Michigan Medicine®, Volume 117, No. 6

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 117 / NO. 6

November/December 2018

Reengineer Your Work Day to Prevent Burnout

ALSO INSIDE Michigan Legislation on Sexual Assault Prevention and the Retention of Medical Records Page 6

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FEATURES & CONTENTS November / December 2018

06

Michigan Legislation on Sexual Assault Prevention and Retention of Medical Records PATRICK J. HADDAD, JD, KERR RUSSELL

08

The Rise of Vaccine-Preventable Diseases ALYSSA NOWAK, MPH, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF IMMUNIZATION

22

Distracting Devices in Healthcare: Malpractice Implications SHELLEY RIZZO, MSN, CPHRM, , THE DOCTORS COMPANY

COLUMNS 04 President's Perspective

14

BY BETTY S. CHU, MD, MBA

10 Ask Human Resources

BY JODI SCHAFER, SPHR, SHRM-SCP

12 Health Care Delivery

BY LUANN JENKINS, CPMA, CMRS, CPC, CEMC, CFPC, MEDTRUST, LLC

FEATURE

Reengineer Your Work Day to Prevent Burnout

BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

STAY CONNECTED!

Research and evidence suggest a few changes in a physician’s daily routine may make a big difference. Read more about on page 14.

NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 3

MICHIGAN MEDICINE® VOL. 117 / NO. 6 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.

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Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2018 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. ©2018 Michigan State Medical Society

4 michigan MEDICINE®

perspective

By Betty S. Chu, MD, MBA, Michigan State Medical Society President

®

Colleagues, New data and research is laying bare an escalating burnout crisis among physicians in the United States. It’s also helping to identify the biggest culprits behind the phenomenon. Physicians—and their patients—continue to pay a high price for dwindling professional satisfaction, but help is on the way.

In this edition of Michigan Medicine® we highlight the latest research, and break down both what causes burnout and a few simple solutions that can make all the difference in the world.

BETTY S. CHU, MD, MBA MSMS PRESIDENT

We hear from experts, like Lisa MacLean, M.D., the Director of Physician Wellness at Henry Ford Health System, where she has garnered national recognition and acclaim for her work to comprehensively support physician wellness at a system level, and from Rose Ramirez, M.D., the former president of the Michigan State Medical Society, who has fought the problem both as a sole practitioner and as the leader of a statewide physician organization.

You’ll also read about meaningful and actionable solutions that can help you reengineer your own workday to improve satisfaction and cut down on burnout.

Teamwork. Mindfulness. Workflow analysis support. Efforts to improve efficiencies in your practice’s use of electronic health records. The solutions are as varied as the problems. Whether it’s changing a day planner or a work culture, every step to combat burnout is an important one. And it might just save a life.

Sincerely,

Betty S. Chu, MD, MBA MSMS President

NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 5

ASK OUR LAWYER

Michigan Legislation on Sexual Assault Prevention and Retention of Medical Records Patrick J. Haddad, JD, Kerr Russell

Q: How does the recent Michigan sexual assault prevention legislation affect the retention of medical records?

P

hysicians who are exposed to the assertion of sexual assault claims by adults and minors, due to their professional practices, should re-evaluate their minimum medical record retention periods in light of Public Acts 182 and 183 of 2018 and House Bills 5783 and 5793, if enacted into law as written as of the publication of this article. Subject to further evaluation once the disposition of House Bills 5783 and 5793 is known, such physicians may need to consider retaining their medical records for no less than 10 years (assuming the exceptions in House Bills 5783 and 5793 apply) from the date of service for adult patients and until minors reach at least 33 years of age.

These periods exceed existing minimum retention periods for Michigan licensing purposes (7 years), the minimum retention period for the medical records of adults enrolled in Medicare Advantage plans (10 years), and the statute of limitations for professional liability claims (capped at 6 years from the date of service for adults and minors age 8 years or older, or capped at 6 years/age 10, whichever is later, for claims which accrue before a minor attains 8 years of age, subject to exceptions for claims which have been fraudulently concealed or for injury to a reproductive organ resulting in the inability to procreate).

A summary of relevant legislation follows:

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Public Act 182 of 2018 (Senate Bill 871) This legislation was adopted on June 12, 2018 and became effective on September 10, 2018. It extends the criminal statute of limitations for second and third degree criminal sexual conduct involving a minor to 15 years after the offense is committed or the victim’s 28th birthday, whichever is later. The criminal statute of limitations for second and third degree criminal sexual conduct offenses against adult victims, and the period for fourth degree criminal sexual conduct offenses against adults and minors, remains unchanged; i.e., 10 years after the offense is committed or the victim’s 21st birthday, whichever is later. An exception which permits tolling of the statute of limitations, based on DNA evidence from unidentified individuals, remains in place for adults and now applies to offenses for second and third degree criminal sexual conduct committed against minors. There continues to be no statute of limitations for first degree criminal sexual conduct offenses committed against adults or minors; i.e., an individual can be charged with first degree criminal sexual conduct at any time after the offense is committed.

Public Act 183 of 2018 (Senate Bill 872) This legislation was adopted and became effective on June 12, 2018. It extends the periods under the civil statute of limitations for lawsuits to recover damages because of criminal sexual conduct. The legislation incorporates the definition of “criminal sexual conduct” from the Michigan Penal Code.

For victims who are adults when the offense is committed, the civil period of limitations is extended from 2 years (i.e., the existing period for assault and battery claims generally) to 10 years (i.e., the new period for claims for criminal sexual conduct). The period of limitations begins to run after the claim first accrues. It is not necessary that a criminal prosecution has been brought or that any

prosecution resulted in a conviction. There is no extended discovery period, which will now be available to victims who are minors as described below. The existing 5-year period of limitations for assault and battery claims involving spouses or individuals in dating relationships remains unchanged, but is extended to 10 years for claims for criminal sexual conduct. Claims for assault and battery not involving criminal sexual conduct or spousal/dating relationships remain subject to the 2-year period of limitations.

Subject to the changes made by the legislation, the existing 3-year period of limitations continues to apply to claims for death or injury to persons or property when no other period of limitations is specified by law.

Before Public Act 183, victims who were minors when sexually assaulted had 2 years or until their 19th birthday, whichever was later, to bring suit. Public Act 183 provides that victims who are minors when sexually assaulted may file suit by the latest of (i) the victim’s 28th birthday or (ii) 3 years after the victim discovers, or through the exercise of reasonable diligence should have discovered, both the injury and the causal relationship between the injury and the criminal sexual conduct. The 3-year discovery period runs indefinitely; there is no statute of repose that cuts off the time to file suit under the discovery standard. As with claims by adult victims, it is not necessary for claims by minors that a criminal prosecution was brought or that any prosecution brought resulted in a conviction.

Public Act 183 has limited retroactive effect.

It provides that an individual who, while a minor, was the victim of criminal sexual conduct after December 31, 1996, but before 2 years before the legislation’s effective date, may file suit within 90 days after the legislation’s effective date, if the person alleged to have committed the criminal sexual conduct

was convicted of first degree criminal sexual conduct against any person and admitted that (i) he or she was in a position of authority over the victim as the victim's physician and used that authority to coerce the victim to submit, or (ii) the defendant engaged in purported medical treatment or examination of the victim in a manner that is, or for purposes that are, medically recognized as unethical or unacceptable. Claims that meet the preceding qualifications that are not filed within the 90-day period will be time-barred by the statute of limitations. Retroactivity is not available to victims who were adults when sexually assaulted.

House Bills 5783 and 5793 These bills passed the Michigan House on May 24, 2018 and as of the date of this publication are pending in the Michigan Senate.

They will require performance of medical encounters involving vaginal or anal penetration to be documented in a patient’s medical records, including records maintained by health facilities or agencies. These records will need to be maintained for at least 15 years.

Such procedures must be within the scope

of practice of the treating health professional. A medical assistant or another licensee or registered health professional must be in the room during the encounter, unless waived by the individual giving the written consent. Licensing and criminal penalties and fines are provided for violations of the legislation.

The legislation will require written parental consent before procedures involving vaginal or anal penetration may be performed on a minor. The consent form must be maintained in the patient’s medical record for not less than 15 years from the date on which the medical treatment, procedure or examination was performed. The Department of Licensing and Regulatory Affairs is required to create a standardized consent form for use by licensed and registered health professionals.

The requirements of the legislation do not apply to treatment: necessary and associated with, or incident to, a medical emergency (i.e., a circumstance that in the licensee’s or registrant’s good-faith medical judgment creates an immediate threat of serious risk to the life or physical health of the patient),

if primarily related to the patient’s urological, gastrointestinal, reproductive, gynecological, or sexual health, if performed at a children’s advocacy center, as defined in Michigan’s Child Protection Law, if performed for purposes of a sexual assault medical forensic examination under Section 21527 of the Public Health Code, if performed for the purpose of measuring the patient’s temperature, or if performed for the purpose of rectally administering a drug or medicine.

The Michigan licensing boards for physicians, chiropractors, physical therapists and athletic trainers will be required to develop a document providing guidance on generally accepted standards of practice for certain services involving vaginal or anal penetration. The document will be publicly available.

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

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michigan MEDICINE® 7

MDHHS UPDATE

The Rise of Vaccine-Preventable Diseases Alyssa Nowak, MPH, Michigan Department of Health and Human Services

Vaccines are considered one of the greatest public health achievements of all time, yet many of the diseases that vaccines protect against are still present today. CDC estimates that vaccination of children born between 1994 and 2016 will prevent 381 million illnesses, 24.5 million hospitalizations and help avoid 855,000 early deaths, so why are they still underutilized?

Only 57%

of Michigan toddlers are up-to-date on all their recommended vaccinations.

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U

nfortunately, sub-optimal vaccination rates persist in Michigan and nationwide, leaving gateways for these diseases to enter society. According to the Michigan Care Improvement Registry as of June 30, 2018, only 57% of Michigan toddlers are up-to-date on all their recommended vaccinations.

Michigan Department of Health and Human Services and the Franny Strong Foundation have teamed up to launch the I Vaccinate campaign to educate parents about the importance of vaccines for their children. To learn more about this campaign visit https://ivaccinate.org/.

Within the last year, Michigan has experienced a severe flu season, an unprecedented number of measles cases and outbreaks of mumps, pertussis and varicella. Ongoing vaccine-preventable disease outbreaks confirm the presence of susceptible communities and emphasize the importance of improving vaccination rates statewide.

Influenza The United States 2017-18 Influenza Season was a high severity season due to widespread influenza activity for an extended period across all age groups. Two pediatric influenza deaths were confirmed in Michigan for the 2017-18 flu season. Nationally, 179 influenza-associated pediatric deaths have been reported since October 1, 2017. Although the 2018-19 influenza season is believed to have “just begun,” an outbreak of influenza was reported in early August and included reports of influenza-like illnesses from more than 130 persons. The severity of last year’s influenza season and this recent influenza outbreak highlights the importance of public health measures to control and prevent influenza year-round. Everyone 6 months of age and older should get an age-appropriate flu vaccine every season. Annual influenza vaccination remains the most effective way to prevent influenza illness.

Measles Michigan has confirmed ten cases of measles so far in 2018. The last time Michigan saw ten cases of measles was in 1998. A large majority of the measles cases reported in the last 18 years included persons who were not adequately vaccinated. Although Michigan only saw two cases of measles in 2017, the presence of measles outbreaks across the nation and worldwide have played a part in the state’s recent uptick of confirmed measles cases. Measles is an extremely contagious virus that is spread via coughing and sneezing and can live in an airspace for up to two hours.

According to CDC, approximately 90% of people within close quarters of an infected individual will become infected themselves if they are not immune. Measles can be prevented with the MMR vaccine. CDC recommends that children get two doses of MMR vaccine starting with the first dose at 12-15 months of age and the second dose at age 4 through 6 years. Prior to any international travel, CDC recommends that infants 6-11 months of age should receive one dose of MMR vaccine, and all adults who do not have evidence of immunity should receive two doses of MMR vaccine separated by at least 28 days. For more information about measles vaccination recommendations, visit https:// www.cdc.gov/measles/vaccination.html. The measles vaccine is very safe and the most effective way to protect yourself and those around you from this highly contagious disease.

Vaccines remain the most effective way to protect infants, children, teens and adults from many potentially harmful diseases. To learn more about the vaccines recommended for you and/or your child, and the diseases they protect against, visit www.michigan.gov/immunize.

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michigan MEDICINE® 9

ASK HUMAN RESOURCES

Providing Letters of Recommendation for Departing Staff: A Worthwhile Pursuit or an Invitation for a Lawsuit?

By Jodi Schafer, SPHR, SHRM-SCP

T

Q: One of my top performing staff members recently gave notice.

She has been an outstanding employee and is leaving because her husband has been transferred out-of-state. She asked me for a letter of reference, which I happily provided. In this letter I sang her praises describing her strong customer service skills, her attention to detail and her loyalty to the practice. She was pleased with it and shared it with another staff member.

Shortly after this occurred, one of my mediocre employees resigned. She also asked for a letter of reference. Unfortunately, I had very few positives to say about her. So, I wrote a letter that was generic. It included a statement that, “She did what was asked of her,” and verified her hire date and wage. She was upset with the letter and wanted to know why her letter was not as nice as her co-worker’s. When I told her that I had some problems with her performance and that I was not going change her letter, she became very upset saying that I should have told her about these problems.

Is this going to get me in trouble? Should I try to fix this?

If so, how?

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o answer your first question, no.

I don’t believe your letter will get you in any trouble because you did not write any negative, unsupported comments about the mediocre employee. Her issue was not with what you said, but rather what you didn’t say.

In Michigan, an employer is presumed to be acting in good faith and thus immune from defamation lawsuits while providing a reference if you can answer in the affirmative to the following questions:

Are the comments job-related?

For example, you can say an employee “was always on time,” but you should not continue that sentence with…”even though she had three children at home.”

Her motherhood is not job-related.

Are the comments you made true?

Opinion is different than facts. Attendance records or patients’ comment cards with complaints are facts. Without documentation in the personnel file to back up your comments, you should avoid talking about it.

Is the behavior/performance documented in the employee’s file?

This is where you could have avoided a bit of heartache with your most recently departing employee. If you had addressed the problems in her performance appraisal, with her signature, she wouldn’t have been surprised by your generic letter.

Any negative comments you might make while providing a reference should be supported by documentation in the employee’s file.

Are you allowed to share this information in accordance with state and federal law?

We hit on this a bit in question #1. Be sure you aren’t sharing confidential employee information that is prohibited by law, I.e. anything to do with an employee’s protected classification and/or health history.

Based on this information and the content of the second employee’s letter, you have nothing to fix in this current scenario. If you wanted to put a more consistent process in place for the future, you might consider limiting what you say in your letters to the employee’s name, position, dates of employment and whether or not s/he was an employ-

ee in good standing when they left. You can then close the letter with permission to contact you for more information.

When a prospective employer calls to follow-up, you can then elaborate on how great (or not great) the ex-employee was using the questions listed earlier to guide your conversation.

To add another layer of protection, I encourage you to get a signed release from the ex-employee before providing any additional information (verbal or written) regarding performance, behavior and/or attendance. You can build the same thing into your hiring process by adding this clause to your employment application. That way you have a signed document to share with past employers whom you are calling for a reference.

”While providing references can be a touchy area, they are a valuable part of the hiring process.“ (either verbally or in writing), using the information provided here as your guide. Many times, the same employee is jumping from one office to another in a community. You want to establish a relationship with these offices so they can feel comfortable telling you the truth about an employee, good or bad, and you can do the same in return.

While providing references can be a touchy area, they are a valuable part of the hiring process. Because of this, I encourage you to keep providing them

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michigan MEDICINE® 11

HEALTH CARE DELIVERY

Does Your Medical License Expire January 31, 2019?

Are You Ready to Renew?

By LuAnn Jenkins, CPMA, CMRS, CPC, CEMC, CFPC, MedTrust, LLC

Did you know that along with the 150 hours of continuing education credits (CME) required to renew, physicians must also have a minimum of 1 hour of continuing education in the area of medical ethics and 3 hours of pain and symptom management?

Separate from continuing education requirements, physicians must also complete a one-time human trafficking requirement. For physicians whose license expires January 31, 2019, this must be completed by January 31, 2022.

12 michigan MEDICINE® | NOVEMBER / DECEMBER 2018

License Renewals Every three years, all Michigan physicians must renew their license and certify compliance with state continuing medical education laws. Every year approximately one-third of Michigan’s physicians are required to renew. The Licensure and CME calendar year runs February 1 to January 31. Each physician is required to complete 150 credits of CME in which a minimum of 75 hours of the required 150 must be earned in Category 1 activities, and the 5 required credits in medical ethics (1), pain management (3) and human trafficking (1).

Physicians who have not met the 150 requirement are strongly urged to not renew until all credits have been achieved.

Doing so is a violation of the Michigan Public Health Code and is subject to license sanctions. Physicians can take advantage of the 60-day grace period to

complete the missing credits. Online renewal must be completed within the 60day grace period, along with the $20 late fee payment in addition to the renewal fee. Physicians whose licenses have been expired for more than 60 days must apply for relicensure.

New Categories of Continuing Medical Education The Board of Medicine has updated the previous six Categories of Credit into two categories. As before, each medical doctor is required to complete 150 hours of continuing medical education approved by the Board of Medicine, which a minimum of 75 hours of the required 150 must be earned in Category 1 activities, and 5 in the before mentioned areas of medical ethics (1), pain management(3) and human trafficking (1).

Breakdown of the two categories for licensure:

Additional Resources

CATEGORY 1

For more information on CME requirements for relicensure, please visit: http://MSMS.org/LARACE

A. Activities with accredited sponsorship - Maximum 150 hours B. Passing specialty board certification or recertification – Maximum 50 hours C. Successfully completing MOC that does not meet requirements of (A) or (B) above. – Maximum 30 hours D. Participation in a Board approved training program - Maximum 150 hours CATEGORY 2 A. Clinical instructor for medical students engaged in postgraduate training program – Maximum 48 hours B. Initial presentation of scientific exhibit, poster or paper - Maximum 24 hours C. Publication of scientific article in a peer-reviewed journal - Maximum 24 hours D. Initial publication of a chapter or portion of a chapter in a professional health care textbook or peer-review textbook - Maximum 24 hours E. Participation in any of the following as it relates to the practice of medicine: -Maximum 18 hours F. Peer review Committee dealing with quality of patient care G. A Committee dealing with utilization review H. A health care organization committee dealing with patient care issues I. A national or state committee, board, council or association J. Until December 6, 2019, attendance at an activity that was approved by the Board of Medicine prior to December 6, 2016 - Maximum 36 hours

To look up your license renewal date, please visit: http://MSMS.org/LARALicenseSearch To renew your license, please visit: http://MSMS.org/LARAMyLicense If you are audited and need clarification of the requirements, please contact: MSMS or an experienced health care attorney, prior to communicating with LARA or the Board of Medicine If you have any questions or need more information, contact: Brenda Marenich, MSMS email: bmarenich@msms.org phone: 517-336-7580

K. Independently ready a peer-reviewed journal prior to December 6, 2016, that doesn’t satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours L. Prior to December 6, 2016, completing a multi-media self-assessment program that doesn’t satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours

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FEATURE

Reengineer Your Work Day to Prevent Burnout

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A feeling of a lack of accomplishment. Cynicism. Less zeal, zest, or enthusiasm for your work.

If you’ve experienced any of these symptoms, you might have something called physician burnout.

But there’s hope. With an open mind, alongside a healthy diet and moderate exercise, you may find again the professional satisfaction you’ve been missing. (Of course, you’ll want to talk to your physician before beginning any exercise regimen.)

While no one’s invented a one-size-all wonder treatment to overcome professional burnout, there is a growing body of research and evidence that suggests a few changes in a physician’s daily routine may make a big difference. That’s great news, because the costs associated with burnout are only growing.

The Problem

P

hysicians experiencing one or more of the symptoms of burnout are in good company. According to a study published by the Mayo Clinic—and regarded as the most comprehensive study of physician dissatisfaction ever conducted—54 percent of physicians experience symptoms of burnout. Perhaps more frightening, the percentage of physicians happy with their work/life balance has plummeted to only 41 percent. And the bad news doesn’t stop there.

The 2015 analysis identified huge swings toward physician burnout and dissatisfaction since 2011. What’s more, the significant negative trends appear unique to the physician community. The same swings, researchers found, are not evident among other working adults.

Add it all up, and the health care community in the United States is facing a very real crisis with very real consequences.

What Causes Burnout?

W

hat’s behind it all? Research and survey data suggests government rules and regulations are a major driver. So is health insurer bureaucracy.

Both public and private payers require the meaningful use of cumbersome health information technology and electronic medical records, but few physicians were driven to complete medical school from an abundance of enthusiasm for onerous paperwork.

EHR and HIT pull practitioners out of the exam room and operating suite (or, perhaps worse, their attention in the exam room away from their patient and towards a screen). They limit their time with patients, and then very often fail to perform as intended by the payers who insist on their use.

CONTINUED ON NEXT PAGE

54%

of physicians experience symptoms of burnout.

And only 41 percent report being happy with their work/life balance.

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michigan MEDICINE® 15

BURNOUT - CONTINUED

Rose Ramirez, MD, is the former President of the Michigan State Medical Society and a family physician at Jupiter Family Medicine in Belmont, near Grand Rapids, Michigan. The varied experiences of leading a small practice and a major statewide physician organization have made her keenly aware of the dangers of burnout, and the impact technology mandates play in the crisis.

“Electronic medical records have not been the panacea that was promised,” said Doctor Ramirez. “It takes more time to document with an EMR, especially in a specialty with such variety of diagnoses as family medicine.”

The lack of EHR interoperability is also a big problem.

Impact on Physicians

P

hysicians experiencing a lack or loss of professional satisfaction soon also experience a host of negative— and sometimes tragic—consequences.

Around the office, burnout has been linked to lower patient satisfaction scores, higher malpractice risk, and higher physician and staff turnover.

Physicians who personally use electronic health records are less satisfied with the amount of time spent on clerical tasks and are at higher risk of professional burnout.

When trying to read notes from other providers that have been done on an EMR, they often do not flow in a natural way that makes them easy to read,” said Doctor Ramirez.

There’s little wonder then that, according to researchers at Mayo Clinic Proceedings, physicians who personally use electronic health records are less satisfied with the amount of time spent on clerical tasks and are at higher risk of professional burnout.

It’s a crisis with a dreadful impact outside the office as well.

The phenomenon has been linked to high rates of depression, substance abuse and even suicide. Researchers at Harvard Health crunched the numbers and concluded that approximately 400 physicians take their own lives in the United States every single year. Studies indicate that physicians – men and women – are more likely than others to take their lives, and that even the numbers we have may be the result of significant underreporting.

A 2018 analysis of data from the American Medical Association found that fully 15 percent of physicians experience clinical or colloquial forms of depression. Among the broader physician population experiencing symptoms, 36 percent report isolating themselves from others, 33 percent turn unhealthy eating habits, and 22 percent drown their frustrations in a bottle.

“Electronic medical records have not been the panacea that was promised.It takes more time to document with an EMR, especially in a specialty with such variety of diagnoses as family medicine.”

ROSE RAMIREZ, MD, PAST PRESIDENT, MSMS

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Impact on Patients

I

f professional dissatisfaction is having so profound a negative effect on health care providers, research suggest patients pay an even greater price.

“A physician feeling burnout may miss important nonverbal cues from the patient, especially if his or her face is turned toward the computer to enter information,” said Doctor Ramirez. “If a patient does not feel like their physician is listening, they also may not provide critical pieces of information that will help in their care.”

One problem rolls into the next, and can sometimes create a snowball effect.

According to a study published this July by the Stanford University School of Medicine, burnout leads to a devastating increase in medical errors. According to researchers, medical errors are already common in the United States, with studies suggesting they may be responsible for as many as 200,000 preventable deaths annually.

When the Stanford researchers dug deeper, they found that physicians experiencing burnout had more than twice the odds of self-reported medical errors, even when adjusted for specialty, work hours, fatigue and other factors.

Then there are the patients who aren’t seen at all.

Burnout, the data suggests, may be connected to a historic physician shortage.

The same problems driving physicians up the wall are discouraging talented young people from entering medical school in the first place. According to the Association of American Medical Colleges, in 2017, medical school applications plummeted by almost 14,000. No wonder the association expects the nation will be short at least 100,000 physicians by 2030.

Reengineer Your Day

T

he first step on the path towards solving a problem is admitting you have one. Michigan physicians are under no illusion about the threat to their practices, their patients, and their collective well-being.

“Whether it's teaching, medical education, research, patient care, administration or something else—find that special thing and make sure you incorporate it into your workweek.”

LISA MACLEAN, MD, DIRECTOR OF PHYSICIAN WELLNESS, HENRY FORD HEALTH SYSTEM

But what’s a physician, practice, or residency program to do about it?

The answer to that question can make all the difference in the world. That’s why organizations like the Michigan State Medical Society and the American Medical Association are working night and day to identify solutions and provide resources to help members combat burnout.

Effective solutions are as varied as the physicians who practice them, but a few broad approaches hold promise, experts contend. With record keeping and reporting at the top of the list of physician frustrations, some creative time management and a focus on identifying and developing efficiencies leads the list.

Want to prevent burnout?

A big first step may just be reengineering your workday.

“Find the thing in your work that gives you meaning and spend time doing it,” said Doctor MacLean. “Whether it's teaching, medical education, research, patient care, administration or something else—find that special thing and make sure you incorporate it into your workweek.”

In addition, studies suggest that mindfulness—or the practice of making intentional time to breath, or clear your mind—can also be an effective tactic in the battle against burnout. It’s so important, researchers at Stanford University actually offer a course on physician mindfulness, citing it as one of the only interventions proven to Want to reduce burnout symptoms in prevent burnout? the physician community.

First, lean on your team. If A big first step For Doctor Ramirez a new paperwork, and electronic may just be approach to the work schedhealth records are consumule made a huge difference. reengineering ing too much of your time your workday.

“One solution for me per(and they almost certainly sonally is to schedule longer are), consider options to visits so I can take the time to connect simplify the process for yourself, or adjust and chat with my patients,” said Doctor responsibilities around the office so you Ramirez. “I may take home a smaller paycan focus on your patients. check, but I feel more satisfied with the Experts also suggest physicians explicitly interaction.” take the time to focus on the things you Whether you take steps to cut down on most enjoy. your time spent in front of a computer, Lisa MacLean, MD, is the Director of Phyincrease your time with patients, get away sician Wellness at Henry Ford Health Sysfrom the exam room to do a little instructem, where she has garnered national rection, or schedule specific time each day to ognition for the system’s efforts to improve CONTINUED ON NEXT PAGE their physicians’ professional satisfaction.

Among the broader physician population experiencing symptoms of burnout,

36%

report isolating themselves from others,

33%

resort to unhealthy eating habits, and

22%

drown their frustrations in a bottle.

NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 17

BURNOUT - CONTINUED

refocus and practice mindfulness, the work doesn’t stop when your shift ends.

The most important step in the process is for physicians to take care of themselves, including after hours, when so many turn to drinking, poor habits, and solitude.

“If you are having symptoms of depression along with the burnout, as these can often go hand in hand, talk with your personal doctor,” said Doctor Ramirez. “And consider talking with a counselor.”

Create a Culture of Wellness For institutions, it is critical to establish a wellness culture. For individual physicians, reengineering the work day alone can have a profound impact.

The AMA has developed a number of online modules to assist practices, hospitals, and individual providers to combat burnout.

On the institutional and program level, according to the AMA, creating a “wellness culture” can make a big difference. Their StepsForward program suggest a 5-pronged approach to prevent resident and fellow burnout, and they are principles that can be applied at just about any level of practice.

First, create a wellness framework. That means securing leadership support and identifying a group or team of individuals who can serve as wellness advocates or champions. Define wellness and then take

a good, hard, honest look in the institutional mirror to evaluate the current state of wellness and burnout.

Use surveys and open communication to create a sustainable “At HFHS, we developed the culture of wellness “We Care” strategy with the priand resiliency. mary goal of assisting physicians

Once leaders, standards, and a baseline have been established, providers and institutions can get to work developing their wellness programs. That might mean taking steps to manage the amount of time trainees work, or scheduling group wellness events like movie nights, potlucks or lunchtime exercise or yoga classes.

With a framework built and an intentional institutional commitment to wellness established, the Association recommends fostering individual wellness. For residents in particular, experts say there are six key aspects of personal well-being: nutrition, fitness, emotional health, preventative care (like dental care), financial health and mindset adaptability. Personal wellness activities should be encouraged with these areas of focus in mind, says the AMA. In the same vein, physicians, faculty, and trainees should be empowered to confront burnout, even if that means creating an internal culture that encourages open communication between team members of all ages and experience levels.

Finally, the StepsForward program recommends using regular surveys and open communication to create a sustainable culture of wellness and resiliency – one where physicians are not afraid to look after their own needs, and if they need it, to ask for help.

“…the primary goal of the We Care strategy is assisting physicians to optimize healthy coping strategies, find good work-life balance, and deliver high quality health care.”

LISA MACLEAN, MD, DIRECTOR OF PHYSICIAN WELLNESS, HENRY FORD HEALTH SYSTEM

18 michigan MEDICINE®

| NOVEMBER / DECEMBER 2018

Closer to home, local Michigan physicians, practices, and health systems are also taking on a big leadership role addressing the crisis.

to optimize healthy coping strategies, find good work-life balance, and deliver high quality health care,” said Doctor MacLean. “Our strategy includes putting patients at the center of who we are and why we exist, but knowing that in order to have patient well-being, we must have physician vitality.”

“Our multi-pronged approach means investing in tactics that create a culture of caring, ease of practice, and finding meaning in work,” said Doctor MacLean.

According to Doctor MacLean, creating a culture of caring starts with firmly establishing organization values, behaviors and leadership that demonstrates caring, support, and compassion for members of the physician team and others.

Processes and practices that promote safety, quality, effectiveness and teamwork – things like EPIC workflow analysis support, audits of workflow, and improved interfaces with technology (like using wider screens on monitors) can meaningfully improve the ease of practice.

While the practice or the health system focuses on institutional opportunities like those, Doctor MacLean suggests the development of personal resilience skills, behaviors and attitudes that demonstrate physical, emotional and professional well-being represent opportunities for physicians to take control of their own circumstances and help them better find meaning in their work.

Whether it’s changing a day planner or a work culture, every step to combat burnout is an important one. And it might just save a very important life—your own.

healthy vitals ProAssurance has been monitoring risk and protecting healthcare industry professionals for more than 40 years, with key specialists on duty to diagnose complex risk exposures.

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Distracting Devices in Healthcare: Malpractice Implications Shelley Rizzo, MSN, CPHRM, The Doctors Company

Digital distraction in healthcare is emerging as a great threat to patient safety and physician well-being.1

D

igital distraction in healthcare is emerging as a great threat to patient safety and physician well-being.1 This phenomenon involves the habitual use of personal electronic devices by healthcare providers for nonclinical purposes during appointments and procedures.2 Some call it “distracted doctoring.”

Matt Richtel, a journalist for the New York Times who won a Pulitzer Prize for his work on distracted driving, coined the term “distracted doctoring” in 2011.3 Like driving, attending to a patient’s complex care needs is a high-risk activity that requires undivided attention and presence in the moment to ensure the safety and protection of others.

But the threat might more aptly be called “distracted practice,” as it impacts all healthcare workers and staff. While distraction is particularly concerning in the

20 michigan MEDICINE®

| NOVEMBER / DECEMBER 2018

operating room, emergency room, and critical care areas, it can impact all healthcare settings—including the office practice. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients. And the consequences can be devastating.

Our Devices Are Addictive In today’s electronic culture, it has become unthinkable to be without personal electronic devices. Growing evidence shows that our personal electronic devices and social media are addictive.4 The reason is dopamine. Our dopamine systems are stimulated by the unpredictable, small, incomplete bursts of information with visual or auditory cues. For example, we

are never quite sure when we will receive a text message and from whom. We may keep checking to see who liked our recent Facebook post. And when our devices ding or vibrate, we know our reward is coming. Yet as when gambling or playing the lottery, the anticipation of the reward is (usually) better than the reward itself. This results in more and more of what some call “seeking” and “wanting” behaviors. Then instant gratification encourages dopamine looping, and it becomes harder and harder to stop the cycle.

Distraction can also be both a symptom of and a contributor to healthcare provider stress and burnout. As a symptom of burnout, digital distraction is a way to escape a stressful environment. As a contributor to burnout, digital distraction impedes human interaction because of the sheer volume of data demanding our attention.

Contributed by The Doctors Company

thedoctors.com

Preventing Distractions Complex problems require a multifaceted approach. Organizations, teams, and individuals all should take responsibility and ownership for reducing the risks associated with digital distraction. The following are risk management strategies to prevent distractions and enhance patient safety.

Organizations Create awareness Recognize the extent of the problem and risks.

Model appropriate personal electronic device use behaviors.

Tier communication to batch nonemergent messages.

Refrain from sending texts on nonurgent matters.

Do not expect immediate responses for non-urgent matters.

Educate system-wide

Medical Malpractice Implications For most healthcare providers, distractions and interruptions are considered part of the job; it is the nature of their work. If we consider healthcare distraction on a continuum, on one end are distractions related to clinical care (e.g., answering team member questions or responding to surgical equipment alarms). On the other end of the continuum are distractions unrelated to clinical care (e.g., making personal phone calls, sending personal text messages, checking social media sites, playing games, or searching airline flights).

From a litigation perspective, the distinction between distractions related to clinical care and those unrelated to clinical care is important. In a medical malpractice claim

where there is an allegation that an adverse event was caused by distracted practice, a distraction caused by a clinical-care-related activity may be found to be within the standard of care and is, therefore, often defensible. But where it can be shown that the distraction was caused by non-patient matters, the plaintiff’s attorney will certainly use that against the defendant.

In these situations, the defendant’s medical care may not even enter the equation, because during eDiscovery the metadata (i.e., cell phone records, scouring findings from hard drives) serves as the “expert witness.” Even if the defendant’s clinical care was within the standard, the fact that there are cell phone records indicating that the healthcare provider was surfing the Internet or checking personal e-mail may imply distraction and could potentially supersede all other evidence.

Train all healthcare providers and staff at orientation and conduct annual refreshers on safety concerns, legal risks of using personal electronic devices when providing care, device-user etiquette, and the addictive potential of technology.

Use simulation-based learning where distractions and interruptions are introduced during high-risk procedures.

Use case studies of real-life examples where distraction was alleged to play a role in an adverse event.

Deploy technology solutions Manage facility-issued devices.

Create technology-free zones.

Limit Internet access to work-related sites only—EMR, labs, images, pharmacy formulary, state Rx databases, and decision support/cognitive aids.

CONTINUED ON NEXT PAGE

NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 21

PREVENTING DISTRACTIONS – CONTINUED

Enforce Monitor compliance with system-wide protocols and guidelines.

Clearly define how personal electronic devices are used in patient care areas.

New CME Courses Address Distracted Practice Concerns Two new CME courses from The Doctors Company, How Healthcare Leaders Can Reduce

Teams

Risks of Distracted Practice in Their Organization and The Risks of Distracted Practice

Reinforce situational awareness and mindful practices with your team or department through:

in the Perioperative Area, address addiction to personal electronic devices and provide

Unit-specific protocols: “Sterile Cockpit” and “Below 10,000 Feet” protocols limiting or eliminating nonessential activities during critical phases of procedures and high-risk activities.

Empowering every team member to speak up when they have a safety concern. For example, encourage team members to speak up when they notice another member is so focused on a personal electronic device that he or she has lost situational awareness about the patient’s clinical condition.

Applying TeamSTEPPS® principles: leadership, situational awareness, mutual support, and communication.

Create a process where employees can be reached via a call to a central location, with messages relayed to the employee by a staff member. This alleviates employees’ desire to have their personal electronic devices nearby in case of a family emergency.

Monitor compliance as part of the team’s quality measures.

Individuals Take personal responsibility—ignore distractions, especially during high-risk procedures, and make sure to speak up, set an example, and remain vigilant.

strategies that individuals and organizations can use to minimize the patient safety risks associated with distractions from these devices.

Find these courses and explore our extensive catalog of complimentary CME and CE activities at: www.thedoctors.com/patient-safety/education-and-cme/ondemand

WORKS CITED 1 Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age https://www.amazon.com/Distracted-Doctoring-Returning-Patient-Centered-Digital/dp/331948706X 2 Treat, Don’t Tweet: The Dangerous Rise of Social Media in the Operating Room https://psmag.com/social-justice/treat-dont-tweet-dangerous-rise-social-media-operating-room-79061 3 As Doctors Use More Devices, Potential for Distraction Grows http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows. html 4 Why We’re All Addicted to Texts, Twitter and Google https://www.psychologytoday.com/blog/brain-wise/201209/why-were-all-addicted-texts-twitter-and-google

ADDITIONAL RESOURCES • Daily Time Spent on Social Networking by Internet Users Worldwide from 2012 to 2017 (in minutes) https://www.statista.com/statistics/433871/daily-social-media-usage-worldwide/ • Anesthesia and the Law, Preferred Physicians Medical Risk Management Newsletter (August 2014, Issue 39) https://www.ppmrrg.com/risk-management/anesthesia-law/archive • Interruptions and Distractions in Health Care: Improved Safety with Mindfulness https://psnet.ahrq.gov/perspectives/perspective/152/interruptions-and-distractions-in-health-care-improved-safety-with-mindfulness • Distracted Doctoring: The Role of Personal Electronic Devices in the Operating Room https://www.sciencedirect.com/science/article/pii/S2405603017300365

Practice situational awareness: Pay attention to what is happening in the present moment.

Increase attention, focus, and concentration.

Leave your device behind.

22 michigan MEDICINE®

| NOVEMBER / DECEMBER 2018

Contributed by The Doctors Company.

For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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 in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in

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michigan MEDICINE® 23

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Welcome New Members Eaton

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Melissa Levoska, MD

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USPS Statement of Ownership

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120 West Saginaw Street, East Lansing, MI 48823

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Michigan Medicine

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8624

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michigan MEDICINE® 25

MSMS Board of Directors Disclosures House of Delegates Resolution 25-13 states that: “MSMS annually provide Michigan physicians with a list of all officers, officials, candidates and staff who receive money as salary or non-patient care compensation from Blue Cross Blue Shield of Michigan (BCBSM) or any other insurer, medical product company or its affiliates annually in Michigan Medicine®.”

Following are the disclosures of the MSMS Board of Directors, officers and staff: Sameen Ansari – None Mohammed A. Arsiwala, MD – None Anita R. Avery, MD – Outside Physician Reviewer, Priority Health Grievance and Appeals Committee

In Memoriam

MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.

DONATO M. CABRERA, JR, MD SAGINAW COUNTY MEDICAL SOCIETY 9/20/18 JON C.E. ANDERSON, MD KENT COUNTY MEDICAL SOCIETY 8/28/18 KIRK J. STUBBS, MD LENAWEE COUNTY MEDICAL SOCIETY 9/26/18

Robert H. Blotter, MD – None T. Jann Caison-Sorey, MD, MSA, MBA – Medical Director, Chronic Conditions and Care Transitions to Home Programs, BCBSM

MICHAEL R. CHOBANIAN, MD 8/23/18

Adrian J. Christie, MD – None Betty S. Chu, MD, MBA – None Sandro K. Cinti, MD – None Talat Danish, MD, MPH, FAAP – None

RABBI SALIMI, MD GENESEE COUNTY MEDICAL SOCIETY 8/10/18

James M. Feeley, MD – None Amit Ghose, MD – None Cheryl Gibson Fountain, MD – None James D. Grant, MD – Board of Directors, Blue Cross Blue Shield of Michigan Theodore B. Jones, MD – None Mark C. Komorowski, MD – None P. Dileep Kumar, MD – None Samuel J. Mackenzie, MD, PhD – None Mark E. Meyer, MD – None James C. Mitchiner, MD, MPH – None S. “Bobby” Mukkamala, MD – None Bassam H. Nasr, MD, MBA – None Donald R. Peven, MD – None

ROBERT D. JOHNSON, MD KENT COUNTY MEDICAL SOCIETY 9/12/18 ROD GOLOVOY, MD GENESEE COUNTY MEDICAL SOCIETY 9/18/18 THOMAS J. DEWIND, MD BERRIEN COUNTY MEDICAL SOCIETY 9/8/18

John J. H. Schwarz, MD – None

WALTER C. AVERILL III, MD, FACFP SAGINAW COUNTY MEDICAL SOCIETY

M. Salim Siddiqui, MD – None

9/10/18

Richard C. Schultz, MD – None

Herbert C. Smitherman, Jr., MD, MPH – Did not disclose by print deadline James H. Sondheimer, MD – None F. Remington Sprague, MD – Board of Directors, Blue Cross Blue Shield of Michigan Brian R. Stork, MD – None J. Mark Tuthill, MD – None Thomas J. Veverka, MD – None John A. Waters, MD – None Phillip G. Wise, MD – None

26 michigan MEDICINE®

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x TO MAKE A GIFT OR BEQUEST: CONTACT REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION CALL 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG

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Federally Qualified Primary Healthcare Center in Shelby, MI seeks Family Nurse Practitioner Key qualifications » NP License in State of Michigan Compensation Package » Health, Dental, Vision » 401 K, Group Life AD&D Std, Ltd, PTO » Holidays » Continuing Education

1.5 Million Dollar Pediatric Gross Practice to be OFFERED CHEAP! After many years of practice, the doctor is passing on the torch to someone younger. Must be able to see 60 patients/day or have help. Must be Boarded in Pediatrics. The price is less than $100K. In 25 years of practice sales I have never seen a better buy. Building is being offered for less than assessment as well, flexible terms.

Bordering Oakland and Wayne County PRIMARY/URGENT CARE Practice with potential to reach million dollar mark per year (again). Call Joe and find out more about what could be your flag ship or second practice! Highly visible, busy road. Set up for success, just need a Primary Care Doctor and maybe a Mid Level.

Fabulous New Medical Space Livonia New concept in medical offices with indoor parking, multi-suite and specialty clinics with room for adult day care !! So much is being done with this building. Located central to Botsford, St Mary's, Providence Park.

Offered at competitive rates.

Dearborn – General Practice Semi-retired Physician has a 2-3 day practice 20-30 patients per week, $20,000 for practice or free when you lease or buy building.

ENT with mostly Allergy Patients, Westland Hearing aid tenant and small general medicine tenant in building. Buy practice (asking $25K) and rent on short or long term agreement, very reasonable rates.

Plenty of room and parking.

Rochester hills Urgent Care/Walk In For years a big money maker, recently due to losing major Carriers the Gross is way down and Physician Owner wants to retire. If you are Primary care, have no license restrictions so you can boost this place back up to the Million Gross per Year. Offered Cheap! ( UNDER $100K) Flexible with terms. Near M-59 so can be reached by several communities. Joe 248-240-2141.

Pediatrics in Westland near Canton 30 years, high volume, yes it does a big gross! A Pediatrician Physician can work into the practice and take over EARN and purchase transaction.

Only a Boarded Pediatrician, potential to earn substantial income.

Call Joe for details, Cell: 248-240-2141.

Looking for Part time/Full time Work as a Provider?

Different locations available. Call Joe Zrenchik.

Joe Zrenchik, Broker 248-240-2141 (cell) • 734-808-0147 (eFax) bestdoctors@yahoo.com 248-919-0037(office) www.michiganmedicalpractices.com

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

NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 27

Educational Offerings MSMS On-Demand Webinars

For a complete listing of On-Demand Webinars visit:

Webinars Offering CME:

Free CME Webinars:

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

2018 Prescribing Legislation* (part of the Pain and Symptom Management Series)

CDL-Medical Examiner Course

Choosing Wisely Part 1 - Stewards of our Health Care Resources

From Physician to Physician Leader

Choosing Wisely Part 2 - Change Strategies to Implement Choosing Wisely

HEDIS Best Practices

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

HIPPA Security and Meaningful Use Compliance Human Trafficking*

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

Inter-professionalism: Cultivating Collaboration

Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

Medical Ethics – Conscientious Objection among Physicians*

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

Opioids and Michigan Workers' Compensation Webinar Patient Portals as a Tool for Patient Engagement

MACRA Series

Pain and Symptom Management Series*

Key Things You Should Know About MACRA

Pain and Opioid Management 2017*

Roadmap for Getting Started

The CDC Guidelines*

MACRA: Alignment Strategy

Treatment of Opioid Dependence*

The Role of Documentation

The Role of the Laboratory in Toxicology and Drug Testing*

Technology Survival Tips to Tackle MACRA

Michigan Automated Prescription System (MAPS) Update

Navigating Need to Know Resources

MAPS Update & Opportunities The Current Epidemic and Standards of Care Balancing Pain Treatment and Legal Responsibilities Physician Online Rating and Reviews: Do's and Don'ts Preparing for the Medicare Physician Value-Based Payment Modifier What's New in Labor and Employment Law *Fulfills Board of Medicine Requirement

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MACRA’s Quality Payment Program: Highlights for 2018

Taking Control of MACRA with a QCDR Michigan Automated Prescription System (MAPS) Update* (part of the Pain and Symptom Management Series) MAPS Update and Opportunities* (part of the Pain and Symptom Management Series) Section 1557: Anti-Discrimination Obligations Understanding and Preventing Identity Theft in Your Practice

*Fulfills Board of Medicine Requirement

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

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

msms.org/OnDemand

Coding and Billing Webinars Billing 101 Claim Appeals Complete Coding Updates for 2018 Compliance in the Office Credentialing ICD-10 for 2017 & Routine Waiver of Co-pays

Upcoming Educational Conferences – REGISTER TODAY! 22nd Annual Conference on Bioethics Date: Saturday, November 10 Time: 9:00 am – 4:00 pm Location: Holiday Inn, Ann Arbor Note: Continental breakfast and lunch will be provided Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues Contact: Beth Elliott at 517/336-5789 or belliott@msms.or

ICD-10 What We Have Learned & What We Need to Know

2019 Spring Scientific Meeting

Managing Accounts Receivable

Morning, afternoon and evening clinical courses available

Reading Remittance Advice Tips and Tricks on Working Rejections Year-End Wrap Up *Fulfills Board of Medicine Requirement

Date: Thursday, May 16 and Friday, May 17 Location: DoubleTree Hotel, Dearborn Note: Continental breakfast and lunch will be provided Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

154th MSMS Annual Scientific Meeting Morning, afternoon and evening clinical courses available.

Date: Wednesday, October 23 - Saturday, October 26 Location: Sheraton Detroit Novi Hotel, Novi Note: Continental breakfast and lunch will be provided.

Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

23rd Annual Conference on Bioethics Date: November 2019 Note: Continental breakfast and lunch will be provided Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues.

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

Register online: www.msms.org/eo or call the MSMS Registrar at 517-336-7581 NOVEMBER / DECEMBER 2018 |

michigan MEDICINE® 29

ADVOCACY

Five Reasons to

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

As the face of physicians, MDPAC bring medical knowledge into

Activate your political voice!

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.

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.

discussions with political decision makers.

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

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

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

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

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

Trial lawyers, insurance companies, and other political opponents raise massive sums of money.

Medicine’s friends, through MDPAC, must dig deeper to raise equivalent or greater amounts of funds to advance Michigan

physician’s agenda.

Get started today at MDPAC.org

The current political landscape is uncertain.

Only through a well-funded, unified voice will physicians and their patients’ interests be heard.

MDPAC is that voice.

Get your voice heard by contributing today at MDPAC.org

16 michigan MEDICINE

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| JULY / AUGUST 2017

| NOVEMBER / DECEMBER 2018

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