Michigan Medicine®, Volume 119, No. 4

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 119 / NO. 4

July / August 2020

ON THE FRONT LINES AGAINST COVID-19

Michigan physicians share their stories

msms.org

FEATURES & CONTENTS July / August 2020

06

Is anxiety about a possible COVID-19 infection upon returning to work considered a disability?

DANIEL J. SCHULTE, JD

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Taking Stock: What COVID-19 Exposed and the Lessons Learned from It JODI SCHAFER, SPHR, SHRM-SCP

10

Protect your patients before the upcoming school year!

ALYSSA STROUSE, MPH

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Physicians Adjust to New Realities; Answer the Call to Advocacy SARAH WAUN

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FEATURE

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Elective Surgery Informed Consent and Shared Decision Making During COVID-19 THE DOCTORS COMPANY

DEPARTMENTS 26 Welcome New Members 28 MSMS Educational Courses

On the front lines against COVID-19: Michigan Physicians Share Their Stories

BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

Health care workers around the globe are at war with COVID-19. And for many of those engaged on the front lines of that effort, that’s been a harrowing experience.

Read their stories, beginning on page 15.

STAY CONNECTED!

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perspective

MICHIGAN MEDICINE® VOL. 119 / NO. 4 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823

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

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

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

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

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2020 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA. ©2020 Michigan State Medical Society

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By S. Bobby Mukkamala, MD, MSMS President

These are strange and uncertain times.

On March 10, 2020, Michigan recorded its first two cases of COVID-19 and nothing has been the least bit normal since.

In the span of just a few short months, the novel coronavirus has managed to turn the world completely upside down. COVID-19 has changed everything about how we live, work, and interact with one another—not to mention the suffering it has inflicted on millions of people across the globe and tens of thousands right here in Michigan.

Through it all, physicians have been called on to lead, and that’s exactly what members of the Michigan State Medical Society have done.

S. BOBBY MUKKAMALA, MD (GENESEE COUNTY) MSMS PRESIDENT

Our 15,000-plus member physicians spread out across the state have risen to the challenge of finding ways to safely provide care and treatment to both COVID-19 and non-COVID-19 patients during this global pandemic. Some have heroically battled the novel virus on the frontlines, while others have changed everything about the way they see and interact with those they treat in an effort to keep their patients out of the COVID-19 fray.

There are likely countless amazing stories worth sharing, and in this edition of Michigan Medicine®, you’ll hear about the experiences of a select few physicians who have been working harder than ever to safely navigate their communities through this public health crisis.

You’ll also learn about the advocacy work – and why it matters – the Michigan State Medical Society has been doing to help ensure that Michigan’s physicians are able to continue providing the absolute best in quality care through these historic and truly challenging times.

S. Bobby Mukkamala, MD (Genesee County) MSMS President

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ASK OUR LAWYER

Is Anxiety About a Possible COVID-19 Infection Upon Returning to Work Considered a Disability?

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

An employee is refusing to return to work. She tells us that she is afraid of COVID-19 infection and this fear is causing her to lose sleep and have anxiety and depression. I have been counseled on my right generally to terminate

employees who refuse my recall to work. I am concerned to do so in this case because I have reason to believe this employee has sought treatment for anxiety and depression issues in the past. Should I be concerned about a disability discrimination claim if I terminate her employment? Could her suspected history of anxiety and depression (heightened by the COVID-19 crisis) be deemed a disability under some law?

You are right to be concerned about this. Generally, the Americans with Disabilities Act (“ADA”) protects employees with mental health conditions that qualify as a disability.

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mployers must provide these employees with reasonable accommodations enabling them to do their jobs instead of disciplining or terminating them for not doing their jobs. Determining whether your employee has a condition that would be considered a disability and entitle them to this protection can be difficult to determine.

Not all mental health conditions will rise to the level of a covered disability.

A general sense of nervousness, fear or anxiety arising from the possibility that as a result of returning to work you may become COVID-19 positive (even if real and tangible to the employee and honestly expressed) is not a disability under the ADA. Instead, only mental health conditions that are an impairment “substantially limiting a major life activity” (e.g. sleep, concentrating, communicating and other activities that effect an employee’s ability to work) are deemed a disability under the ADA.

Employees experiencing mental health conditions must request accommodation (e.g. paid or unpaid leave) from their employer. This request should then trigger a dialogue with the employer concerning the issue. Employers have a right to ask for documentation from a doctor to verify the employee’s condition. This determination may also include recommendations from the doctor as to the type and duration of accommodations that are necessary for the employee.

Assuming an employee requests accommodation and documentation has been obtained establishing that in fact the employee has a disability requiring reasonable accommodation under the ADA, the question then becomes what such a reasonable accommodation would be. Most employees in the situation you describe are seeking paid or unpaid leave for some period.

If you decide leave is going to be the reasonable accommodation offered (because working from home or other accommo-

dations are not possible) there is no legal requirement that the employee be paid while on this leave. The duration of the leave then becomes the difficult question.

Employers are not required to provide open-ended or indefinite leave. A duration can and should be set by the employer so that at some point it is known whether the employee can do the job and if not when a replacement employee must be found.

There is no specific legal guidance that can be given as to the duration of leave in this situation. The best practice is to consider recommendations of the doctors, if any, and, to the extent possible, make the duration of leave consistent for all your

employees having similar disabilities requesting leave as an accommodation.

This will, to the extent possible, make any discrimination claims defensible.

DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL

In your case, since the employee did not tell you that she has a mental health condition constituting a disability (and/or provide you with documentation from her doctor describing her condition) and make a request of you for a reasonable accommodation you have no obligation to consider a leave or other request for accommodation on her behalf. Instead, you should decide whether to terminate or allow her to remain laid off.

“Not all mental health conditions will rise to the level of a covered disability. A general sense of nervousness, fear or anxiety arising from the possibility that as a result of returning to work you may become COVID-19 positive (even if real and tangible to the employee and honestly expressed) is not a disability under the ADA.”

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ASK HUMAN RESOURCES

Taking Stock: What COVID-19 Exposed and the Lessons Learned from It

By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

It’s been an unforgettable four months to say the least.

Who knew that qualifiers like, ‘never in our lifetime’, ‘these unprecedented times’ or ‘the new normal’ would become so commonly used that they’ve lost their luster?!

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The impact COVID-19 has had on our lives and on the world as a whole have left an impression that no turn of phrase can adequately describe.

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ur priorities, our businesses, our economy, our relationships, our physical/emotional/mental health, and even our patience have been pushed to the breaking point. And yet, we’re still standing. We look to the future.

But, let’s not forget, to take stock of where we’ve been and the lessons learned along the way.

enough in savings to cover more than one or two payrolls, let alone rent and other expenses. Having a financial cushion buys you time to make important business decisions. In the wake of something unexpected, like a pandemic, extra time allows for more clarity and confidence in the path you choose.

The value of professional resources.

The correlation between highly engaged teams and resiliency.

WHEN UNEXPECTED CRISIS HIT, PHYSICIANS TURNED

A STRONG TEAM RISES TO THE OCCASION; FLEXIBLE,

TO THOSE THEY TRUSTED MOST TO GUIDE AND ADVISE

WILLING TO HELP, AND SOLUTIONS-ORIENTED.

THEM THROUGH THE ROUGH WATERS AHEAD.

A disengaged team crumbles under the pressure; is more focused on individual gain than group goals and creates problems for someone else to solve. We’ve seen the impact of these team dynamics in our practices during ‘normal’ times, but it was during this recent crisis that the fabric of your team was exposed and tested. Leaders who invested time and effort to engage their people pre-COVID-19 reaped the benefit of those relationships when it came time to respond to this pandemic. Teams who were less committed and/or resisted change turned an already difficult situation into a near impossible one.

Organizations like the Michigan State Medical Society went into overdrive to serve members and anticipate the next need. Policymakers, HR consultants, attorneys, bankers, and CPAs earned their stripes in these recent months too, providing subject matter expertise in this ever-changing environment. If you previously questioned the worth of these relationships and memberships, now you know you can’t run a successful practice without them.

The importance of a ‘rainy day’ fund.

FINANCIAL ADVISORS HAVE LONG TOUTED THE IMPORTANCE OF HAVING THREE TO SIX MONTHS’ WORTH OF EXPENSES SET ASIDE IN CASE OF EMERGENCY.

While many understood the wisdom of this advice, surprisingly few have heeded it. For physicians who are just starting out, this was a goal they were not yet able to achieve. However, many experienced medical practices were also caught without

The need to reassess and reinvent the way business is done.

MANY PRACTICE OWNERS NEVER GAVE MUCH THOUGHT TO THINGS LIKE SUPPLY CHAIN, LOGISTICS, REMOTE WORK OR SCALABILITY

Mandated closures and skyrocketing demand forced hospitals and outpatient clinics to find new ways of getting supplies. Limited operations led to virtual meetings with staff, telehealth alternatives for patients and the realization that not all work has to be done AT the office.

Investments that practices make in technology, cross-training, PPE, and sanitation measures will pay off long after this pandemic comes to an end.

Perspective.

YOU’VE ALL HEARD THAT ‘BALANCE’ IN YOUR LIFE IS IMPORTANT FOR YOUR OVERALL HEALTH AND HAPPINESS, BUT HAVING THE WORLD TURN UPSIDE DOWN WITH LITTLE WARNING REALLY DROVE HOME HOW OUT OF BALANCE MANY OF US HAD BECOME.

Suddenly, priorities became very clear. The distractions and busy-ness of everyday life fell away in an instant. The things that kept us going, the people and routines we clung to like lifelines in the storm, were what mattered most. Unfortunately, those are often the first things to go when ‘normal’ resumes. Set an intention. Prioritize what’s most important to you and let that guide how you choose to spend your time going forward.

Leaders learn from situations like this. Use this opportunity to take stock, to implement needed changes, and to prepare for the next crisis. COVID-19 exposed the cracks, it’s up to us to fill them in.

BEFORE THE CORONAVIRUS HIT, BUT THIS SITUATION HAS HIGHLIGHTED SIGNIFICANT CHALLENGES IN THE WAY WE USED TO OPERATE.

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MDHHS UPDATE

Protect your patients before the upcoming school year!

Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization Maria McGinnis, BSN, RN, Vaccines for Children Coordinator, MDHHS Division Immunization

The back-to-school season includes several checklists as parents are busy making sure their children are equipped with the right supplies and ready to take on the next school year. This year, many children have been participating in e-learning for months due to the COVID-19 pandemic and are that much more eager to return to school. Summer months are the ideal time to call parents and remind them that vaccines are important back-to-school items as well.

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his year, that message is even more important as many children and adolescents have fallen behind in their immunizations throughout the COVID-19 pandemic. The Michigan Department of Health and Human Services (MDHHS) urges you to call your patients who are overdue or coming due for vaccines and encourage them to get vaccinated before the upcoming school year.

According to the Michigan Care Improvement Registry (MCIR), data published in a Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), looked at up-

The number of non-influenza vaccine doses administered and reported for children ≤18 years decreased 21.5% DURING JANUARY-APRIL 2020, IN COMPARISON TO THE SAME AVERAGED TIME PERIODS IN 2018 AND 2019.1

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to-date status for individual vaccines and recommended age-based vaccine series at a point in time in May 2020 and compared it with 1-month age cohort assessments for points in time in May 2016-May 2019.

The data indicated a sharp decline in upto-date status in almost all age cohorts.

Further, the number of non-influenza vaccine doses administered and reported for children ≤18 years decreased 21.5% during January-April 2020, in comparison to the same averaged time periods in 2018 and 2019.1 For more information on this MMWR, visit https://www.cdc.gov/mmwr/volumes/69/ wr/mm6920e1.htm.

Providers are encouraged to utilize the MCIR to conduct reminders and recalls to ensure their patients are up-to-date on all vaccines. Recall letters can be generated from the MCIR and can identify cohorts of patients overdue for specific vaccines. Further, providers have the option to change verbiage on the letters to illustrate specific messages that their practice may want to share. These messages can include information on the importance of vaccines and how to schedule a vaccine appointment for their child. In addition, reminders and Quality Improvement Eligible Not Yet Overdue Immunizations reports can also be generated using the MCIR to identify any patients that may be coming due for vaccines. For more information on how to run reminders or recalls, visit www.mcir. org or contact your MCIR regional staff.

For more information on how to run Quality Improvement reports in MCIR, contact your Local Health Department (www.michigan. gov/LHDmap).

As families face challenges such as unemployment and insurance status changes, utilization of programs such as these are more important than ever. Being a VFC provider is a sound

Vaccines for Children With the peak in need for vaccines during this back-to-school rush, it is essential to ensure access to vaccine, particularly to those who need it most. Families across the country and state rely on a public-funded vaccine program called the Vaccines for Children (VFC) program. This program provides vaccine at NO COST to eligible patients and providers. Eligible patients are less than 19 years of age and meet one of the following: Medicaid-eligible Uninsured American Indian or Alaska Native Underinsured

investment in your practice and patients – supporting vaccine access to families who may otherwise not be able to afford it. As a VFC provider, you can provide government purchased vaccine to your eligible patients and reduce your out of pocket costs. You can have the ability to provide all ACIP-recommended vaccines to your eligible patients, aligning with services provided to populations receiving Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Patients can receive VFC vaccine at no cost. However, an “administration fee” can be charged per vaccine to help offset costs of business.

Inform your patients that you are now a VFC Provider!

Now is the time to assess the vaccination status for your patients and ensure that they are caught up on all their recommended vaccines. It is crucial that we protect all Michigan residents from diseases that we have vaccines to protect against, especially as we continue to fight this COVID-19 pandemic. Make sure your patients are equipped with everything they need, including their vaccines, for a safe, happy, and healthy 2020-2021 school year.

Are you interested in enrolling or learning more?

Review Michigan VFC details: www.michigan.gov/vfc

REFERENCE 1 Bramer CA, Kimmins LM, Swanson R, et al. Decline in

Contact your Local Health Department (LHD) to enroll: www.michigan.gov/lhdmap

Child Vaccination Coverage During the COVID-19

Pandemic — Michigan Care Improvement Registry,

May 2016–May 2020. MMWR Morb Mortal Wkly Rep

2020;69:630–631. DOI: https://www.cdc.gov/mmwr/

Receive a site visit from LHD to review requirements and ensure proper storage and handling of vaccines.

volumes/69/wr/mm6920e1.htm

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LEGISLATIVE

Physicians Adjust to New Realities; Answer the Call to Advocacy Sarah Waun, State and Federal Government Relations, Michigan State Medical Society

On March 10th, 2020, Michigan diagnosed it’s first case of COVID-19 and our lives changed in the blink of an eye.

Physicians were called to the front lines to care for the sickest patients fighting for their lives on ventilators. Some were called to donate PPE and all but shut down their practices except for emergency

At MSMS, while physicians were expertly adjusting to their new realities in clinical practice, many also answered the call to advocacy.

The team stepped up to the plate and hit it out of the park.

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n April 1, 2020, the Michigan State Medical Society (MSMS) called on eight physicians to participate in weekly calls with the Governor’s office to update key decision makers about the frontlines of the fight against COVID-19. After working overnight shifts, balancing clinical practice with family life, and learning about this brand-new virus, our physician members showed incredible dedication to public service every single week. Their efforts paid off.

After weeks of building the physician voice in Lansing and making sure physicians on the frontlines, and the ones who

were anxiously waiting to see patients again, had a voice, S. Bobby Mukkamala, MD, President of MSMS, stood up with the Governor at a Press Conference on May 21, 2020, to announce the resumption of non-essential and elective procedures. The advocacy efforts of physician leaders at MSMS helped to inform policies, influence decision-makers, and ultimately allow patients to once again safely seek out care from their trusted physician partners.

Another strong voice for the Michigan State Medical Society came from Paul Bozyk, MD, a critical care pulmonologist at Beaumont Royal Oak. He spent his

cases. All have been drastically impacted in some way by this virus.

Doctor Mukkamala, President of MSMS, stood up at Governor Whitmer's Press Conference on May 21, 2020, to announce the resumption of non-essential and elective procedures.

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The physician voice reverberated through the halls of the Capitol, and MSMS physicians were sought out as the foremost experts on all-things COVID-19. We couldn't have done it alone.

days and nights in the ICU, caring for the sickest COVID-19 patients, while simultaneously worrying about the patients who were delaying care in his outpatient pulmonology clinic. His unique perspective became an invaluable resource when Senator Michael MacDonald introduced Senate Bill 899, legislation to add much needed liability protections into law for physicians who were responding to a novel virus and complying with executive orders that led to circumstances outside of the standard practice of Medicine.

across the state. Physician task forces were created to address the frontlines of COVID-19, re-engaging the economy, safe clinical practice, and financial relief for practices that saw massive reductions in patient visits and revenue. Over the course of 10 weeks, MSMS met with and educated over 20 elected officials and public policy makers. The physician voice reverberated through the halls of the Capitol, and MSMS physicians were sought out as the foremost experts on allthings COVID-19.

We couldn’t have done it alone.

Doctor Paul Bozyk, testified before the House Committee on Judiciary on May 13, 2020.

On May 13th, Doctor Bozyk testified before the House Committee on Judiciary.

He shared his experiences both on the front lines and with delaying non-essential care pursuant to EO 2020-17, and explained the need for reform, not to protect bad actors but to protect physicians who were making decisions to save a human life. The havoc wrecked on medical practice from COVID-19 remains a stark reality for physicians statewide. His advocacy efforts helped decision makers understand the realities on the ground and the extent our physician community went to save lives. Thank you, Doctor Bozyk.

Physicians also sacrificed time daily to educate and update elected leaders

We also reached out to various stakeholders to better understand their industries, where there were synergies, and how we could be a united voice. Doctor Mukkamala stood up with Brian Calley, President of the Small Business Association of Michigan, and called for both economic health and public health. MSMS worked closely with Local Public Health and the University of Michigan School of Public Health to merge clinical education and observations with the science behind public health decision making. We worked with our partners in Health, from specialty societies, to advanced practices nurses, to dentists and physical therapists.

And throughout, we stayed in touch with the Michigan Health and Hospital Association, the voice of the infrastructure responding to COVID-19.

“The advocacy efforts of physician leaders at MSMS helped to inform policies, influence decision-makers, and ultimately allow patients to once again safely seek out care from their trusted physician partners. ”

It was a very busy spring at MSMS. One that no one could have anticipated. But as we look to the future, we are grateful to our physician leaders for giving the physician community a voice in Lansing and D.C.

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FEATURE

ON THE FRONT LINES AGAINST COVID-19

Michigan physicians share their stories

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Front lines.

It’s phrasing we cannot seem to escape these days, and that alone is telling.

The “front line” is a military term used to describe the position where opposing forces meet. It’s where the battle is. The conflict. The struggle. The tip of the knife. It’s where any confrontation is most dangerous, terrifying, and chaotic. And it’s the perfect language to describe the environment in which physicians responsible for treating patients with COVID-19 currently reside.

Health care workers around the globe are at war with COVID-19.

There’s nothing hyperbolic about that statement. In the span of a few short months, millions of people have contracted the novel coronavirus and hundreds of thousand have succumb to it. Meanwhile, physicians everywhere are working around the clock to better understand the virus and to treat the afflicted who are suffering.

And for many of those engaged on the front lines of that effort, that’s been a harrowing experience.

Often understaffed, overworked, and under protected in the fight against COVID-19, physicians everywhere have remained steadfast in their commitment to providing quality care to those in need despite the risk the highly contagious virus poses to their own health and the health of their loved ones.

It’s been a challenge to say the least.

For all intents and purposes, the past few months have been unprecedented—it’s been over a hundred years since a pandemic has so firmly gripped the world. Health care providers everywhere—both those directly treating COVID-19 and those on the periphery who continue to provide care, treatment and medicine for patients with countless other ailments—have been forced to adapt to the fluid and rapidly changing circumstances surrounding this pandemic. Patient interaction has changed. The delivery of care has changed. Medicine in general has changed.

Despite these challenges, physicians continue to lead. And members of the Michigan State Medical Society are trailblazing patient care during these critical times. With more than 15,000 members responsible for providing care throughout a state hit particularly hard by COVID-19, there are likely countless stories of Michigan physicians stepping up to the plate and finding ways to continue to deliver outstanding care and support to patients in need.

On the following pages are the stories of just a small few...

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“I’d say about 90 percent of the work I do would be considered non-urgent, and all of that has ceased since the COVID-19 outbreak began over two months ago.”

S. BOBBY MUKKAMALA, MD, MSMS PRESIDENT, GENESEE COUNTY

S. Bobby Mukkamala, MD GENESEE COUNTY As an otolaryngologist who typically treats children with chronic ear infections, recurring sore throats, and sleep apnea due to large tonsils and adenoids, S. Bobby Mukkamala, MD, is among the large group of Michigan physicians whose work has largely been on pause since the COVID-19 crisis began.

“I’d say about 90 percent of the work I do would be considered non-urgent, and all of that has ceased since the COVID-19 outbreak began over two months ago,” says Doctor Mukkamala.

However, despite the dramatic drop in patient volume, Doctor Mukkamala has made it a point to keep his office open, both for his patients and his employees.

“I felt it was important to stay open and continue providing care to the 10 percent of our patients who really do need to be seen,” said Doctor Mukkamala. “Providing those patients with care in the office helps mitigate the risk of them potentially getting more ill and ending up in an already stressed hospital. And it’s also a nice thing to be able to do for my employees. I don’t want any of them to feel financial strain due to COVID-19, so I’m thankful that we have been in a position to remain open and fully staffed.”

To keep those patients and employees safe, Doctor Mukkamala has implemented new precautionary measures to help everyone maintain an appropriate level of social distance. In addition to the standard best practices of wearing masking and frequent handwashing, Doctor Mukkamala also has his patients wait for their appointments in their cars and come straight to the exam room when it’s time for their appointment.

“In the interest of everyone’s safety, we’re really doing everything we can to eliminate all unnecessary interaction,” he said.

And just because the curve is flattening doesn’t mean the work is done. With new COVID-19 cases declining across the state, Doctor Mukkamala is ready to start looking to the future.

“I think the big takeaway in all of this is we must take action to be prepared for the next public health crisis,” says Doctor Mukkamala. “And while there will always be illness and diseases that kill people, we must do our best to minimize the deaths due to lack of preparation and management of those diseases. It will be critical that we all thoroughly review how this pandemic was handled, learn, adjust, and continue to try to heal better.”

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Warren Lanphear, MD, FACEP KENT COUNTY It’s been a strange and stressing time for emergency medicine physicians. Normally, these physicians see a whole host of patients presenting with any number of acute illnesses and injuries, all in need of immediate care. Heart attacks, strokes, severe trauma—these are the sort of everyday, life-threatening events emergency department physicians typically see and treat.

COVID-19 changed everything.

For many emergency departments around the state, the past few months have been feast or famine—overwhelming COVID-19 outbreaks or a concerning lack of non-COVID-19 patients. As the president of the Michigan College of Emergency Physicians, representing more than 2,000 emergency medicine physicians across the state, Warren Lanphear, MD, FACEP, is keenly aware of the impact COVID-19 is having on emergency departments.

“It’s been a challenge to treat and diagnose patients acutely ill with coronavirus while also treating any and all other patients presenting to our emergency departments—we have to treat everyone as

if they might have COVID-19 when they first present,” says Doctor Lanphear.

As such, Doctor Lanphear and his colleagues are outfitted in PPE at all times, and trips in and out of patient rooms are minimized as much as possible.

“Pandemic care has meant limiting our time spent in rooms on some of our usual customer care practices like simply sitting and talking with our patients or making repeated visits back into the room to check on them, and that’s been tough,” said Doctor Lanphear. “That connection is definitely important to patients and physicians alike.”

He is just as concerned about the patients they’re not seeing though.

“Overall, emergency department volumes dropped dramatically in March, likely due to the stay-home orders and fear of contracting COVID-19 in the hospital,” Doctor Lanphear said. “We’re starting to see patients return to the emergency room, but still in lower number than what would be typical for this time of year, and that’s definitely concerning. Strokes, heart attacks—these kind of health events are still happening, so it’s important that patients know they can still safely seek care for these kind of life-threatening emergencies at their local emergency room. That’s a message we need to continue to push out.”

“It’s been a challenge to treat and diagnose patients acutely ill with coronavirus while also treating any and all other patients presenting to our emergency departments– we have to treat everyone as if they might have COVID-19 when they first present.”

WARREN LANPHEAR, MD, FACEP, KENT COUNTY

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Juliette M. Perzhinsky, MD, MS.c.

SAGINAW COUNTY Juliette Perzhinsky, MD, wears many hats.

When not busy splitting her clinical time between working in an urgent care facility and an outpatient primary care practice specializing in integrated complex pain management and medicated-assisted treatment (MAT), there’s a good chance she’s busy teaching patient safety or MAT as an Associate Professor of Medicine at Central Michigan University College of Medicine.

The work certainly hasn’t stopped—it’s just changed.

“With the clinical practice, the big change over the past few months has been shifting much of our patient care to virtual and audio visits, which has been a real challenge for many of our older patients,” Doctor Perzhinsky says. “However, we’ve managed to establish successful phone encounters with these patients, ensuring there’s been no interruption in the medication these patients need to manage their chronic pain condition and/or opioid use disorder.”

On the other end of the spectrum, face-toface encounters have gone uninterrupted at the urgent care clinic.

“The key to ensuring everyone’s safety in the urgent care clinic is to treat every patient as if they have SARS-CoV-2, the virus that causes COVID-19,” said Doctor Perzhinsky. “That’s the safest way to approach direct patient interaction.”

As such, she and her colleagues have adjusted their standard protocol, requiring health care personnel to be outfitted with masks and personal protective equipment (PPE) in the exam room.

“It’s certainly been tough—you can’t really maintain 6 feet of distance when examining a patient,” she said.

In addition to staying outfitted in the appropriate PPE, Doctor Perzhinsky has done her best to practice good hand-hygiene and has taken steps to minimize potentially exposing those around her.

“I leave my shoes in my car and immediately shower and wash my clothes upon arriving home,” said Doctor Perzhinsky. “I don’t kiss my husband or my son on the face or cheeks anymore, and we do our best to maintain some distance in the house—it’s been extremely hard to not be around them as much as I would like to be, but that’s just the safest course of action right now.”

Stephanie Duggan, MD, FACEP, CPE SAGINAW COUNTY As a practicing emergency department physician for more than 20 years who now serves as the regional president of Ascension Michigan Northern Ministries, consisting of Ascension St. Mary’s, Ascension Standish and Ascension St. Joseph hospitals, Stephanie Duggan, MD, FACEP, CPE, thought she had “seen it all” in her career.

And then a global pandemic hit.

For Doctor Duggan, as a critical administrative leader in a large health care organization, working to develop, implement and manage the various hierarchies and processes necessary to effectively and efficiently respond to the COVID-19 pandemic has been a massive undertaking.

“When COVID-19 hit, Ascension set up national, state, and local incident command (IC) teams, which changed how hospital and ambulatory operations were handled for us,” said Doctor Duggan.

“Those are large, complex teams, and meetings were held twice a day with a specific reporting structure to facilitate better communication both up and down the command chain.”

Complicating logistical matters even further was the 500-year flood that ravaged much of the region served by Ascension Michigan Northern Ministries during the middle of the COVID-19 pandemic.

care was unwavering. Watching that was very humbling, and it reminded many of us of why we went into health care in the first place—to make a difference to those whom we serve.”

“The way we practice medicine is going to be forever changed coming out of this pandemic, and I think one of the good ways is that telehealth is going to become more robust and more heavily utilized.”

DELICIA PRUITT, MD, SAGINAW COUNTY

“On day 72 of our COVID-19 incident command when those two dams broke in our service area, that was certainly a new and unanticipated additional challenge we had to manage,” she said. “Those floods left so many displaced. We had to set up an additional IC structure just to manage the details associated with the flooding disaster, so that was another wrinkle.”

Delicia Pruitt, MD

Despite the challenges, Doctor Duggan’s staff rose to the occasion.

That’s the position Delicia Pruitt, MD, found herself in when she became the medical director of the Saginaw County Public Health Department in January 2020.

“I’m so proud of all the health care workers on our team here at Ascension Michigan Northern Ministries—in my eyes, they truly are heroes,” she said. “We learned something new about COVID-19 every single day. And invariably, that new information had to be shared up and down the chain, and processes were changed as a result—sometimes several times a day. That’s a taxing thing for any sort of team. However, despite the challenges, our health care worker’s collective resilience and commitment to delivering quality patient

SAGINAW COUNTY Serving as a medical director for a major county during a public health crisis is stressful enough on its own. However, starting that position at the onset of a global pandemic adds a whole new degree of difficulty to the role.

“I don’t know public health without COVID-19,” says Doctor Pruitt.

Unsurprisingly, the transition has been laden with challenges.

“I essentially had to become an expert in COVID-19 overnight to effectively perform the duties of my position, which includes providing critical public health (CONTINUED ON PAGE 20)

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guidance to community organizations, health care providers and allied health organizations throughout the county,” said Doctor Pruitt. “And with COVID-19 being a novel virus, I had to quickly learn how to be comfortable with the unknown, which was certainly a challenge.”

In addition to providing county-wide oversight, Doctor Pruitt directs Saginaw County’s COVID-19 testing efforts, regularly co-leads educational Facebook Live events, and oversees the county’s Medical Command and Control group, while also still managing to see patients on a daily basis—something she now does more and more of through telemedicine.

“In my opinion, utilizing telehealth visits when possible is absolutely the best precaution physicians can take regarding COVID-19, both for their health and safety and the health and safety of their patients,” she said. “The way we practice medicine is going to be forever changed coming out of this pandemic, and I think one of the good ways is that telehealth is going to become more robust and more heavily utilized. Currently, half of my patient visits are through telehealth, and it’s been a really good experience for both me and my patients.”

Paul Bozyk, MD OAKLAND COUNTY The COVID-19 pandemic has been a strange and scary time for everyone.

However, for most, the ill-effects have been ancillary—disrupted work life, cramped home life, canceled trips, canceled appointments. The list goes on.

Thankfully, most have been lucky enough to avoid the true horrors of COVID-19, and the dangerous effects of the infection itself. Most health care systems weren’t overrun and overburdened. Most hospitals weren’t battered by a steady and seemingly ceaseless wave of sick and dying patients.

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Too many communities and hospitals, though, weathered that experience, and without fail, there were physicians in those places leading the charge.

Paul Bozyk, MD, is one of them. As a pulmonary critical care doctor in southeast Michigan, Doctor Bozyk has truly been on the front lines in the fight against COVID-19.

seeing at the bedside when families can’t see it for themselves. We used things like tablets and FaceTime calls to demonstrate to families the care that’s being provided, or to give the family an opportunity to try to communicate with the loved one in the hospital, but that was often times the best we could do and that alone was very hard.”

“Since the pandemic hit southeast Michigan, I hadn’t seen a patient without COVID-19 up until the last week of May,” he said.

“Despite the challenges, I was so grateful for the way that the entire health care team pulled together to provide the best care possible. I really do love my work family.”

The number of patients with COVID-19 has been alarming. During the pandemic's peak, Doctor Bozyk would provide care to at least 20 COVID-19 patients, sometimes overseeing a unit of over 50 COVID-19 patients.

Thankfully, things have started to settle.

And should a second wave hit, Doctor Bozyk is confident his health care system would be prepared for it from an operational standpoint, though no one is ready for the emotional toll it might take.

“The volume of critically ill patients was like nothing we’ve ever seen before, so it was just physically and emotionally exhausting.”

For Doctor Bozyk—and many other physicians in his position—one of the hardest parts was the challenge of communicating with patients and their loved ones.

“It’s a whole new level of emotional burden having to do all the communication with the patient’s family over the phone,” he said. “It’s so hard to explain what we’re

“This was an education that I wouldn’t wish on anyone, but I learned so much through the process—supply chain process, allocation and distribution of resources across the System, dealing with a new pathogen, there’s just so many things,” he said. “So operationally, we’re ready and prepared.

But it would be incredibly taxing for physicians and other members of the health care team to have to go through what we just went through all over again.”

Sandro Cinti, MD WASHTENAW COUNTY One of the things that makes COVID-19 so difficult to treat, contain and model is the fact that it’s brand new to everyone.

COVID-19 is a novel coronavirus—everyone on earth is experiencing this particular infection for the very first time.

Thankfully, there are physicians who are uniquely poised to battle the virus, and Sandro Cinti, MD, is one of them.

As an infectious disease specialist at the University of Michigan who is wellversed in pandemic preparedness, Doctor Cinti is one of the physicians others are looking to for help and guidance through this global pandemic.

“I’ve done this all of my adult life,” says Cinti. “I was involved in the response to the anthrax attacks in 2001, the SARS outbreak in 2003, the pandemic flu of 2009 and the Ebola outbreak from just a few

years ago, so it’s only natural that people come to me and my colleagues with question about COVID-19. And I’m more than happy to serve as that resource. I work hard to stay up to date on the latest quality research and reliable information, and I feel a sense of responsibility to pass that information along and to make myself available as resource for everyone as much as I can.”

Identifying that right information is no small task. With medical professionals and researchers around the globe desperate to develop effective treatments and vaccines, new research is being published every day, and unfortunately, not all of it is always up to snuff.

“It definitely takes a lot of work to stay upto-date on the latest, and critically, most reliable information,” says Doctor Cinti. “The amount of new literature and research being produced related to COVID-19 is just enormous, and unfortunately, the immediacy of this pandemic means a lot of that literature hasn’t been fully peer-reviewed.”

“I work hard to stay up to date on the latest quality research and reliable information, and I feel a sense of responsibility to pass that information along.”

SANDRO CINTI, MD WASHTENAW COUNTY

Doctor Cinti’s advice for his colleagues: remain vigilant and continue to do the work.

“We all need to continue doing our due diligence to get the right information,” he said. “There’s an overwhelming amount of research out there, but the obligation is on us to keep tabs on it, and ultimately get our heads around the best, and ultimately, right information. That’s what we all need to be doing to deliver on our promise to provide the best possible quality care to our patients.”

Driven by results.

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

DETROIT

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Elective Surgery Informed Consent and Shared Decision Making During COVID-19 Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, and Julie Ritzman, MBA, CPHRM, Vice President, Department of Patient Safety and Risk Management

R

estarting elective surgeries and procedures after suspension during the COVID-19 pandemic requires

a great deal of planning and consideration of many factors, including those related to patients, locations where you practice, and the larger community. To support those delivering care during this unprecedented time, we are providing recommendations for resuming elective surgeries and procedures—with a focus on keeping you, your staff, and your patients safe.

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As you create your individual plan to resume elective cases, clear and deliberate communication with your patients will be a critical step. In addition to the customary informed consent discussion related to the procedure, you will need to have a candid conversation with your patients about COVID-19. The discussion should focus on measures in place to safely undergo the intended procedure, including any risks of becoming infected during the perioperative episode.

Recognizing that medicine is a blend of science and compassion, on the following pages we highlight areas to discuss with patients undergoing elective surgery or procedures.

(CONTINUED ON PAGE 24)

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Elective Surgery Informed Consent and Shared Decision Making During COVID-19

(CONTINUED FROM PAGE 22)

Setting expectations Discuss any contingency plans related to a resurgence of COVID-19 cases in your community. Your patient’s surgery is scheduled, and the patient is eager to proceed, but it is important to maintain flexibility. Factors exist that can change your plan, including a hospital’s bed capacity or availability of equipment and supplies, forcing you to postpone the care. Due to the limitations of testing and the contagiousness of COVID-19, any member of the team, such as an anesthesia provider, nursing staff, or even a patient may develop symptoms of COVID-19, resulting in more delays. It is best to discuss this up front, so your patient is prepared for all possibilities.

Option to defer Talk to your patient about the benefits and any risks related to delaying the surgery to a time when the local community is more stable in terms of active COVID-19 cases or a known treatment is available. Make the decision to defer with the patient’s full understanding of the situation and when delaying the care will not alter the outcome.

Pre/post preparations Inform your patient that they will be asked to complete a COVID-19 screening assessment to evaluate exposure to the virus. It is important to consider the patient’s effectiveness in preoperative social distancing and the risks related to their contacts who may have been exposed to COVID-19. If recent COVID-19 exposure elevates the risk, postpone the

surgery until the patient has self-isolated for a period of 14 days or until it is safe to move forward with the planned care.

Explain to your patients the steps that are being taken at the facility to keep them safe and to protect the surgical team from contracting COVID-19. Instruct patients to wear a cloth mask from home to the facility. If they do not have a mask, provide one on the day of the surgery. Make them aware that for everyone’s safety the staff will all be wearing masks as they greet them and throughout their care.

Testing Alert your patients that they will be tested for COVID-19 prior to the procedure.

(Even if they have been tested previously, they may have been exposed after that result was provided.) If their pre-op test is positive, regardless of whether they are symptomatic, their procedure will be rescheduled until there are two negative test results performed 24 hours apart. For more information, see the ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus. In some cases of extended delays, patients may have to repeat tests that were previously performed such as x-rays, lab tests, EKGs, and COVID-19.

Elevated risk Educate patients about the current limitations around testing and about the fact that even with a negative COVID-19 test result, there is up to a 30 percent false negative rate. Discuss the possibility they may contract the illness post-op.

Specifically discuss that undergoing the surgery may weaken their ability to fight

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Contributed by The Doctors Company

thedoctors.com

the COVID-19 virus, and they may be at a higher risk of complications involving intensive care, ventilator support, or death from COVID-19.

Changes in facility operations Discuss any process changes implemented at the care facility because of COVID-19.

Examples include a different process for patient drop off/pick up, as well as limiting visitors and screening protocols when they are allowed.

Post-op setting

ADDITIONAL RESOURCES Specialty organizations have joined forces to develop detailed recommendations that include administrative and clinical guidelines. The following resources provide detailed information, including a checklist and guidance related to resuming elective surgery: Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic COVID-19: Elective Case Triage Guidelines for Surgical Care

Discuss where the patient will convalesce after the surgery. Will they be able to shelter in place and maintain social distancing in a separate location in the home? Emphasize infection control practices to prevent COVID-19. Also consider the timing of the surgery for the best outcomes.

In supporting the medical profession during these unprecedented times,

Post-op visits

medicine. For the latest updates on our responses to members’ concerns, visit

Consider the use of telehealth for postop visits. Ensure the patient has adequate technology, and they understand what parts of the body you will ask to see, such as a surgical incision. Also discuss when you may need to see the patient in person.

our frequently asked questions page at https://www.thedoctors.com/articles/

Local Resumption of Elective Surgery Guidance

The Doctors Company continues to listen to our members and work to respond to their unique concerns as part of our mission to advance the practice of good

informed-consent-for-covid-19-risks-frequently-asked-questions/.

Documentation Document your discussions with patients and their response related to the inherent risks associated with proceeding with an elective procedure during the initial resumption phase post COVID-19.

Also include the clinical judgement that went into the decision to continue with the surgery at this time. If appropriate, document that the patient was given the option of a rescheduling but has chosen to proceed at this time.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2020 The Doctors Company (thedoctors.com).

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Educational Offerings

MSMS On-Demand Webinars Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates Billing 101 Claim Appeals Credentialing Medical Necessity Tips on Documentation to Prove it Reading Remittance Advice Tips and Tricks on Working Rejections

Webinars at No Cost to Members:

NEW, FREE ON-DEMAND WEBINAR! Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management

Webinars that meet Board of Medicine Requirements:

Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Decision Making Capability Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Pain and Symptom Management Series Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System Update Opioid Town Hall Pain and Opioid Management Prescribing Legislation Tapering Off Opioids The CDC Guidelines The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019 (Fulfills the 1-time training on opioids and other controlled substances awareness)

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Balancing Pain Treatment and Legal Responsibilities CARES Act Impact Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media MAPS Update and Opportunities Medical Necessity Tips on Documentation to Prove it Michigan Automated Prescription System Update Opioid Town Hall Prescribing Legislation Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting Telemedicine and Other Technology Codes in a COVID-19 Environment Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS What Physicians Need to Know as Employers During the COVID-19 Pandemic

Other Webinars: Michigan Medical Marihuana Law Non-Pharmacologic Management of Musculoskeletal Pain Syndromes

Visit msms.org/OnDemandWebinars for complete listing of On-Demand Webinars.

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

SAVE THE DATE for 2020!

FREE! COVID-19 On-Demand Webinars COVID-19: AMA Advocacy and Physician Resources CME Credits: .75

COVID-19: Best Practices for Implementing Telemedicine CME Credits: .75

COVID-19: CARES Act Impact

A Day of Board of Medicine Renewal Requirements Date: Tuesday, October 20 Tentative Location: The Westin, Southfield Intended for: Physicians and all other health care professionals.

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

CME Credits: 0.50

COVID-19: CARES Act Impact: Q&A with CPAs CME Credits: .75

COVID-19: CARES Act Impact: Q&A with CPAs 2.0 CME Credits: .75

COVID-19: New Employment Policies for Practices CME Credits: .50

COVID-19: New Waivers and Billing Changes for Telemedicine CME Credits: 1.0

COVID-19: Race Inequalities and COVID-19: Contagion, Severity, and Social Systems CME Credits: .75

COVID-19: Safe and Innovative Office Procedures for Seeing Patients

Annual Scientific Meeting Date: Wednesday - Saturday, October 21 - 24 Tentative Location: The Westin, Southfield Intended for: Physicians and all other health care professionals.

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

24th Annual Conference on Bioethics Date: Saturday, November 14 Tentative Location: DoubleTree by Hilton, Ann Arbor Intended for: Physicians and all other health care professionals.

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

CME Credits: .75

COVID-19: Telemedicine and Other Technology Codes in a COVID-19 Environment CME Credits: 0.75

COVID-19: Testing, Tracing and Tracking

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

CME Credits: .75

COVID-What Physicians Need to Know as Employers During the COVID-19 Pandemic CME Credits: 1.0 AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

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URGENT: Oppose Surprise, Out-of-Network Billing Consider a comprehensive, balanced solution to House Bills 4459, 4460, 4990, and 4991

A

t a time when physicians are busy adjusting to the new world of COVID-19, the Michigan Legislature has re-started the conversation about price fixing for out-of-network physicians. Surprise, out-of-network billing legislation has been a topic of conversation in Lansing for years.

Unfortunately, the sponsors of legislation introduced in Michigan – HB 4459 & 4460 and

HB 4990 and HB 4991 – believe there is a simplistic answer, namely implementing a fee schedule that constitutes a pay cut for physicians, with very limited recourse for physicians to dispute that payment.

MSMS supports holding patients harmless from unanticipated, out-of-network medical bills and believes the most effective approach – that has been successful in other states – allows the insurers and providers to negotiate in good faith with a truly independent dispute resolution process, when no other agreement can be reached. The independent dispute resolution proposed by HB 4459 requires physicians to prove network inadequacy and only applies in narrowly defined special circumstances.

Michigan physicians understand that every discussion about health care and health policy should start and end with what is best for Michigan patients. The proposed “solution” could create more problems for patients than it solves.

This bill package is now in the Senate Committee on Health Policy and Human Services.

ENGAGE – msms.org/engageOON:

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Fix Prior Authorization Because Health Can’t Wait

Activate your political voice!

Support Senate Bill 612

Get started at mdpac.org

Prior authorization and step therapy/fail first requirements hamstring treatment, drive up nonadherence to medication and lead to diminished health. It’s onerous and needless insurance company bureaucracy, and it’s negatively affecting patients, physicians, providers and their practices.

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

It’s time we cut out the red tape, because at the end of the day, health can’t wait.

And now we can do just that.

State lawmakers recently introduced SB 612, a bill that reforms the prior authorization and step therapy/fail first process by introducing new transparency, fairness and clinical validity requirements, ensuring our patients receive timely coverage decisions, and ultimately, the care and treatment they need.

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.

Join MDPAC today!

This is the kind of reform our patients deserve—it’s time to put them first.

Five Reasons t

BACK the

Please contact your lawmakers today and urge them to support SB 612.

The Michigan Doctor Action Committee (M and maintains strong with lawmakers, as w dates running for po

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MSMS Engage – https://MSMS.org/engage

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Activate your political voice!

For more than thre MDPAC has mount successful lobbyin behalf of physician

Connecting constituents and lawmakers is a critical and central function of grassroots advocacy. MSMS’ Engage gives users access to an editable, The Michigan Doctors’ Political Action Committee (MDPAC) is prefilled web-form letter sending system, which has become the easiest and most effective way fortheconstituents to contact theirSociety. lawmakers. political arm of the Michigan State Medical It is a bipartisan political action committee made up of Communicate, educate, engage, and activate on the things that are most important to Michigan physicians.

With Engage, YOU become a “virtual physicians, their families, residents, medical students and others interested in making a positive contribution to the medical lobbyist,” so please familiarize yourself with Engage and take action now! profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.

JULY / AUGUST 2020 |

For example... MDPA strengthens tort refo the physician’s tax,

helped to stop the e non-physician’s sco

MDPAC has power, respect! If you wake giant, MDPAC could m positive change for p patients. It could eas pressures with the cu authorization proces

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michigan MEDICINE® 29 physician’s agenda.

The current political

Welcome New Members www.msms.org/Membership

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