THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 116 / NO. 1
January / February 2017
Making MACRA Work for You MIPS
APM
www.msms.org
WEALTHCARE ADVISORS
Year-End Tax Planning Strategies Congratulations
to Michigan’s Patient Centered Medical Homes
® every card. Confidence comes with
Congratulations to the 4,534 physicians practicing in Blue Cross Blue Shield of Michigan-designated Patient Centered Medical Homes in 2016.
There are
Blue Cross PCMH practices improve health care quality and outcomes statewide, including: •
Fewer emergency visits and hospital stays
•
More breast, cervical and colorectal cancer screenings for adults, and more well-child visits for children
primary care
•
More medication reviews and management especially for patients with chronic conditions
practices in 80
•
Widespread use of disease registries aiding in better care coordination
Blue Cross PCMH-designated
of Michigan’s 83 counties.
Thanks to the dedication and commitment of physicians statewide, the Centers for Medicare & Medicaid Services has approved Blue Cross PCMH-designation for physicians to be potentially eligible to earn merit-based incentives under MACRA. MSMS members: To learn more about PCMH designation, contact your BCBSM provider consultant or visit valuepartnerships.com.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
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FEATURES & CONTENTS January / February 2017
10
Medicare Meaningful Use in a MACRA World BY STACEY P. HETTIGER
14
Optimize the EHR: Better Workflow Means Better Work-Life Balance BY CHAD ANGUILM, MEDICAL ADVANTAGE GROUP Contributed by The Doctors Company
IN EVERY ISSUE 04 President's Perspective
BY DAVID KRHOVSKY, MD
07 Ask Our Lawyer
BY DANIEL J. SCHULTE, JD
08 MDHHS Update
BY JACKLYN CHANDLER, M.S.
12 Ask Human Resources
BY JODI SCHAFER, SPHR, SHRM-SCP
22 WealthCare Advisors
COVER STORY
16
BY NICOLE GOPIAN WIRICK, JD, CFP®
DEPARTMENTS 13 MSMS Foundation Education Courses 20 Welcome New Members In Memoriam 20 In Memoriam 21 MSMS Med Opps
Making MACRA Work for You Have you heard of MACRA? And more importantly, are you prepared for it?
STAY CONNECTED!
If the answer to either of these questions is ‘no’ or you’re unsure, strap in. Changes are afoot in the world of Medicare reimbursement and it’s critical that providers everywhere are prepared to navigate the soon-to-be changing environment. See page 16 for story.
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michigan MEDICINE 3
perspective
MICHIGAN MEDICINE Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Graphic Design STACIA LOVE, REZÜBERANT! INC. rezuberantdesign@gmail.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 Hannah Dingwell 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 2017 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. ©2017 Michigan State Medical Society
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This issue of Michigan Medicine highlights the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program and, given the calendar, the timing could not be more appropriate. As we enter the new year, the changes brought forth by MACRA on Jan. 1, 2017 should weigh heavily on the minds of physicians across the state. MACRA is more than a simple payment rule—it is far-reaching, transformative policy that has the potential to fundamentally restructure health care delivery in the United States.
That statement is meant to neither scare nor excite – simply to inform.
Like most health policy, the motives behind MACRA are well-intentioned. All players in the world of health care share the same end goal; we all want to operate in a system that provides quality, cost-effective care that produces positive outcomes for patients. Unfortunately, the complexities of reality often make that aim easier said than done. In the coming year, I’m sure we’ll all come to find that MACRA is not perfect, and that’s okay as long as we’re willing to remain vigilant in our health care system. As members of the Michigan State Medical Society, we must be thoroughly prepared to both meets the challenges MACRA poses in the present and respond appropriately in shaping its final form in the future. And that effort starts with education.
Like many other recent health policy initiatives, MACRA serves to drive the transition away from a fee-forservice payment model to value-based reimbursement. Conceptually, a valuebased payment model is admirable; physicians should be rewarded for providing exceptional quality care. But in practice, the model in which we’re now operating proves onerous for physicians, patients and payers alike. Quality is elusive. Quality is variable. Quality is not easily captured or measured and therein lies the challenge for organized medicine
By David M. Krhovsky, MD, Michigan State Medical Society President
going forward. Thankfully, it’s at least a challenge that will be largely familiar to physicians everywhere. Most of MACRA isn’t new. In fact, it’s fair to generally characterize MACRA as a streamlined amalgam of currently existing reporting programs and requirements. With that being said, it still requires serious scrutiny and it will undoubtedly present infrastructural and reporting challenges to all providers in 2017 and beyond. And despite being largely familiar, there’s no question that the complexity of this rule is overwhelming. With that in mind, as we begin 2017, physicians need to direct their focus to where they fit in this new model instead of trying to make sense of the full landscape. Are you exempt from MIPS? Do you want to participate as an individual or as a group? Which improvement activities are you in engaged in now? Answering these kinds of questions will inform your standing and immediate needs in regards to MACRA participation and compliance. And there are resources and support out there to help you get started. Between the AMA, CMS and MSMS, a wealth of materials and literature have already been produced to guide physicians through this transition including checklists, webinars and training sessions. And as we move beyond the most pressing concerns associated with the initial implementation, the Michigan State Medical Society – and organized medicine as
®
whole – needs to make sure it addresses its members concerns of this policy. Health care reform is fluid. And while MACRA is undoubtedly here to stay, there is ample room and opportunity to make improvements, and we have already experienced success in that regard. In partnership with the American Medical Association and Blue Cross Blue Shield of Michigan, MSMS successfully petitioned CMS to modify the final rule to recognize BCBSM designated Primary Cares Homes under the QPP. This was a huge win for physicians across the state. It remains our responsibility to remain informed and respond appropriately.
As physicians, our paramount goal has, and always will be, to provide quality care to our patients. We must work to remind the regulatory arm of the U.S. health care system that when physicians have opportunity to truly listen to what our patients want and focus on their needs, the quality will follow. With a new Administration and Congress entering Washington D.C., the time is right to recommit ourselves to working with policy-makers to advance reforms that promote a model which provides outstanding value to patient, providers, and payers. It’s our job as physicians to step forward and be that voice for organized medicine.
DAVID KRHOVSKY, MD, MSMS PRESIDENT
“Health care reform is fluid. And while MACRA is undoubtedly here to stay, there is ample room and opportunity to make improvements, and we have already experienced success in that regard.”
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ASK OUR LAWYER By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
“When Must a Data Breach be Reported?” Q My practice billing person recently missed some time due to an illness. She was a few weeks behind in processing claims. She took home a thumb drive loaded with patient records so that she could work on getting caught up over a weekend without having to come into the office. The thumb drive disappeared. She claims she last saw it in a pile of papers at home on her dining room table where she was working and fears she accidentally threw it in the trash with the pile of papers by accident. Is this a HIPAA data breach? Do I need to report this to someone? Contact Kim Burley, Director of Recruitment, at 517-827-3149 or kim.burley@corizonhealth.com.
The HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414, requires HIPAA covered entities (i.e. your medical practice) and their business associates to provide notification following a breach of unsecured protected health information. I can only assume that the thumb drive your biller took home contained protected health information because this would certainly include the types of information necessary for her to make claims for payment. Notification of a breach is only required if the protected health information is unsecured. Were the files on the thumb drive encrypted or secured (i.e. some measure put in place to prevent an unauthorized person from accessing the information)? If the protected health information on the thumb drive was not secured then the situation you describe is a data breach and reporting is required unless you can demonstrate that there is a low probability that the protected health information has been compromised. This determination is based on your assessment of the risk by taking into account at least the following: the nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification; what you know about any unauthorized person known to have used the protected health information and/or those to whom disclosure was made; whether the protected health information was actually acquired or viewed by an unauthorized person; and the extent to which the risk to the protected health information has been mitigated. In your case a judgement call has to be made. There seems to be a low probability that the information has been compromised based on the fact that the thumb drive went straight to your biller’s home and appears to have been accidentally thrown in the trash instead of being taken by an unauthorized person. You must document this risk assessment in writing.
If you are not comfortable concluding that there is a low probability of compromise then you must determine which type of report(s) must be made. Individual notice is always required. Generally, all patients whose protected health information was on the thumb drive must receive written notice by first-class mail without unreasonable delay and in no case later than 60 days following the discovery of a breach including, to the extent possible, a brief description of the breach, a description of the types of information that were involved in the breach, the steps affected individuals should take to protect themselves from potential harm, a brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches. If there are more than 500 affected individuals, you must provide notice to prominent media outlets in addition to individual notice. Finally, in addition to notifying affected individuals and the media (if more than 500 affected individuals) the Secretary Health and Human Services must be notified. This can be done electronically by going to the HHS web site and filling out and electronically submitting a breach report form. If a breach affects 500 or more individuals, covered entities must notify the Secretary without unreasonable delay and in no case later than 60 days following a breach. If, however, a breach affects fewer than 500 individuals, the covered entity may notify the Secretary of such breaches on an annual basis. Reports of breaches affecting fewer than 500 individuals are due to the Secretary no later than 60 days after the end of the calendar year in which the breaches are discovered.
DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTER OF KERR RUSSELL ATTORNEYS AND COUNSELORS.
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MDHHS UPDATE By Jacklyn Chandler, MS, Outreach Coordinator, MDHHS Division of Immunization
Important Reasons to Vaccinate Vaccines have greatly decreased or eradicated many infectious diseases that commonly harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable diseases (VPDs) still exist and can be easily passed on to people who are not fully protected by vaccines1. The success of a vaccine in protecting communities depends entirely on the extent of vaccine coverage. With enough people immunized against a disease, it is difficult for the disease to get a foothold in the community. The Economic Burden of VPDs Vaccines are the best protection against VPDs and related complications. Vaccines are also a safe and cost-effective tool. Low uptake of vaccines produces: 1. individual and society losses in terms of deaths and disabilities. 2. economic costs from doctor visits, hospital stays, and lost income. Ozawa et al. (2016) present a more thorough study among adults in the United States2. In 2015 alone, VPDs were responsible for an estimated economic burden of $9 billion. Adults who are not vaccinated contributed $7.1 billion, or 80 percent, of that burden.
Vaccine Efficacy: 13-Valent Pneumococcal Conjugate Case Study Pneumococcal disease in adults was estimated at $1.86 billion in 20152. Routine use of 13-valent pneumococcal conjugate, or PCV13, vaccine in children has already shown a direct reduction in invasive pneumococcal disease (IPD) among children. Furthermore, adult populations have indirectly benefited since reduced IPD in children has decreased transmission of the disease to adults. Within the first three years that PCV13 was introduced, Moore et al. (2015) estimated that 30,000 cases of IPD and 3,000 deaths had been prevented3.
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That being said, PCV13 serotypes still cause 20 to 25 percent of IPD cases in adults aged 65 years and older4. With the 2014 recommendation from the Advisory Committee on Immunization Practices (ACIP), immunization providers have the opportunity to prevent pneumococcal disease in this vulnerable adult population.
The Role of Vaccines in Antimicrobial Stewardship When antibiotics are used for viral infections like the flu, patients are not getting the best care. A course of antibiotics will not fight the virus, help your patient feel better, or lead to a quicker recovery. It may even be harmful. Misuse of antibiotics is feeding the increase of drug-resistant bacteria. This leads to infections that are difficult, and sometimes even impossible, to cure. Timely, recommended pneumococcal vaccination lowers infections and transmission of pneumococcus – also slowing the spread of antibiotic-resistant infections. Strongly consider the role of vaccines as part of antimicrobial stewardship efforts5.
Immunization Provider Actions The increase in drug-resistant bacteria, recent disease outbreaks, and the significant economic burden of VPDs underscore the value of immunizing all of your patients according to the recommended schedules6. To
keep patients up-to-date, it’s crucial to assess immunization status and recommend needed vaccines at each clinical encounter. Recommending and administering vaccines during the same visit reduces missed opportunities. Practices that don’t stock all needed vaccines should make the recommendation and refer patients to a known vaccinating provider. Help your office, your patients, and your patients’ other providers know which vaccines they have had by using the Michigan Care Improvement Registry (MCIR). Practices should use MCIR to both assess patients’ vaccine history and to document vaccines received by your patients. According to zoster vaccination data in MCIR from July 1, 2015 through June 30, 2016, approximately 1 in 45 administered doses were unnecessary second doses. By assessing patient history in MCIR, practices can avoid over-immunizing and improve the quality of patient services. References 1 Centers for Disease Control and Prevention. (2016). Why Vaccines are Important for You. Retrieved from http://www. cdc.gov/vaccines/adults/reasons-to-vaccinate.html 2 Ozawa et al. (2016). Modeling the economic burden of adult vaccine-preventable diseases in the United States. Health Affairs 35(11), 1-9. doi: 10.1377/hlthaff.2016.0462 3 Moore et al. (2015). Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: Analysis of multisite, population-based surveillance. Lancet Infect Dis 15(3), 301-309. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/25656600 4 Tomczyk et al. (2014). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 63(37), 822-825. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6337a4.htm 5 National Vaccine Advisory Committee. (2016). A call for greater consideration for the role of vaccines in national strategies to combat antibiotic-resistant bacteria: Recommendations from the National Vaccine Advisory Committee. Public Health Reports 131(1), 11-16. 6 Centers for Disease Control and Prevention. (2016). Immunization Schedules. Retrieved from http://www.cdc.gov/ vaccines/schedules/hcp/index.html
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Seeking Practice Coach Huron Valley Physicians Association P.C. Ann Arbor, MI The Practice Coach will educate and support HVPA’s Primary Care and Specialty physicians and offices to understand population health management and optimize financial performance in incentive programs. Practice Coaches are expected to understand the detailed nuances of all incentive and practice transformation programs in which HVPA participates and to be able to customize the approach at the office. This includes understanding the quality, utilization, and cost dashboards available to HVPA and/or created by HVPA. HVPA Secure portal, Health Focus Registry, MiHIN information connections, MedFusion, and any other tools that HVPA can enlist to support offices in optimizing their performance in incentive programs.
More information: http://www.hvpa.com
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HEALTH INFORMATION TECHNOLOGY (HIT) ALERT By Stacey P. Hettiger, Michigan State Medical Society, Director of Medical and Regulatory Policy
Medicare Meaningful Use in a MACRA World With the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), three existing Medicare quality programs (Physician Quality Reporting System, ValueBased Payment Modifier, and Medicare Electronic Health Record Incentive/Meaningful Use) are rolled into one new Medicare payment model known as the Merit-Based Payment System (MIPS).
O
ne of the key components of MIPS for which physicians and other eligible clinicians will be evaluated is called Advancing Care Information (ACI). Thus, physicians may find themselves asking several questions including:
Is meaningful use gone for good? The simple answer is yes and no. Medicare Meaningful Use (MU) as a standalone program, its pass/fail approach, and related negative payment adjustments for non-participation or unsuccessful participation will be gone by 2019. However, MACRA emphasizes the use of health information technology as tool to help advance the sharing of information among care settings and to engage patients in their care through more accessible personal and educational information. Therefore, several components of MU are incorporated into the new ACI component of MIPS. It is anticipated that physicians who are current successful MU participants will have a smooth transition to ACI expectations. In addition to greater flexibility in selecting measures, the measures will be familiar and several experts have predicted that meeting ACI requirements in 2017 will likely be easier than under MU. Of note, the Medicaid Electronic Health Record (EHR) Incentive Program is NOT affected by MACRA. Therefore, physicians participating in this program will continue to report meaningful use through their respective state Medicaid agencies. Additionally, the incentives under the Medicaid EHR Incentive Program continue through 2021.
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Has my investment in Certified Electronic Health Record Technology (CEHRT) been for naught? No. When the Medicare and Medicaid EHR Incentive Programs were initially created, the legislation and related regulations called for the standardization of certain functionality. Congress, the Centers for Medicare and Medicaid Services, and the Office of the National Coordinator for Health Information Technology intended that physicians and others purchasing EHRs would have some assurance that their EHR met minimum standards necessary for them to accomplish MU requirements. Regardless of whether a physician participates in Medicare via the Advanced Alternative Payment Model or MIPS pathway, he/she will be expected to utilize CEHRT to meet certain requirements. For the 2018 performance period, physicians and other eligible clinicians must use CEHRT that meets the 2015 edition certification standards. Ask your EHR whether your system meets those standards and if not, when will the vendor will have upgrades available and what is their plan for dissemination, installation, and training if necessary.
If the MU penalty is going away, do I still need to attest? Yes. It is imperative that physicians attest to 2016 meaningful use participation by February 18, 2017, to avoid a 3 percent penalty in 2018. If you have not previously participated in MU and 2017 would be your first year, you can avoid a penalty in 2018 by successfully completing 90 consecutive days of MU within the first 9 months of 2017 and attesting by October 17, 2017.
What are the requirements of the ACI component? All physicians and eligible clinicians for whom the ACI requirements are applicable must meet the following base requirements in 2017 (for those using 2015 edition CEHRT, there are some additional measure options): Electronic Prescribing Health Information Exchange Provide Patient Access (e.g., patient portal) Security Risk Assessment Additionally, scoring can be enhanced by reporting on optional measures: Immunization Registry Reporting Medication Reconciliation Patient Specific Education Secure Messaging Specialized Registry Reporting Syndromic Surveillance Reporting
For additional information including a link to sign-up for future CMS notifications of updates and MACRA programming, visit https:// qpp.cms.gov/
View, Download, or Transmit/VDT (e.g., one patient VDTs their health information to a third party)
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ASK HUMAN RESOURCES By Jodi Schafer, SPHR, SHRM-SCP
“This Will Only Hurt for a Minute...” Q We just went through a nasty flu season and I had several employees out sick for multiple days as a result. Given the close proximity of our working conditions, it doesn’t take much for the flu to spread like wildfire through our office. I’d like to be more proactive next year and want to require my employees to get a flu shot. Not only would this help protect my staff, but it would also help limit the likelihood of my staff passing the virus to my patients (especially those with compromised immune systems). Is this something I can legally do? Is there anything I should be aware of or consider before I decide to go forward with this?
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You make a good point about lost productivity and potential health/exposure concerns for both your staff and your patients as a result of the influenza virus. In fact, many healthcare employers have arrived at the same conclusion and do require that their staff be vaccinated. So the answer to your first question is ‘Yes’. Barring an employment contract or collective bargaining agreement to the contrary, it is legal to make vaccination a condition of employment in an at-will state like ours. Your next question gets at the nuances of requiring a flu shot and this is where you will need to take note if you want to go down this path. First and foremost, you will want to draft a clear, legally sound policy to inform all staff (both existing and future new hires) that obtaining an annual flu vaccination is a condition of employment. Part of creating this policy will be deciding how far you will go to enforce it. Will those who refuse to be vaccinated be disciplined? Will they be terminated? What about those who refuse based on their religious beliefs or those who are unable to be vaccinated due to a health condition? Your desire to stop the spread of the flu virus does not trump an employee’s right to request an accommodation or an exemption for religious and/or health reasons. Since medical conditions and religion are protected under the Americans with Disabilities Act and the Civil Rights Act, you may have to make some exceptions to your new rule if an employee is able to legitimately prove their resistance to your policy is based on one of these legally protected reasons.
This brings up another important set of questions. Who will be monitoring employees’ compliance with this policy? How will employees prove they have been vaccinated? Are you going to allow a grace period if an employee goes more than 12 months between each shot? Are you going to issue reminders? If you have a small office then it may not be that difficult to manage this process. However, if you have a larger group or multiple locations then you’ll want to spend some time thinking through a tracking system and perhaps a point person to make this policy effective. Finally you’ll want to think through how to best communicate this policy to your employees. Focus on the benefits of being vaccinated (both for your staff and for your patients) and provide factual information to address any efficacy and/or safety concerns your employees may have. The more notice you can give your staff that this change is coming the better. If you’d like to ease employees into this, you could consider making the flu vaccine strongly recommended for the first year and then move to requiring it in subsequent years. The goal is to make participation as easy as possible, so you might consider hosting a free flu clinic for your staff and (possibly) their family members. For those who are scared of needles you could offer the intranasal option as well as the shot. At the end of the day, a measured approach with a focus on health will yield the best results!
2017 Education Offerings MSMS LUNCH-N-LEARN SERIES Grab a lunch, click the link, and join us! For more information, follow this link: https://www.msms.org/Education/UpcomingWebinars.aspx
MSMS ON-DEMAND WEBINARS Physician Executive Development Programs: • Health Care Law for Physicians in ACO’s • Medicaid Issues and Trends: Outlook for 2014 and Beyond • In Search of Joy in Practice: Innovations in Patient Centered Care • From Physician to Physician Leader • Inter-Professionalism: Cultivating Collaboration • Financial Information Analysis, Budget Development, and Monitoring • Choosing Wisely • CDL-Medical Examiner Course Legalities Practicalities, and Compliance including: • Cyber Security: Issues and Liability Coverage • Engaging Patients on Their Own Turf: Using Websites and Social Media • Summary of the Affordable Care Act • HIPAA Security Rule • End of Life Concerns and Considerations • What’s New in Labor and Employment Law • Preparing for the Medicare Physician Value-Based Payment Modifier • Understanding and Preventing Identity Theft in Your Practice • Stepping Up to Stage 2 • Physician On-line Rating and Reviews: Do’s and Don’ts • Patient Portals as a Tool for Patient Engagement • Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities • Opioids and Michigan Workers’ Compensation • Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction
BILLING AND CODING COURSES MSMS/MMBA billing webinar series at noon on the third Wednesday of each month. Below are past billing webinars available on-demand: • Compliance • ICD-10 for 2017 & Routine Waiver of Co-pays • ICD-10 • Credentialing • Billing 101 • Managing Accounts Receivable • Understanding the Remittance Advice • Tips and Tricks on Working Rejections • Claim Appeals For a complete list of billing courses, contact Stacie Saylor 336-5722 or ssaylor@msms.org
EDUCATIONAL CONFERENCES Annual Joseph S. Moore, MD Conference on Maternal and Perinatal Health Date: Thursday, May 18 Time: 9:00 am - 4:15 pm Location: Somerset Inn, Troy Contact: Marianne Ben-Hamza 517-336-7581or mbenhamza@msms.org Intended for: Physicians, nurses, residents, students, and all other health care professionals working with women and their infants.
Spring Scientific Meeting Morning, afternoon and evening clinical courses available Date: Thursday, May 18 and Friday, May 19 Location: Somerset Inn, Troy Contact: Marianne Ben-Hamza 517-336-7581or mbenhamza@msms.org Intended for: Physicians and all other health care professionals
• Section 1557: Anti-Discrimination Obligations Visit www.msms.org/OnDemand for complete listing of MSMS On-Demand Webinars.
Register online at msms.org/eo or call MSMS at 517-336-7581 for more information. JAN / FEB 2017 |
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THE DOCTORS COMPANY
Optimize the EHR: Better Workflow Means Better Work-Life Balance By Chad Anguilm, Director of Professional Services, Medical Advantage Group
Today, physicians have access to more data than ever before, and complying with new quality programs and pay-for-performance initiatives requires doctors to aggregate that data in various ways. Physicians and their office staff now spend a significant amount of time sorting through data in order to satisfy all the checkboxes— leaving them overwhelmed and dissatisfied.
Enhancing the EHR
But there are tools that can streamline patient care and payment workflows in the electronic health record (EHR). By dedicating time and effort up front to optimize the EHR, physicians can get relief from administrative tasks, reduce duplicate entry of data, and save time by not having to search for records in multiple places. Effectively maintaining an EHR is an ongoing process—the industry offers nearconstant improvements—but the reward is a better work-life balance.
3. Establishing predefined care alerts to
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Enhancing the EHR means focusing on these four top areas:
1. Building a direct data interface. When
all patient data, from both within the practice and from outside sources, is routed through the EHR in a structured format, a physician has all the information required at the pointof-care when treating a patient. The interface can include data from lab tests, radiology, and health information exchanges (HIEs); devices like blood pressure cuffs and health trackers; and other outside vendors.
2. Organizing patient data to provide a
central point of access in the EHR. Immediate and organized access to complete patient information can help reduce unnecessary office visits, imaging, and labs tests.
guide physicians through the treatment portion of the visit. The parameters of each alert should be set by the physician, based on the Healthcare Effectiveness Data and Information Set (HEDIS) or other quality metrics or quality-based programs the doctor participates in. By setting up alerts that are triggered by the receipt of structured data instead of being manually triggered, a practice can see
more patients and provide customized treatment plans without running recalls or prepping charts prior to the patient’s arrival. Setting up alerts is a one-time effort—then, armed with the right tools, the physician can rely on educated decision-making at the point-of-care, when time is of the essence. At a minimum, the EHR should identify gaps in care and alert the physician in real-time as to what the patient needs.
4. Integrating population health management reporting tools that
allow the physician to see gaps in care or future care needs based on gender, age, and medical history, such as foot exams, immunizations, and colonoscopies. These tools—offered in many EHRs through the EHR vendor or a clinically integrated network (CIN)—analyze data from the EHR, HIEs, payer claims systems, and lab and radiology facilities, so that a physician can make decisions based on the patient’s longitudinal medical record. This offers the ability to bill for services during the office visit, send campaign messages (such as for a flu shot or annual physical) to patients, and report data in a useful format to referring physicians. In addition, a clinical rules engine takes action based on what is documented in the chart. For example, when a patient is diagnosed with asthma for the first time, it automatically recommends a medication and a follow-up appointment.
Getting Help in Optimizing the EHR When optimizing their EHR, physicians would benefit from working with an experienced consulting team that understands the tools available as well as the flow of the practice. An outside firm with wide knowledge and perspective on the industry and various EHR systems will be most aware of the optimization opportunities available. The firm might also be able to use economies of scale to integrate the EHR systems of multiple practices within a physician organization, physician-hospital organization, CIN, or accountable care organization through a HUB or HIE—increasing the flow of data or decreasing cost. The EHR vendor will often be involved in the optimization process, but an outside consulting firm should lead the project. Many EHR vendors offer a complete EHR solution but are ineffective at optimizing workflow during implementation. And once the EHR is implemented, an inexperienced office manager may be charged with managing the vendor relationship remotely to ensure the full functionality of the EHR. At this point, the office manager or physician may not be aware of the full capabilities of the EHR and may not be equipped with the questions to ask a vendor to determine if the vendor can help the practice get the most out of the EHR—or if it’s time to hire a consulting firm.
Here are the questions a practice should ask the vendor: What local laboratory/radiology/ report interfaces are available in the area that may help streamline the flow of data in and out of my practice? What data can be submitted electronically through a commonly accepted file for incentive programs like PQRS, Meaningful Use, and other payer-directed programs in order to decrease duplicate entry? What devices such as trackers, kiosks, or EKGs connect directly to the EHR to decrease manual entry? What inbound interfaces can be set up to accept ADT data, structured data from other physicians, or vaccine registries? What type of remote access capabilities—such as smartphone or tablet apps or web-based accessibility—are available in order to complete tasks without being tied to the office?
Maximizing Workflow to Minimize Work Time Ultimately, when an EHR system is optimized, physicians can focus their time on caring for patients and maintaining a good work-life balance. Take the example of Michael Little, MD, a pediatrician in Clinton Township, Michigan. Dr. Little was staying at his practice until late at night to enter data due to an inefficient EHR system that caused him to take notes by hand and then enter them manually into the EHR. By working with an outside consultant to redesign workflows, optimize templates, and complete a HIPAA analysis, Dr. Little reduced the amount of time he spent entering data from 30 minutes per patient to 2 to 3 minutes. He now has more direct faceto-face interactions with his patients and no longer stays late to update his charts, providing him more time at home with his wife and small children. CONTRIBUTED BY THE DOCTORS COMPANY. MEDICAL ADVANTAGE GROUP IS A WHOLLY OWNED SUBSIDIARY OF THE DOCTORS COMPANY. FOR MORE PATIENT SAFETY ARTICLES AND PRACTICE TIPS, VISIT WWW.THEDOCTORS. COM/PATIENTSAFETY.
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Making MACRA Work for You Have you heard of MACRA? And more importantly, are you prepared for it? If the answer to either of these questions is ‘no’ or you’re unsure, strap in. Changes are afoot in the world of Medicare reimbursement and it’s critical that providers everywhere are prepared to navigate the soon-to-be changing environment. Having a firm grasp on MACRA and what it means for you and your practice will undoubtedly save you time, money and plenty of headaches, leaving you with more time to devote to caring for your patients. What is MACRA? It may seem like a silly place to start, but not really – in fact, only about 50 percent of practicing physicians have even heard of MACRA according to Deloitte’s 2016 Survey of U.S. Physicians. MACRA stands for Medicare Access and CHIP Reauthorization Act of 2015 and it was signed into law well over a year ago. Don’t worry, you’re not already behind. Despite being well over a year old, the Center for Medicare and Medicaid Services (CMS) just recently released the final rule explaining the forthcoming sweeping changes. At its essence, MACRA charts a roadmap for how the Medicare physician reimbursement system will move away from a volume-based, fee-for-service model and more toward a value-based care payment model stressing prevention and wellness management. MACRA sets out to reward physicians for providing quality care and achieving good outcomes in a cost-effective manner.
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With CMS’s Final Rule on MACRA clocking in at just under 2,400 pages, there is plenty of complexity and nuance that deserves serious consideration. Physicians everywhere will need to do their homework on this issue as they develop their own strategies for achieving success in regards to new MACRA performance requirements. But for now, let paint a broad picture of what MACRA does and how it will impact you and your practice in the very near future.
Immediate Impact Most immediately, MACRA repealed the sustainable growth rate formula for Part B payments and replaced it with the coupling of annual of inflationary increases (0.5 percent until 2019 and 0.25 percent starting in 2026) and the new Quality Payment Program, which is the actual policy mechanism responsible for transitioning Medicare from a fee-for-service to a pay-for-performance reimbursement model.
So, what does that mean? a decision to make for most. To put it simply, a new set By default, physicians and Physicians and other ECs will be placed on of metrics will play a part in the MIPs track and most – determining how physicians other eligible even if they want to – won’t are reimbursed for Medicare services going forward. clinicians have the be able to meet the initial re2017 will be the first year choice between quirements for the Advanced APM path. As the transition of reporting in this new entwo paths…MIPS away from fee-for-service in vironment, and the results or APMs. Medicare begins, MIPS will of this initial performance undoubtedly be the starting year will be reflected in 2019 place for most in 2017. Medicare payment adjustments. Physicians and other eligible clinicians (ECs) have the So, what exactly is MIPS? choice between one of two paths dictating the specifics of how they will be reimbursed: MIPS is a modified FFS reimbursement (1) the Merit-based Incentive Payment Sysmodel in which participating physicians tem (MIPS) or (2) Advanced Alternative are given a payment adjustment based on Payment Models (APMs). data they submit in four categories deemed
Does everyone have to participate? Actually, no. There are a few ways to be exempt from the Quality Payment Program. The most likely path to an exemption is having a low number of Medicare patients – physicians with less than $30,000 in Medicare Part B charges or 100 or fewer Medicare patients qualify as a low-volume provider and are eligible for an exemption. “The low-volume exemption provides a sigh of relief for a lot of physicians right off the bat,” said Stacey P. Hettiger, Director of Medical and Regulatory Policy at the Michigan State Medical Society. “It’s estimated that this change alone will exempt 32.5 percent of eligible clinicians from the QPP. Thankfully, this is one of many recommendations from MSMS and others in organized medicine that CMS recognized in the final rule.” Practitioners newly enrolled in Medicare are also exempt from MACRA through their first year. Finally, qualified physicians participating via the AMP pathway are exempt from the MIPS requirements.
Which path to choose for eligible providers? Assuming you don’t qualify for an exemption at the onset, there won’t be much of
emphasizing value over volume.
The four categories are: 1. Quality, 2. Resource Use/Cost, 3. Advancing Care Information 4. Clinical Practice Improvement Activities Scores in these four categories will be weighted and rolled into one composite score ranging from 1 to 100. Physicians with a composite score above an identified threshold will receive an upward payment adjustment, and conversely, payments to physicians with scores below the threshold will be adjusted downward.
Value-Based Payment Modifier (VBPM) and Medicare Meaningful Use (MU). “MIPS may sound overwhelming but the reality is most physicians are already engaged in performance, improvement and reporting activities well-aligned with the program,” Hettiger said. “Evaluating those activities in which you’re already engaged and then figuring out how they fit into this new model is the first and likely biggest step a lot of physicians will need to take to ensure they’re on their way to meeting their MIPS participation requirements.”
Additionally, getting a handle on your quality reporting is critical. Quality measures account for 60 percent of a physician’s total MIPS score in the initial payment adjustment year of 2019 before being gradually adjusted downward to 30 percent by 2021. If you have reported to PQRS in the past, you’re already in good shape. The data collection and reporting process will be largely unchanged under MIPS. The only real difference is that physicians will now select the six quality measures that best apply to the specifics of their practice or specialty, whereas PQRS currently requires physicians to report on nine quality measures.
In this transition year, physicians already familiar with PQRS should report on metrics for which they have historically performed well and that cut across multiple Important to note is the fact that MIPS payers. Doing so likely provides the best will be a zero-sum game – positive and chance at a positive payment adjustment negative adjustments will be distributed without making any significant modificaequally to ensure MIPS retions to the manner in which mains budget-neutral. Also, your practice tracks and rethe swing of the adjustment ports data. Most of will spread as time passes, The Advancing Care InforMIPS growing from +-4 in 2017 mation (ACI) metric is the isn't new. to +-9 in 2022 and beyond. next most heavily weighted category in the first year of This should sound someMIPS, constituting 25 percent of a physiwhat familiar to physicians. Most of MIPS cian’s composite score. Again, the reportisn’t new. In fact, measurement in three of ing in this category should be familiar to the four performance categories will rely anyone previously attesting to Meaningheavily on elements from three legacy ful Use. This component of MIPS modiquality reporting programs – the Physifies and replaces the Medicare Electronic cian Quality Reporting System (PQRS),
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MAKING MACRA WORK FOR YOU (continued)
Health Record (EHR) Incentive Program. Emphasis has been placed on using technology in a way that promotes information exchange and interoperability between both physicians and patients. The Clinical Practice Improvement Activities (CPIA) component of MIPS is entirely new and designed to reward physicians engaged in activities that are recognized as drivers of improvement and innovation. Despite the fact that physicians have not previously reported these activities to CMS, most will find that they are already engaged in one or more of the specified CPIAs. In fact, many physicians in Michigan will fully meet the CPIA requirement without having to make any changes whatsoever. Thanks to advocacy efforts led by the MSMS, Blue Cross Blue Shield of Michigan (BCBSM), and American Medical Association (AMA), CMS modified the final rule to recognize Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home (PCMH) designation as fully meeting the PCMH definition under the final rule. “CMS’s decision to recognize BCBSM’s PCMH designation is a huge boon for physicians here in Michigan,” MSMS President David M. Krhovsky, MD, said. “The rule modification is both a testament to the quality of our state’s well-established efforts to lead innovation and of our combined advocacy efforts. Additionally, it provides a hopeful indication of CMS’s willingness to work with organized medicine as the Quality Payment Program is rolled out and refined.”
to identify additional improvement activities relevant to their practice. Examples of other qualifying activities include shared decision-making, extended access, care coordination between providers, participation with the Michigan Automated Prescription System (MAPS), and reporting to the Michigan Care Improvement Registry (MCIR).
2, 2017 before beginning their full 90-day period tracking performance measures and still potentially qualify for a small positive payment adjustment in 2019, which leaves physicians with several months to learn the ins and outs of MACRA and confidently prepare for implementation without fear of being penalized.
The last component contributing to your MIPS score is the resource use category. This element will have an initial weight of zero percent in 2017 before being gradually adjusted upward to 30 percent of the composite MIPS score, and it will produce no additional reporting burden for physicians. This component of the MIPS score replaces the value-based modifier and is solely based on certain costs which are culled from Medicare claims.
“The most important thing for physicians to know is they should strive to report something for 2017. At minimum, reporting on one quality measure or on one improvement activity during 2017 will be enough to keep physicians from receiving an initial downward payment adjustment in 2019,” Hettiger said. “With that being said, there are definitely advantages to participating as fully as possible in 2017.”
Setting a pace Sound complicated? That’s because it is. “MACRA is complex,” said MSMS Past President Rose M. Ramirez, MD, a solo family medicine physician based in Grand Rapids and past MSMS president. “It’s more than just a replacement for the SGR. It’s a law that attempts to address the full diversity of the medical profession and as a result it’s daunting for everyone.” And while this may seem like a lot all at once, the good news for physicians will have some additional time transitioning into MIPS.
“The overall implementation timeline is definitely ambitious, but I think the pickyour-pace flexibility CMS has provided is going to make a huge difference to a lot of providers,” Hettiger said. “Having a full For those who don’t practice in a qualifying year to assess what infrastructure needs to PCMH, there are plenty of other ways to be in place and what workfulfill the requirement. Of flow processes need to be the over 90 CPIA qualifying adjusted to make this viable activities, physicians need The pick-yourwill undoubtedly ease some only to participate in one to anxiety for many.” gain some credit in this cat- pace flexibility is egory. Again, participation going to make While the initial 12-month beyond the bare minimum performance period is set will be rewarded, so physi- a huge difference to begin on Jan. 1, 2017, physicians have until Oct. cians should make an effort to providers.
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Physicians that report more than the bare minimum are more likely to be rewarded, says Hettiger. Those that submit a full year of 2017 data will almost certainly qualify for a positive payment adjustment and may even receive the maximum positive adjustment available under MIPS in 2017. “If you can do it, try to identify those components of MIPS that are aligned with your practice and quality goals and commit to submitting data reflective of your efforts,” Hettiger added. “There’s no downside risk to reporting for 90 continuous days or longer in 2017. At the very least, it will hopefully better prepare you to make necessary adjustments in 2018.”
The APM path With all this being said, there is an alternative to MIPS. The Quality Payment Program offers physicians the choice between two paths in this transition to a to value-based reimbursement system. MIPS is the default payment model under which most physicians will initially participate, but there is another other option available to qualifying physicians ahead of the curve and already
utilizing certain innovative payment models.
APM pathway
cent bonus payment in 2019, physicians must receive 25 percent of their Medicare Part B payment or see 20 percent of their patients through the Advanced APM. And after 2021 these thresholds increase considerably.
Physicians sufficiently parbonuses become ticipating in Advanced Alternative Payment Models more lucrative (APMs) are provided a 5 as MACRA percent bonus payment moves beyond and are exempt from MIPS “There’s a lot of good that will reporting. And while most its infancy. come out of MACRA, but won’t initially qualify for this one thing they definitely got track, physicians will be increasingly incenwrong is the steep qualifying requirements tivized to adopt the Advanced APM pathfor the Advanced APM track,” said John way as potential payment bonuses become Billi, MD, of the University of Michigan more lucrative as MACRA moves beyond Health System and MSMS Board member. its infancy. “From the perspective of both the physician This path should also offer a sense of familiarity for some. There are already numerous Alternative Payment Models in existence that incentivize participating physicians to engage in population health strategies and value-based care delivery. Advanced APMs are a new subset requiring participating physicians to take on even greater risk – and potential reward – related to patient outcomes.
and CMS, the Advanced APM pathway is the preferred route, so why not make it easier to initially qualify? Starting small and gradually increasing the risk requirement over time would have provided practices the opportunity to accrue the experience and infrastructure necessary to effectively manage and understand all the complex contributing factors to the total cost of care, which is one of the primary objectives of MACRA.”
For an APM to qualify as ‘advanced,’ the following requirements must be met: • Require participants to use certified EHR technology • Base payment on quality measures similar to the quality measures identified under MIPS • Require physicians to bear more than nominal financial risk for monetary losses, or is a Medical Home Model expanded under CMMI authority
In total, CMS estimates that only four to 11 percent of participating clinicians will qualify for the Advanced AMP track in 2017. Almost making the cut does count for something though. Those not meeting the participation threshold or participating in APMs not categorized as “Advanced” will receive favorable consideration for certain reporting requirements under MIPS.
Given these criteria, most APMs won’t qualify as ‘advanced’ in 2017. The CMS shortlist of Advanced APMs includes the Medicare Shared Savings Program (Track 2 and 3), Next Generation ACO Model, Comprehensive ESDR Care, Comprehensive Primary Care Plus and Oncology Care Model. CMS will work to grow this list in the coming years, but for now the options are clearly limited. Making it even more difficult to qualify for reimbursement on the Advanced APM track is the participation requirements associated with these models. To earn the distinction of ‘Qualified Provider’ and thus earn the 5 per-
MIPS-eligible physicians in practices with 15 or fewer clinicians and those providing services in rural and underserved areas. This money will be distributed to a variety of organizations including regional extension centers. Practices lacking the technical infrastructure required of MIPS should certainly make it a point to take advantage of this additional support. Additionally, CMS, the AMA, MSMS and other organizations whose members are impacted by MACRA will have an extensive amount of literature and training resources available to guide physicians through the transition. MSMS will have a full calendar of in-person and online education to help physicians navigate MACRA. Two all-day sessions have been scheduled on May 5 in Grand Rapids and October 25 in November. Topics include how to get started, documentation using technology, and quality clinical registries. Online modules on these topics will also be available early this year. Please visit http://msms.org/eo for the latest updates. “My advice to physicians out there looking for additional support – especially small practice primary care physicians – is look to MSMS, the PRIME registry, look to your CIN, and look to your physician organization and specialty societies,” said Craig Ross, MD. “There’s a tremendous amount of resources out there to help physicians navigate their way through this.” The best advice: take it one step at a time and focus on what you can control.
“Small or large, urban or rural, every physician and eligible clinician will face The simple answer: it depends. challenges with MACRA implementation,” MACRA is comprehensive legislation that Hettiger said. “But don’t get too bogged will bring forth major changes and investdown in the details initially. First ask ment in medical reporting technology and yourself ‘where do I fit in?’ and once you’ve infrastructure and its impact will undoubtfigured that out, evaluate what you’re edly be felt throughout the already doing and how that medical community, but the fits into this new Medicare immediate effect it will have Take it one step payment structure. I think on the individual level will be a lot of physicians are going at a time and different for every provider. to be pleasantly surprised by how much they’re already CMS has earmarked $100 focus on doing that’s perfectly aligned million to be spent on techwhat you can with the requirements of nical assistance and training control MACRA.” over the next five years for
What does this all mean for me?
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Welcome New Members Barry
Muskegon
Abhimanyu Beri, MD
Thomas Andrews MD, FACC Michael Howe MD, FACC Matthew Roos, MD Marilyn Conlon, MD Hilarion Bibicoff, VII, DO
Genesee
Ingham
Northern
Belan Amat-Martinez, MD
Berrien
Richard Hennig, DO Katie Nolen, DO Paul Adams, MD R C Ravikumar, MD Karsten Fliegner MD, PhD, FACS Michael Sorscher, MD Gurjit Ajimal, MD Vivekanand Palavali, MD Ahmad Abdel-Halim, MD David Diskin, MD Jeffrey Diskin, MD Gary Keoleian, MD Veena Kalra, MD Melinda Wheatley, MD Stacey McEwen, DO Pratap Aravapalli, MD Fawaz Haddad, MD Mark Mattingly, MD Manisha Naran-Kia, DO Ashish Sarin, MD Nabil Zaki, MD Aftab Aftab, MD Saqib Maqsood Ahmad, MD
Erik Wert , DO Patrick Hennessey, MD Ahmed Sufyan, MD Kashif Khan, MD John Mitchell, MD Sarah Walton, MD
Grand Traverse/Benzie/ Leelanau
Livingston
Andrew Luea, DO Kyle Ver Steeg, II MD, FACS Jelanie Bush MD, FAAP Katherine Elms, MD Adrienne Wagner, DO William Kanner, MD Anthony Livorine, MD Jonathan Bott, MD Mark Cannon MD, PhD Jamshid Amanzadeh, MD Aleksandar Milovanovic, MD Glen Ackerman, MD Yelena Kier, DO Nicole Gunn MD, FACP, FACR Scott Selle, MD Amy Ranger, MD Bevin Clayton, DO Jurgen Runschke MD, FACEP Tara Bournay, DO Hillary Loomis-King, MD Christopher LaFond MD, MPH Andrew Adams, DO Robert LaPorte, MD Anne Cavanagh, MD
Jackson
Brian Daly, MD Maurice Jones, MD Mark Zande, MD Manzar Rajput, MD
Kalamazoo
Robert Gorman, III, MD Kurt Haller, MD
Kent
Susan Phillips, MD Brian Phillips, MD Harland Holman, MD Michael Kozminski, MD Donald Malcolm, MD Laura Gago, MD Pranita Rambhatla, MD John Vassallo, MD
Macomb
Jeremy Feldman, MD Faiz Francis, DO Nadia Khan, MD Nanci Mercer, MD Sundeep Patel, MD Cory Trivax, MD Michael Trpkovski, MD Steven Zuska, MD Mahmoud Al-Hadidi, MD
Manistee
David Fleszar, DO Mark Dangelo, DO Alan Fark, MD David Quimby, MD Rachel Vandenberg, DO Charles Vandenberg, IV, DO
Mason
James Ryan, DO
In Memoriam
THE MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER WITH RESPECT THEIR COLLEAGUES WHO HAVE DIED.
Steven Brinn, MD
Newago
Carol DeWeerd, MD Benjamin Edwards, MD Chris Loewen, MD Shafer Kurshuk, MD Laura Most, MD
Oakland
Kathleen Dass, MD Lori Joy Gallardo, MD Graham Krasan, MD Jody Jones, MD Marie McDonald, MD Sarah Hans, MD Amin Farokhrani, MD MinhChau Ha, MD Rebecca Heeney, MD Gypsa Katoch, MD Eleanor King, MD Nicole Lopez, MD Mitul Mehta, MD Andrea Milne, MD Pari Patel, MD Lilia Peress, MD Marco Peterson, MD Joseph Thomas, MD Olayinka Warritay, MD Starr Whittaker, MD Alexander Yang, MD Kaitlin Zeytuncu, MD Pauline Zhang, MD Usha Kiran Abbineni, MD Alexander Adams, MD Mhd Hussam Al Jandali, MD Salwan Al Mutar, MD Mohammad AlFityan, MD Omar Al-Hourani, MD Israa Ali, MD Muhammad Ali, MD Tiba Alwardi, MD Hashim Alwash, MD Sarah Asghar, MD Jasmeet Bal, MD Arham Barakzai, MD Nour Chams, MD Sana Chams, MD Amanda Chivu, MD Nisha Deol, MD Danielle Fabry, MD Jenil Gandhi, MD Faris Hannoodi, MD Adam Hull, DO Marwah Hussein, MD Daniel Kapadia, MD Shahniwaz Labana, MD Reem Mahdawi, MD
Tapasya Mandalapu, MD Lina Masso, MD Noor Naji, MD Maliha Naseer, MD Christopher Renkiewicz, MD Hussam Sabbagh, MD Ahmed Saleh, MD Jacob Salman, MD Kushal Shah, MD Alicja Sobilo, MD Toribiong Uchel, MD Janjenali Villaflor, MD Lucinda Wenzlick, MD Amardeep Dhaliwal, MD Anna Gregoire, MD Amanda Ismail, MD Anver Khan, DO Jeremy Lou, MD Gerta Mane, MD Tyler Phelps, DO Yasaira Rodriguez Torres, MD Steven Schoenfeld, MD Abdala Sirajeldin, MD Christina Stinnette, MD Adam Wolfe, MD Han Yang Yin, MD Sara Yungner, MD Leland Babitch MD, MBA Deborah Charfoos, MD Kamran Sheikh, MD Desiree Aird MD, MPH David Bracho, DO Philip Dela Merced, MD Lisa Gilbert, MD Christopher John, MD Nakul Kumar, MD Spurthy Narreddy, MD Nishankkumar Patel Nooli, MD Vennela Reddy, MD Mustafa Shukr, MD Hanish Singh, MD Kristin Swenson, DO Gina Gora, MD Paul Olejniczak, MD
Saginaw
Sue Tobin, DO Syed Alam, MD Mohammad Kanjwal, MD Peter Bistolarides, MD Joseph Yacisen, DO
Shiawassee
Keith Morrow, DO
Washtenaw
Ursula Knoepp, MD Raymond Hutchinson, MD Emily Shuman, MD Gary Gallagher, MD Jennifer Reeve MD, PhD Terence Joiner, MD
Wayne
Nasreen Bowhan, MD Katherine Fontichiaro, MD
Mark Goralewski, MD Elena Hadjicharalambous, MD Nancy Parquet, MD Douglas Piernick, MD Geoffrey Potts, MD Lindsay Sklar, MD Michelle Walby, MD Rachel Ward, MD Babatunde Babalola, MD Maryam Berri, MD Braden Boji, MD Omaima Bokhari, MD Wendy Contreras, MD Russell Deutscher, MD Mark Diamond, MD Robert Gapinski, MD Adil Hussain, DO Arun Idiculla, MD Michael Kasprzak, DO Melissa Kawa, MD Jose Mendez, MD Rene Ruggiero, MD Tyler Williamson, MD Jason Wright, MD Paul Yoo, DO Teresa Holtrop, MD Marsha Henderson, MD Bernard Acho, MD Benjamin Lack, MD Daniel Noujaim, MD Michael Scheer, MD Dominic Semaan, MD Kathryn Winkler, MD Megha Mohey, MD Ibrahim Bawab, MD Michael Blasco, MD Dennis Bojrab, MD Daniela Burchhardt, MD Frank Chen, MD Michael Chen, MD Thai-Duong Cung, MD Catherine Mae Geller, MD Tedean Green, MD Amar Gupta, MD Houmehr Hojjat, MD Thomas Jetmore, MD Andrew Johnson, MD Sean Mutchnick, MD Priyanka O'Brien, MD Hani Rayess, MD Peter Svider, MD Angela Vong, MD Jonathan Waxman, MD Rohith Arcot, MD Priyanka Arshanapalli, MD Kevin Ginsburg, MD Jesse Jacobs, MD Aram Loeb, MD Navneet Mander, MD Sunil Reddy, MD Kahlil Saad, MD Elie Chidiac, MD Pranita Rambhatla, MD
Wexford/Missaukee April Kurkowski, DO
Paul G. Schutt, MD, Kent County Medical Society, 10/8/16 Robert A. Winfield, MD, Washtenaw County Medical Society, 10/14/16 Gerald J. Aben, MD, Wayne County Medical Society, 10/18/16 Walter M. Belenky, MD, Wayne County Medical Society, 10/22/16 Paul J. Sullivan, MD, Wayne County Medical Society, 10/27/16
If you would like to recognize a colleague by making a gift or bequest to the MSMS Foundation in their memory, contact: Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw St., East Lansing, MI 48823 p: 517-336-5729 e: rblake@msms.org
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MSMS Medical Opportunities msms.medopps.org
MSMS Medical Opportunities has been connecting physicians with employers since 1944. It is a nonprofit program through the Michigan Health Council designed to simplify your job search by posting jobs that match your practice preferences. Learn more at msms.medopps.org. Internal Medicine GME Faculty Position
After Hours/Family Care Clinic - GIGP
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Great Critical Care-Intensivist Opportunity
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msms.medopps.org
Orthopedic Surgeon: Big Rapids Michigan Spectrum Health, Big Rapids, MI OPPORTUNITY ID: 11081
Pediatrician
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Adult Psychiatry Opportunity Pine, Grand Rapids, MI
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Psychiatry Opportunity Trinity Health, Ann Arbor, MI OPPORTUNITY ID: 9877
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Urology, MD, DO - Twp Opportunities in MI Sparrow Health System, Lansing, MI
OPPORTUNITY ID: 1733 | OPPORTUNITY ID: 8158
Heart & Vascular Institute: Cardiothoracic Surgeon UP Health System - Marquette, Marquette, MI OPPORTUNITY ID: 6661
Radiation Oncologist
St. Mary’s of Michigan - Saginaw, Saginaw, MI OPPORTUNITY ID: 10025
Family Medicine Physician
Pediatric Urgent Care
Epileptologist
OPPORTUNITY ID: 11314
OPPORTUNITY ID: 11578
OPPORTUNITY ID: 9534
Hills And Dale General Hospital, Cass City, MI
Family Health Care, East Lansing, MI
Bronson Methodist Hospital, Kalamazoo, MI
Staff Physician-Carson City
Pediatrics - General
Urologist needed in a thriving practice!
OPPORTUNITY ID: 11109
OPPORTUNITY ID: 11548
OPPORTUNITY ID: 10140
Corizon, Carson City, MI
North Ottawa Community Health System, Grand Haven, MI
McLaren, Bay City, MI
JAN / FEB 2017 |
michigan MEDICINE 21
WEALTHCARE ADVISORS By Nicole Gopoian Wirick, JD, CFP®
Year-End Tax Plannng Strategies The end of the year is quickly approaching. This means it’s time to evaluate the advantages of year-end tax planning strategies as they relate to your situation.
Savings and Retirement Accounts PRE-TAX RETIREMENT PLAN CONTRIBUTIONS
Maximize your pre-tax retirement plan contributions and at a minimum, contribute the amount needed to maximize any employer match available to you. Many employers now offer a Roth 401(k) plan. TRADITIONAL OR ROTH IRA
Consider making a contribution to a Roth or Traditional IRA. Depending of your income level and participation in an employer sponsored plan, the contribution may or may not be deductible. A well tailored financial plan will address this savings opportunity based upon your tax situation. AFTER-TAX SAVINGS
Save additional discretionary income into a tax efficient after-tax investment portfolio. Wise financial planning suggests creating pools of tax-deferred, tax free and taxable assets for greater planning opportunities down the road. ROTH CONVERSION STRATEGY
If systematic Roth conversions have been part of your financial plan, a re-evaluation should be considered annually. This could provide a great opportunity in years of atypically low income or if you are in AMT territory. REQUIRED MINIMUM DISTRIBUTION
You generally have to start taking withdrawals from your IRA, SEP IRA, SIMPLE IRA, or retirement plan account when you reach age 70½. However, Roth IRAs do not require withdrawals until after the death of the owner. If required, ensure you take the required minimum before December 31. The IRS imposes steep tax penalties if you fail to take your required minimum distribution.
22 michigan MEDICINE
| JAN / FEB 2017
Education Planning Education funding for a loved one is an excellent way to give the gift of education. Due to potential estate and state income tax benefits, consider a 529 plan—a tax-advantaged savings plan designed to encourage saving for qualified higher education expenses. This type of plan allows for tax deferred accumulation and tax free distributions so long as they funds are applied to a qualified educational expense. A five year accelerated gift can also be made it your situation permits.
Charitable Planning Coordination of your charitable goals with your financial plan is a great way to meet your philanthropic objectives. The following are year-end charitable planning considerations: HIGHLY APPRECIATED STOCK
Donating from your taxable investment portfolio can be a great way to meet your charitable planning goals, accomplish portfolio rebalancing needs, as well as receive potential tax benefits such as a charitable deduction and avoidance of capital gain tax on the appreciated asset. QUALIFIED CHARITABLE DISTRIBUTION
In December 2015, Congress passed a law allowing you to give up to $100,000 to charity directly from your individual retirement account (IRA) when you are over 70½ years old. This can be applied to your required minimum distribution and without counting the distribution as taxable income. With the close of 2016 comes opportunity for year end tax planning. Contact your tax professional and financial planner to determine the best strategy for you.
[=] SOLID ADVICE.
REAL SOLUTIONS. FOR HEALTH CARE BUSINESS.
At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value. The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA
TheHLP.com [284.996.8510]
www.MSMSInsurance.org
Committed to protecting Michigan physicians, MSMS Physicians Insurance Agency knows it’s your life. Your family. Your dreams. We focus on you first and foremost, because we have the novel idea that protecting you is protecting Michigan. MSMS Physicians Insurance Agency is uniquely qualified to offer our insurance portfolio to Michigan physicians, their families and office staff. We make it our business to know your business. By knowing the unique issues physicians face every day, MSMS Physicians Insurance Agency: • • • •
Eliminates the need for you or your practice to contact insurers for billing purposes; Has direct access to the insurer’s systems to add, terminate or change a subscriber’s information within 24 hours, which removes the administrative burden from you and your staff; Will research claims inquiries and benefit questions for you or the subscriber, which will eliminate the frustration of contacting a complex customer service center; and, Handles all COBRA administration for groups with more than 20 employees, free of charge, thus removing another administrative burden.
You always get more with MSMS Physicians Insurance Agency because we focus on you.
For more information or to request a quote for affordable, high-quality health insurance, please connect with Ty at 877/742-2758 or tliggons@msms.org.