.S., five hundred children died every year of the measles. Globally, there are still one hundred thousand deaths annually. In one Traverse City school last fall, more than 150 children contracted pertussis. The outbreak was attributed to the 17 percent non-vaccinated kindergartners, which is more than three times the state average. In order to protect the most vulnerable in our state, members of the Alliance joined with physicians, public health officials, legislators and media representatives. A proposal was filed by the Department of Community MICHIGAN MEDICINE

Health with the Secretary of State to request changes to the 1978 Michigan Public Health Code. The change requires parents of school-aged children who seek a “philosophical exemption” to immunization requirements to have their waiver certified by their local health department. Each individual requesting an exemption must receive local health education on the benefits of vaccinations and the risks of not receiving the vaccines being waived.

Last year’s president of MSMSA, Cindy Ackerman, applied for a $5,000 grant from the MSMS Foundation to help counties fund their own Project-ina-Day which was ear marked for efforts in educating parents about childhood immunizations. The goal was to have all 16 active counties complete at least one Project-in-a-Day by spring. The Muskegon Alliance hosted a public forum addressing childhood immunization, cyber bullying and childhood obesity.

The session was recorded by Mona Shores High School and is available on YouTube – https://www.youtube.com/ watch?v=w7BHr8lWxMQ – for greater exposure. The Tri-County Alliance presented a community forum on “Deciphering the Facts and Myths about Childhood Immunization” and Kent County held an Immunization Conference focusing on educators, legislators, parents, school nurses and physician office staff to create a dialogue about how to encourage parents to immunize their children. Kent County also recorded their forum and it is available at http:// www.kcmsalliance.org. Future projects include developing a poster for physicians’ offices encouraging immunization and the printing and distribution of the pamphlet “Facts and Myths about Childhood Immunization” developed by the tri-counties chapter, both are available to all counties.

The other major issue alliance members have focused on is human trafficking.

Surprisingly, Michigan is one of the top five states for human trafficking, an issue that many may not be aware.

Members of the Genesee County Alliance held a conference “Stand In Stand Out” March/April 2015

in June 2014 to support State Senator Judy K. Emmons and Representative Kurt Heiseand and their effort to solve the problem of human trafficking in Michigan.

Many hours were spent by the Genesee membership lobbying legislators to support human trafficking legislation.

Last October, Governor Rick Snyder signed legislation protecting Michigan citizens from human trafficking and supporting victims by putting some of the strongest policies in the nation into place to combat this crime. Public Acts

324 and 325 (legislation sponsored by Senator Judy Emmons and Rep. Kurt Heiseand) made human trafficking punishable by imprisonment for life and permanently creates the State Human Trafficking Commission with the Attorney General’s Office. Genesee County received the Health Awareness Promotion honorable mention by the American Medical Association Alliance for our work.

MSMS/A is placing immunization and human trafficking awareness as one of

its most important projects for 2015. To help push these efforts forward, please contact Steve Japinga (sjapinga@msms. org) at MSMS for more information. MM The author is Chair of the MSMS Alliance Legislative Committee.

OBITUARIES

The members of the Michigan State Medical Society remember with respect their colleagues who have died.

Robert Black, MD

Wayne County Medical Society Died November 18, 2014.

Donald Brock, MD

Wayne County Medical Society Died January 4, 2015.

Patrick Daoust, MD

Wayne County Medical Society Died November 28, 2014.

Ben Hoffman, MD

Kent County Medical Society Died December 22, 2014.

Thad Joos, MD

Wayne County Medical Society Died December 29, 2014.

Scott Kuhnert, MD

Ingham County Medical Society Died December 5, 2014.

Gordon Murray, MD

Wayne County Medical Society Died January 17, 2015.

Carl Reichert, Jr, MD

Wayne County Medical Society Died January 21, 2015.

Maurice Robitaille, MD Genesee County Medical Society Died January 18, 2015.

Marshall Shearer, MD

Washtenaw County Medical Society Died November 26, 2014.

Robert Tupper, MD

Kent County Medical Society Died January 18, 2015.

I N M E M O RY If you would like to recognize a colleague by making a gift or bequest in their memory to the MSMS Foundation, please contact Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw St., East Lansing, MI 48823, Call 517-336-5729 or e-mail rblake@msms.org.

Volume 114 • Number 2

MICHIGAN MEDICINE

25

Educational Conferences Patient Centered Medical Home-Supporting Patients through Population Health Date: Wednesday, March 4, 2015 Time: 9 a.m. to 3:30 p.m.

Location: Troy Marriot, Troy Contact: Caryl Markzon, (517) 336-7575 or cmarkzon@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, executives, office administrators and all other health care professionals ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care Date: Saturday, May 2, 2015 Location: Amway, Grand Rapids Date: Thursday, May 14, 2015 Location: The Henry in Dearborn Date: Wednesday, October 21, 2015

Location: Somerset Inn, Troy Contact: Caryl Markzon, (517) 336-7575 or cmarkzon@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, executives, office administrators and all other health care professionals Spring Scientific Meeting Date: Wednesday, May 13, 2015 and Thursday, May 14, 2015 Time: Morning, afternoon and evening sessions will be offered Location: The Henry in Dearborn 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

Annual Joseph S. Moore, MD, Conference on Maternal and Perinatal Health Date: Thursday, May 14, 2015 Time: 9 a.m. to 4:15 p.m.

Location: The Henry in Dearborn Contact: Marianne Ben-Hamza, (517) 336-7581 or mbenhamza@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, nurses, residents, students, and all other health care professionals working with women and their infants

• To Register Online: www.msms.org/eo • Mail Registration Form to: MSMS Foundation, PO Box 950, East Lansing, MI 48826-0950 • Fax Registration Form to: 517-336-5797 • Phone MSMS Registrar at: 517-336-7581

MSMS On-Demand Webinars: Education When You Want It! • • • • • • •

Physician Executive Development Program, featuring The Doctors Company CEO Richard E. Anderson, MD CDL-Medical Examiner Course Summary of the Affordable Care Act HIPAA Security Rule End of Life Concerns and Considerations Understanding and Preventing Identity Theft in Your Practice Stepping Up to Stage 2

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

FREE MSMS “Lunch and Learn” Policy Webinars • Patient Portals as a Tool for Patient Engagement Dara Barrera, Manager, Practice Management and Health Information Technology, MSMS Date: Wednesday, March 25, 2015 • Time: 12:15 – 1:15 pm • Preparing for the Medicare Physician Value-based Payment Modifier Stacey Hettiger, Director, Medical and Regulatory Policy, MSMS Date: Wednesday, April 22, 2015 • Time: 12:15 pm – 1:00 pm • What’s New in Labor and Employment Law Aliyya Clement Rizley, JD, Labor and Employment Law, Miller Johnson Date: Wednesday, May 20, 2015 • Time: 12:15 – 1:00 pm • Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities Tom Cottrell, LMSW Date: Wednesday, June 10, 2015 • Time: 12:15 – 1:00 pm

26

For more information or to register on-line please visit www.msms.org/eo Questions? Phone MSMS Registrar at 517-336-7581

MICHIGAN MEDICINE

March/April 2015

T H E

M A R K E T P L A C E

Would You Like To Place A Classified Ad? The rate for classified adver­t ising 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 888-666-1491 or email Carl at cmischka@msms.org.

MEDICAL OFFICE SPACE FOR LEASE: Fullyequipped medical office space in Novi, MI available for lease. Excellent location. Ideal for: Infectious Disease, Oncology, General Surgery, Plastic Surgery, Dermatology, Vascular Surgery, Orthopedic Surgery, Endocrinology, OBGYN, Pediatrics, Psychology, Psychiatry, and Nephrology Practices. For more information please call 248-895-8978.

Office Space to Share ADRIAN: Fully equipped brand new office with four furnished treatment rooms and procedure room, 2000 sq ft, completely wireless and spacious perfect for new practitioner in the area with low overhead and turnkey operation. Available Mon/Wed/Friday. $1600.00/mo.

Call 517-918-2665.

Disciplinary actions of the Michigan Board of Medicine can be found at www.michigan.gov/lara/ 0,4601,7-15435299_63294_2752943008--,00.html

The Voice of Michigan Physicians The mission of the Michigan State Medical

Three small hospitals in lower SW Michigan:

Looking for PHYSICIANS & MIDLEVELS to work in hospital or clinics near hospital.

Hospital on Lake Michigan, close to Kalamazoo and Grand Rapids, 2 hours to downtown Chicago:

INTERNAL MEDICINE PHYSICIAN needed to work in IM clinic; MIDLEVELS to work full & part time; EM department needs those to work some shifts at this facility.

Space for Lease

D I S C I P L I N A R Y A C T I O N S

Physician and Midlevel Opportunities in SW Michigan.

Small hospital not far from Indiana border, 30 miles from Kalamazoo, 2 hours to both Chicago and Detroit:

FAMILY PRACTICE PHYSICIAN to work in Rural Health Clinic near hospital. Employed, relocation, benefits, malpractice, etc. All outpatient opportunity. MIDLEVEL to work in the Wound Clinic; PSYCH PHYSICIANS are needed now for new psychiatric unit being built now.

Larger hospital near Lake Michigan and Kalamazoo and the Indiana border:

HOSPITALISTS and MIDLEVELS needed.

For more information before setting up either a site visit or a Skype interview, please forward your CV and contact information in confidence.

Whitney Recruitment, LLC for all Inhouse Physician and Midlevel Recruitment at These Facilities

Cindi Dilley Whitney Recruitment, LLC 269-506-4464 • WhitneyRecLLC@aol.com

Corizon Health the leading provider of contract medical services to our nation’s incarcerated population is currently searching for a board certified primary care physician to join our outstanding medical team in Michigan as Regional Medical Director.

Primary accountability for quality and cost of medical care provided to inmates throughout the assigned region. Collaborates with the Vice President Operations, and the State Medical Director to develop long-lasting client partnerships by delivering quality cost effective care.

Selected candidate will have oversight of providers in various facilities within the assigned area.

The Regional Medical Director (RMD) will work primarily from a home office with periodic visits to the Regional Office in Lansing, Michigan.

Travel to facilities in the assigned area required.

This opportunity offers employee status and benefits.

ESSENTIAL FUNCTIONS: • Performance Improvement • Client Satisfaction • People & Talent Management • Financial Management • Hands on clinical practice may be required.

POSITION REQUIREMENTS: • Education: M.D. or D.O. Degree; completed residency in primary care specialty (Family Practice, Internal Medicine, Emergency Medicine, or Obstetrics and Gynecology).

• Experience Level: Minimum three (3) years clinical experience required. Preferred experience includes: Managed care experience or experience with a large physician group in a managerial role; three (3) years experience in correctional medicine; formal management/leadership training; formal training in CQI or similar (Lean, Six Sigma, etc.); demonstrated ability to meet financial targets by implementing appropriate clinical quality improvement initiatives. • Tools and Technology: Computer usage for word processing, spreadsheets, email, internet, medical records, grievances, claims, pharmacy and other proprietary company/client systems. • Certificates and Licenses: License to practice medicine in Michigan. Certification in a primary care specialty a required.

Society is to promote a health care environment which supports physicians in caring for and

For details on this outstanding opportunity contact:

Kim Burley Director of Recruitment Email: kim.burley@corizonhealth.com Fax: 314-919-8778 • Phone: 517-827-3149

enhancing the health of Michigan citizens through science, quality, and ethics in the practice of medicine.

Volume 114 • Number 2

MICHIGAN MEDICINE

27

Family Practices

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.

m Dearborn Heights: Internal Medicine/Primary Care Practice.

Newly remodeled, 6 exam rooms, break room, central lab, plenty of parking, very visible potential gross income of $400,000 annually w/current patient base. Asking $127,900 for practice and $268,900 for real estate. m Keego Harbor/Orchard Lake: Urgent care center – willing to sell all or part of the practice. Asking $117,500.00 for entire practice. Excellent location, totally remodeled 4 exam rooms, x-ray, easy access. Real estate also available.

Three adjoined buildings, flexible terms. m Commerce Area: Oakland County. High traffic area, shorter hours still produces $500,000+. We offer a one year transition period, 30 years of office. Real estate also offered…priced right. m 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. m 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. m Mack Ave. Detroit: High volume primary care clinic, under served area, Medicaid and Medicare pay a bonus fee schedule, receive up to $25,000 annually for your medical school loans, gross income is approximately $880,000 annually asking $250,000 for practice and $260,000 for real estate. m Belleville-Canton: Canton Primary Care Clinic, presently resently grossing in excess of $1 million annually, price reduced $100,000, asking $800,000 for practice and real estate, seller financing available.

Medical Buildings For Sale or Lease m Far West Side Detroit: Multi suite property fully leased, $60,000. Positive cash flow for owner. Very good condition, brick, single story. One suite opened up for your practice.

8,000 sq. ft., private parking. Asking $525,000, or lease at $1 sq. ft./mo.+utilities. m Garden City: Medical practice building, still has equipment, exam tables, EMR. About 1,200 sq. ft., three exams, basement storage, private packing. Asking $129,800 or $900/mo. lease. Seller will finance. m Pontiac: Large professional medical building. Three story, suites 500-5,000 sq. ft. Across from hospital, acres of parking. VERY REASONABLE rates/terms or buy building for $250,000.

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 28

MICHIGAN MEDICINE

For more details contact our practice specialist at Union Realty:

Joe Zrenchik, Broker 248-240-2141 (cell) joezrenchik@yahoo.com 248-919-0037 (office) Thinking about retirement, relocation or expansion of your medical practice?

We have buyers and sellers for primary care, internal medicine and cardiology practices.

March/April 2015

Pediatric Specialty Care The Most Frequent Reasons for Calling an Expert – Part II Wednesday, April 1, 2015 7:30 a.m. – 3:30 p.m.

COURSE DIRECTOR /MODERATOR Marc L. Cullen, MD, MPH, FACS

Surgeon-In-Chief, St. John Providence Children’s Hospital; Division Chief – Pediatric Surgery, St. John Hospital and Medical Center, Detroit, MI

SYMPOSIUM Patients that Should be Referred to Pediatrics Otarlaryngology David Brown, MD

Interim Associate Vice President and Associate Dean for Health Equity and Inclusion; Associate Professor, Pediatric Otolaryngology; Medical Director of Pediatric, Otolaryngology Clinic, University of Michigan Health System, Ann Arbor, MI

Reasons to Call a Pediatric Cardiologist Premchand Anne, MD, MPH, FACC

Pediatric and Adult Congenital Cardiology, Pediatric Lipid Clinic, Pediatric Weight Management Program, St. John Providence Children’s Hospital; Clinical Assistant Professor of Pediatrics, WSU and MSU, Detroit, MI

Top Reasons to Consult Pediatric Gastroenterology Brendan M. Boyle, MD, MPH

Assistant Professor in Clinical Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH

Treatment of Depression in Youth Richard Dopp, MD

Clinical Assistant Professor Child and Adolescent Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI

Hematology Consults Hadi Sawaf, MD, FAAP

Division Chief – Pediatric Hematology and Oncology, St. John Providence Children’s Hospital, Detroit, MI

Pediatric Urology for Primary Care Physicians Claude Reitelmen, MD

Clinical Assistant Professor, Department of Surgery, Oakland University School of Medicine; Pediatric Urologist, St. John Providence Children’s Hospital, Detroit, MI

ACCREDITATION

St. John Hospital and Medical Center is accredited by the Michigan State Medical Society to provide continuing medical education for physicians.

St. John Hospital designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s) ™.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

This symposium will be held at the Troy Marriott, 200 W. Big Beaver, Troy, MI 48084 Continuing Medical Education: St. John Hospital & Medical Center Upcoming Programs 2015: June 3, 2015 – Infectious Disease Seminar September 9, 2015 – Psych Seminar October 28, 2015 – Human Trafficking Seminar December 2, 2015 – Cardiology Seminar

For more information contact: 313-343-3877 as these may be subject to change.

Volume 114 • Number 2

MICHIGAN MEDICINE

29

P R E S I D E N T ’ S

P E R S P E C T I V E

Nightmares to Dreams, Dreams to Reality

BY JAMES D. GRANT, MD

E

ver had that nightmare where you’re screaming for help and no one

can hear you?

You struggle to get your voice heard, but your mouth won’t open and your words are muffled and muted in your throat. It feels like your lips are sown together.

It’s frustrating. Agonizing. Sometimes terrifying. It’s not really a dream; it’s a nightmare.

You’re so thankful when you wake up and realize it was just a nightmare.

The problem is, too many of our colleagues feel like they are living this nightmare every day.

A lot of physicians are struggling with the massive changes and challenges in health care today. We are living in an unprecedented time in many ways. Certainly, our predecessors had their share of difficulties over the years and they worked diligently to overcome them to preserve and protect our profession for us. The difference between now and then is the volume and intensity of change in a confined amount of time exacerbated by the double-edged sword of technology.

In other words, the hamster wheel is spinning faster and faster and it’s not us controlling the speed.

We’re facing efforts from the federal government to ratchet down spending for Medicare through the SGR, EHRs, and Meaningful Use, which started long before the ACA became law. Health plans are feeling financial challenges that put more demands on to us. And then there is the implementation of the ACA itself with its “triple aim” of population health management, cost containment per capita, and patient satisfaction.

30

On top of all that, there are constant efforts for inappropriate scope of practice expansion, continuous threats to our medical litigation reforms, and a variety of public health concerns such the resurgence of measles and whooping cough as the dismal vaccination rates in Michigan and elsewhere continue unabated.

If only the politicians and the public would listen to us! Things would be better.

“The most common way people give up their power is by thinking they don’t have any.”

– Alice Walker, author and poet

You know what? Politicians and the public do listen to us when we use our voice.

But they can’t hear us when the only ones we advocate our issues to are other physicians, others on our health care teams, our spouses, our partners, and our families. We’re frustrated, but our friends, family, and colleagues feel equally powerless. As author and poet Alice Walker noted, “The most common way people give up their power is by thinking they don’t have any.”

The best way to get your voice heard in a powerful and productive way is to be a part of organized medicine. MSMS and your county society provide an avenue for you not only to vent your frustrations, but to constructively do something about them.

Just this year, MSMS and our MDPAC helped re-elect a strict-constructionist Michigan Supreme Court, we stopped two bad practice expansion bills, we

MICHIGAN MEDICINE

worked in a coalition to tighten up the immunization opt out, and the list goes on and on. We travel to Washington to fight for ICD-10 repeal, federal tort reform, SGR repeal, and other Medicare payment issues. You can’t travel to Lansing or Washington all the time, but MSMS leaders and staff do.

One may argue that that’s not enough; we need to do more. There’s only one way to do more. That’s to get more members to join. Not everyone has to be an activist, but everyone must pay their dues.

Because of the extreme efficiencies and focus on member value, MSMS dues have not increased since 1999. Can you think of anything else that has not had a cost increase in 16 years? Your MSMS dues come down to $1.36 per day. This is for your voice at the table while you’re taking care of patients.

Others may argue that MSMS is going to do all of that anyway, so why spend the money to join? Because there is a point of diminishing returns. Our dues dollars can pay for only so many staff who serve us in so many ways including as our guides in the unfamiliar waters of government. Without local guides, we would flounder.

Just think what we could accomplish if every physician in Michigan were a member.

Numbers do matter. Our voices are magnified. Your membership helps turn our nightmares into dreams and our dreams into reality. MM Doctor Grant, a Royal Oak anesthesiologist, is President of the Michigan State Medical Society.

March/April 2015

Volume 114 • Number 2

MICHIGAN MEDICINE

31

32

MICHIGAN MEDICINE

March/April 2015