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PHYSICIAN WELLNESS:

FINDING A BALANCE BETWEEN PATIENT CARE & SELF CARE

DOMOA.ORG VOLUME 28: ISSUE 3, 2017


Passing up vaccines can pass on diseases.

Outbreaks of vaccine-preventable diseases like whooping cough and measles are still a risk. Unvaccinated children are about 25 times more likely to get these contagious diseases, which can be very serious. The more children go unvaccinated, the greater the threat to everyone. When you vaccinate your child, you not only protect them, you protect others as well. Do your part to stop these diseases and keep Michigan communities safe. Get the facts at ivaccinate.org.


TABLE TABLE OF CONTENTS FEATURES

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09

Michigan Osteopathic Association CME Info

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Physician Burnout: The Numbers Are In

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Advice for Physicians Struggling with Burnout or Mental Illness

The DO, http://thedo.osteopathic.org

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Innovative Curriculum Helps Medical Students Reduce Diagnostic Error

Contributed by The Doctors Company

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DOs Together

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MHA Keystone Center Leads the Way in Patient Safety

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Controlling risk of C. diff saves lives, prevents infection and reduces health care costs

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25

Beaumont Health & Wellness News

118th Spring Scientific Convention Photos

25 2017 House of Delegates Recap 26

New Care Team Promotes Student Mental Wellness

DEPARTMENTS 05

President's Page

07

CEO’s Message

08

Component News

17

Eye On Advocay

27

Advertiser Index

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IT’S HAPPENING HERE Hail to a new era of care. To an award-winning network of doctors and specialists. To being champions of every single person who turns to us.

THANK YOU, 2017 MOPAC DONORS! The MOPAC headshoot booth was a success, and we hope you like your new professional photos! Also, thank you to our MSUCOM Student Liaisons for volunteering their time to participate in our efforts at convention. If you can’t give time, give money. If you can’t give money, give time! Our goal of $125,000 for the upcoming 2017-18 election cycle cannot be met without your contribution.

MAIL A CHECK: 2445 Woodlake Cirlce, Okemos, MI 48864 DONATE ONLINE: domoa.org/joinmopac 4

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PRESIDENT’S PAGE This issue of the TRIAD is devoted to Physician Wellness. Historically, physician wellness has been overlooked and in many ways been stigmatized. This can no longer be accepted.  

JOHN SEALEY, DO, FACOS MOA PRESIDENT

According to the American Foundation for Suicide Prevention, 28 percent of medical residents experience a major depressive episode versus just 7-8 percent of the general population. Recent data has shown that more than 50% of physicians and up to 40% of students, interns and residents experience burnout. U.S. physicians are more than twice as likely as the general population to commit suicide, a rate higher than any other profession.

The disparity between healthcare professionals and the general public is jarring. It is unfair to ourselves and to our profession if we turn a blind eye to those who are always there to care for us. If we don’t make it our mission to highlight physician wellness and address the causes, who will? As doctors, our working lives are often spent helping patients through their hardest days. We are accountable for helping and healing countless individuals, often at the expense of our own well-being. In many ways, physician wellness is paramount to community wellness. Reports and resolutions can only get us so far in addressing such a key issue. That is why, as I outlined in my inaugural address as President of the MOA, I am starting a Physician Wellness Task Force. Regardless of demographics, geography or specialities, physician wellness matters. The work this task force will do will not only help doctors, but patients too. Along with raising awareness and breaking the stigma, we want to organize programs and provide resources to help physicians better manage issues that lead to stress and depression. The issues surrounding physician wellness stretch across every stage in an osteopathic physician’s career, from student to those who have retired from practice. Education and resources should be available at every stage. Our colleagues, and the physicians of tomorrow, are looking for leadership to shine a light on the issues of depression and offer resources to help manage the stress that can affect our profession. The Physician Wellness Task Force will make a difference. Both in providing resources and in results.

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is in the company you keep. Sparrow became the first health system in Michigan and one of the first five in the country to join the Mayo Clinic Care Network. This collaborative relationship is another way Sparrow continues to find innovative ways to deliver the finest healthcare to you. Sparrow.org/Mayo

Choose Wisely. Choose Sparrow. 6

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CEO’S MESSAGE

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n Thursday, June 22, the Michigan Osteopathic Association (MOA) hosted a press conference addressing the growing opioid epidemic in Michigan, with a specific focus on how it affects pregnant mothers and infants.

The tragedy of opioid addiction in our communities is clear, but never more so than when it affects the most vulnerable victims. As I said after the press conference, “The opioid epidemic is tearing families apart with a heartbreaking impact on the most innocent victims, who are children.” KRIS NICHOLOFF CEO AND EXECUTIVE DIRECTOR

“The opioid epidemic is tearing families apart with a heartbreaking impact on the most innocent victims, who are children.”

Aside from the clear message about what needs to be done to aid those most in need in the struggle against addiction, there was a secondary message to be heard. That of collaboration. At the press conference, over half a dozen groups — the Michigan Association of Health Plans, the Michigan Department of Health and Human Services, the MOA, Michigan State Medical Society, and more — were represented, all uniting behind a common goal. I think that collaboration is one of the most important tools in confronting the challenges most difficult to overcome. We are always stronger together. There is always new insight, knowledge and perspective to be gained, and it can only be attained by partnering with others. That’s why the MOA is proud to take a leading role and be open to partnerships in the efforts for a safer and healthier Michigan. From hosting press conferences to organizing events to working with our Michigan legislators, collaboration is key. When we work together, more can be accomplished and everyone can benefit. The group that gathered in June at the MOA was a perfect example of what can be done. It wasn’t just hospitals. It wasn’t just insurers. It wasn’t just nurses. It was a multidisciplinary group joining together to fight this horrifying epidemic. In these uncertain times, collaboration is the key. From opioids to vaccinations to physician wellness, we must look beyond our own lens for solutions.

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COMPONENT NEWS YOUR LOCAL DO FAMILY. UPCOMING COMPONENT MEETINGS Macomb County Osteopathic Medical Association Membership Meeting Presentation by Aralez Pharmaceuticals Does not qualify for CME credit Tuesday, August 15, 2017 - 6:30 pm Andiamo’s Warren, 7096 E 14 Mile Rd, Warren, MI 48092 Contact: Cyndi Earles, Director, MOA Service Corporation | MOA, at cearles@domoa.org or call 517-512-4307

Western Michigan Osteopathic Association ENT Interface-Eustachian Tube, Middle Ear Disease-Sinusitis

Speakers: Paul Lomeo, DO & Paul Belanger, DO

2 AOA Category 1-A Credits

Tuesday, September 12, 2017 - 6:00 PM

Arboreal Inn Restaurant, 18191 174th Ave., Spring Lake, Michigan 49456

Contact: Shirley Atchison at wmoa87@gmail.com or call 231-750-5070

GYN Interface-Pediatrics and Adolescent Gynecology for Primary Care

Speaker: TBA

2 AOA Category 1-A Credits

Tuesday, November 14, 2017 - 6:00 PM

Arboreal Inn Restaurant, 18191 174th Ave., Spring Lake, Michigan 49456

Contact: Shirley Atchison at wmoa87@gmail.com or call 231-750-5070

TO SHARE YOUR COMPONENT NEWS, MEETINGS AND EVENTS IN TRIAD, EMAIL TODD ROSS AT TROSS@DOMOA.ORG. 8

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MICHIGAN OSTEOPATHIC ASSOCIATION CME INFO

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our MOA Education Committee continues to develop CME programs to meet the needs of our members. The ongoing changes in CME requirements by the AOA, specialty boards and various state mandates makes this very challenging. At the MOA 118th Annual Spring Scientific Convention, two new programs were piloted with a focus on Emergency Medicine and Hospitalist Medicine specialties. From this experience, MOA will strive to continue providing additional specialty-focused sessions during our conferences. In addition to the ongoing 150 hours of CME required by the Michigan Board of Osteopathic Medicine and Surgery, the state of Michigan now requires two new educational requirements for osteopathic license renewals: 1. Recognition and Interventions for Human Trafficking 2. Pain & Symptom Management

STAY in PRACTICE Training & updates for office managers on

• MACRA • Revenue cycles • NP/PA regulations • Insurance • Recognizing victims of human trafficking in medical scenarios NEW!

to help keep your office sharp & in practice.

more info at

DOMOA.ORG/PAGE/PRACTICEMANAGERS November 3-5, 2017 Grand Rapids, MI

CME & required training offered at:

MOA 13th Annual Autumn Scientific Convention November 3-5, 2017 Amway Grand Plaza, Grand Rapids Will offer 3 hours of Pain & Symptom Management as well as 1 hour of training on Recognizing Victims of Human Trafficking.

In future conferences, the MOA will offer the necessary sessions to encompass the state’s specific standards for this education. While these additional educational requirements were not mandated as CME, the MOA will design these programs to also meet the standards to achieve CME credits. The AOA has eliminated its three year, 120 hour CME requirement for AOA membership. However, the specialty boards have not reduced their explicit requirements for continued certification for board-certified members. This is one of the reasons why the Education Committee has pursued the development of specialtyfocused programing. If you are interested in participating in development of specialty-focused programing at future MOA conferences, please contact Melissa Budd, MOA Educational Coordinator, at mbudd@domoa.org or 517-347-1555 Ext. 112.

State of Michigan Osteopathic Physician Requirements (per 3-year reporting cycle) 150 hours of CME required 60 hours must be Category 1 40 hours must be AOA approved Remaining 20 hours can be allopathic-approved CME Remaining 90 hours of 150 can be Category 1 or Category 2 Pain & Symptom Management (effective Dec. 2017) Minimum 3 hours per 3-year period Training on Recognizing Victims of Human Trafficking: One-time requirement TRIAD 2017 | ISSUE 3

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PHYSICIAN BURNOUT: THE NUMBERS ARE IN BY MICHAEL ZICCARDI JR., DO, MEDICAL DIRECTOR, MCLAREN PHYSICIAN PARTNERS

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placed on providers, there are things physicians can do to build resilience against the threat of burnout. Here’s how one osteopath is confronting that threat.

Since 2011, when the first national study of physician burnout across medical specialties was published, several other studies have confirmed that physician burnout is not only occurring, but is increasing in many specialties. Since physician burnout is known to directly impact quality of care, it is a reality that cannot be ignored. Earlier this year, the “Medscape Lifestyle Report 2017” revealed some stunning statistics gathered from the responses of more than 14,000 physicians surveyed nationwide.

“Being a physician is an unbelievable honor and privilege, but it brings significant challenges and stresses,” Ferguson said. “Frankly, those stresses are not present with other careers where life and death is not dealt with on a daily basis. Being able to cope with the challenges of this career takes a multidisciplinary approach.”

n the practice of medicine today, the ever-pressing goals of increased patient satisfaction, reduced health care costs and improved overall population health drive how we work. During the past several years, however, this “Triple Aim” has evolved into the “Quadruple Aim” which includes a fourth imperative – improved clinician satisfaction and well-being – to stem the growing threat of physician burnout.

According to the report, burnout rates among all respondents escalated overall from 40 percent in 2013 to 51 percent in 2017 with no medical specialties reporting a decrease in burned out physicians. Emergency medicine saw the highest rate of burnout among all specialties with a rate of almost 60 percent, up from 50 percent in the 2013 report. Following emergency medicine were OB-GYN at 56 percent, and family medicine, internal medicine and infectious disease, each at 55 percent. The report cited 17 causes for the rising tide of burned out physicians, with the most-cited cause being “too many bureaucratic tasks.” On a scale of 1 to 7, with 1 being the lowest contributing cause and 7 being the highest, too much bureaucracy earned the highest score of 5.3. Following were “spending too much time at work” at 4.7, “feeling like a cog in a wheel” at 4.6, “increasing computerization of practice” (electronic health records) at 4.5 and “income not high enough” at 4.1. So physician burnout is real, it’s escalating and it’s pervasive, but it isn’t necessarily inevitable. While systemic change is needed to address the bureaucratic and regulatory burdens

Troy Ferguson, DO, a McLaren Greater Lansing-affiliated general surgeon, acknowledges that burnout is a “significant issue” and one that is unique to professions like medicine where the well-being of others is at stake. But he also recognizes that each physician must find ways to relieve stress and develop coping skills.

Ferguson said he has found that sharing the day-to-day frustrations with those he trusts and having outside interests are two helpful tools for building resilience. “Personally, I feel it is imperative to have a strong support structure of family and friends where you can feel comfortable expressing any concerns or issues you may be dealing with. It is also important to be well rounded and be able to escape when needed with other hobbies or activities,” he said. “I think it is impossible to not think about your patients constantly, but being able to process your thoughts in a different environment is very important. “I have always lived with the concept that being a physician is not a ‘job,’ it is a ‘lifestyle,’ and accepting that and understanding that will only help you be a better caretaker for your patients.” It is clear that practicing medicine is challenging on many levels, but perhaps the greatest challenge is to care for ourselves as well as we care for our patients. Just like the flight attendant cautions before each flight, ‘In the event the cabin loses pressure, please put your own oxygen mask on before you attempt to help others.’ The oxygen masks are dangling before us. We need to put them on so we can continue to help others.

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TANGIBLE ADVICE

ADVICE FOR PHYSICIANS STRUGGLING WITH BURNOUT OR MENTAL ILLNESS BY KATE SAMANO SOURCE: The DO, http://thedo.osteopathic.org/2017/06/advice-for-physicians-struggling-with-burnout-or-mental-illness

Robert Piccininni, DO, dFACN, says the best thing you can do to help a struggling physician is to talk to them about it.

that enacting change can be slow, Robert Piccininni, DO, chair of the AOA’s Physician Wellness Task Force, says that the best thing physicians can do immediately to help a struggling colleague is to talk to them about it.

In the medical community, it is no secret that U.S. physicians are more than twice as likely as the general population to commit suicide, a rate higher than any other profession. Preventing physician suicide starts with recognizing symptoms of burnout before they snowball into depression.

The Mayo Clinic and the American Foundation for Suicide Prevention explain how everyone can help prevent suicide in the medical profession.

To help address increased rates of physician burnout, depression and suicide, the AOA formed  the Physician Wellness Taskforce at the House of Delegates meeting last July. Systemic changes to the health care landscape must occur to better support physician well-being. Recognizing 12

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When in conversation with a physician struggling with burnout or symptoms of mental illness, it may be useful to have some tangible advice on hand. The DO talked with members of the osteopathic community who offered advice to share with physicians who are struggling, whether they are in crisis or just beginning to experience burnout and depression.


Therapy is an option, despite confidentially and privacy concerns Physicians should be encouraged to seek professional help at all junctures of mental illness, especially those suffering from suicidal ideation and debilitating symptoms of depression. Some physicians avoid seeking help for mental health issues to circumvent running into patients or acquaintances, notes Vania Manipod, DO, a psychiatrist. But Dr. Manipod says attending therapy helped her work through feelings of failure over not maintaining her expected levels of productivity.

Track your emotions daily Dr. Manipod blogs  about her experience recovering from burnout and depression in order to destigmatize mental illness and help other physicians and medical students recognize signs of burnout and depression. Tracking her emotions in a tangible way helped her to better identify the progression of her healing, Dr. Manipod says. “I started noticing I was writing more about self-care than my super busy life as a physician,” says Dr. Manipod. “I noticed that putting myself and my priorities first ultimately made me a better physician to my patients.” Asking a loved one to pay attention to your mood and outlook is also a great idea, Dr. Manipod says. This way, someone else is actively looking out for you and will raise their concerns if they notice symptoms of burnout or depression.

Practice self-observation through mindfulness meditation In a recent webinar  about mental illness among medical students and physicians, Ulrick Vieux, DO, MS, the psychiatry residency program director at Orange Regional Medical Center in Middletown, New York, discusses how meditation can help students and physicians create a more thoughtful and less automatic response to stress. However, mindfulness meditation takes practice, and it may take some time before physicians notice results, so this mental exercise may be more helpful to combat mild symptoms of burnout and depression. “People connect with me because most of us don’t talk about mental illness, and I decided to even publicize that I was in treatment and made some tangible changes as a result,” says Dr. Manipod, who drove an hour from home to see a therapist who wasn’t in her medical organization. “There are things we can do instead of waiting for larger bureaucratic changes, and I’m an example of that.” — Vania Manipod, DO

“Insight is a key aspect in maintaining mental wellness and can be learned with effective practice,” says Dr. Vieux. “Insight can challenge hopelessness and negative automatic thoughts that are at the crux of physician burnout and dissatisfaction.” — Ulrick Vieux, DO, MS A study from the Journal of the American Medical Association supports Dr. Vieux’s claim that individual and group mindfulness meditation can be beneficial. It found that physicians participating in a group mindfulness curriculum had improved engagement and morale at work.

Visit your local art museum Physicians and medical students suffering from mild cases of burnout and depression could benefit from a trip to the art museum. At Kansas City (Missouri) University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM), educators find trips to the Nelson-Atkins Museum of Art improve reflection and empathy skills that can help alleviate burnout and encourage renewal. Jim Dugan, PhD, KCU-COM’s director of counseling and support services, says with depression rates among medical students at 27%, KCU-COM’s Art, Observation, and Medicine program is a beacon of well-being for medical students. “Critiquing and discussing art can foster emotional intelligence and critical thinking, and serve as a buffer against the all too common maladies of medical students – depression and anxiety.” — Jim Dugan, PhD

In case of emergency If you or someone you know is suicidal and in need of emergency help, call 911 or call the National Suicide Prevention Lifelife at (800) 273-8255. If you reside outside of the U.S., the International Association for Suicide Prevention provides hotlines and information for crisis centers around the world. The American Foundation for Suicide Prevention also provides resources for medical students, residents, fellows and physicians, including a toolkit for hospital and program leaders and prevention programs. In a perspective piece from the National Academy of Medicine, AOA leadership recognized the need to talk with state licensing boards about physician concerns that they must report visits to a psychiatrist to boards, which could negatively impact their licensure and ability to practice.

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INNOVATIVE CURRICULUM HELPS MEDICAL STUDENTS REDUCE DIAGNOSTIC ERROR It is estimated that 1 in 10 diagnoses is wrong or delayed, and 1 in 20 patients will experience a diagnostic error every year in ambulatory clinics. That's why a first-of-its-kind curriculum for U.S. medical students, called DX: Diagnostic Excellence, is working to change that.

D

iagnostic accuracy is the foundation of safe, effective medicine. However, diagnostic error is the leading cause for malpractice claims in the U.S. Because most medical schools lack formal curricula focused on the diagnostic process, many medical students are forced to learn about diagnostic errors the hard way— when they first make them. “Most medical students don’t learn the techniques and tools they need to avoid diagnostic error and improve the diagnostic process early on,” said Paul Epner, executive vice president and co-founder of the Society to Improve Diagnosis in Medicine (SIDM). “Earlier education on what leads to these errors—and how to prevent them—is essential to reduce the risk of patient harm.” In an effort to reduce diagnostic errors, SIDM and MedU, a nonprofit

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consortium of medical educators and developer of virtual patient courses, have developed a first-of-its-kind curriculum for U.S. medical students called “DX: Diagnostic Excellence.” Development of the curriculum was funded by a $200,000 grant from The Doctors Company Foundation. The DX course and its supporting inclassroom learning materials will be distributed via MedU’s online learning platform, which is used by more than 90 percent of medical schools in the U.S. Over 500 students at seven medical schools have participated in the curriculum’s pilot program. The course and materials will be available free of charge to medical education institutions through MedU for the 2017 to 2018 subscription year beginning July 2. Andrew Olson, MD, Medicine and Pediatrics, University of Minnesota, and project manager of the


curriculum pilot program, attributes a few factors to the education gap in diagnostic safety. “Most students still learn by doing, instead of proactively learning about what could go wrong,” Dr. Olson said. “Yet historically, there have been questions about the capacity of medical students to learn about diagnostic error, including concerns that students will get scared and that the information will be destructive so early in their careers. Our goal was to explore the best way to make this information relevant and accessible, but not damaging, for medical students.” The “DX: Diagnostic Excellence” curriculum includes six full-length cases and six shorter assessment cases on the online MedU platform, allowing students to experience realistic clinical situations in which a diagnostic error occurs and to gain skills to prevent and handle diagnostic errors.

Each interactive module assists students in recognizing and avoiding pitfalls in the diagnostic process, while providing methods for creating discourse around everyday errors. “We’ve seen that the online module is truly the best way to not only bring the clinical setting to life for the student in a safe and approachable way, but also to make the classroom content adaptable for a variety of universities,” Dr. Olson said. Epner also emphasized that the modules are designed to educate students on the team-based nature of care and to help students better empathize with patients and those who make the errors. “There are many factors and stakeholders leading up to a diagnostic error— and like in a relay race, often the last person in the chain will unfairly get the blame,” Epner said. “Our course helps medical trainees understand that diagnosis is a team sport.”

“DX: Diagnostic Excellence” also supports classroom content designed and provided by SIDM and MedU to help faculty bring the learnings to life and empower students to become more comfortable discussing difficult topics. Some universities have leveraged the materials as in-class activities, while other schools with students spread out across the nation have utilized webinars for their online discussion. “We launched this project on a leap of faith with the support of The Doctors Company Foundation,” Dr. Olson said. “After two years, we’ve helped medical student education to enter a new frontier in diagnostic safety and shown how students have enormous potential to be advocates for patient and diagnostic safety.” To learn more about The Doctors Company Foundation, visit tdcfoundation.com.

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Friday, Nov. 3- Sunday, Nov. 5, 2017 20 -22 AOA Category 1-A Credits

SESSION HIGHLIGHTS:

*CME required by Michigan state law. • Pain Management Workshop* • MACRA • Human Trafficking* • Pediatric Oral Care • HPV & STD Cervical Cancer Prevention • Risk Management • Adult Immunization & Vaccine Preventable Disease • Community & Hospital Institution Aquired Pnemonia

Includes new education required for Michigan License Renewal. CME SESSIONS: F R I DAY 12:30 - 6:30 pm SATURDAY 7 am - 6:15 pm SUNDAY 7:30 am - 1 pm EXHIBITS: SATURDAY 7 AM - 4 PM

Speakers, agenda & online registration at

WWW.D O M OA.O RG/G R2017 Login required for member discount. By default, your username is set as your AOA number. If you experience difficulty logging in, please call 800-657-1556.

• RTP/Concussions • Tension, Migraine & Cluster Headache • Polypharmacy in the Eldery

SPONSORED IN PART BY:

• Practice Managers Program available separately. Visit DOMOA.org/page/ PracticeManagers for details.

AMWAY GRAND PLAZA

187 Monroe Ave. NW, Grand Rapids, MI 49503

RESERVATIONS $136 rate by Oct. 3, 2017 • 800-253-3590 • domoa.org/amway

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EYE ON ADVOCACY MAINTENANCE OF CERTIFICATION   We have urged our members to contact their legislators in regards to House Bills 4134 and 4135 that would end the burdens of Maintenance of Certification (MOC) for physicians in Michigan. In response to that call to action, physicians have come forward to offer  their  story on how MOC requirements are hurting their ability to treat patients. We heard from physicians with many compelling stories about themselves and their colleagues. Particularly compelling was an email we received from Daniel Kulick, DO, from Brown City, Michigan:

To: The Michigan Osteopathic Association From: Daniel Kulick, DO If you would like to share your concern and/or your story, please contact Todd Ross at the MOA: Todd Ross  517/347-1555 ext. 120  tross@domoa.org 

Date: June 13, 2017 As the past chief of staff of a critical access hospital and family physician in a rural setting, the loss of one physician makes a huge impact on the community. In the last 3 years, we have seen over 50% reduction in family physicians within a 30-mile radius. One might ask why this is so and how we could prevent this from becoming worse. The answer is simple. We have lost a number of physicians and we will lose more physicians in this area because of this increased work load imposed on us by the same people that are supposed to represent us. Maintenance of Certification and re-certification has placed undue stress on physicians. Physicians are now turning to other means for income and also are retiring early. I myself have trained residents in family medicine. One of my trainees would have been an excellent candidate to practice medicine in this rural setting. However, after practicing medicine for less than 6 months, he found he could make more money driving a semi truck than practicing medicine. We have already seen the devastating affect of undue stress on family doctor's in the State of Oklahoma. The State of Oklahoma acted quickly. There have been two large studies, one done by the VA that shows there is no improved outcome for the patient with respects to maintenance of certification and re-certification of the board examination. It is so obvious that this maintenance of certification and re-certification has no place at this time. At this time, I would urge you to support the bill authored by Representative Edward Canfield, DO. At least listen to the majority of the physicians in the State of Michigan and you will see that the vast majority are against maintenance of certification and re-certification. This bill supports initial board certification and continued medical education. If you can and have the time to speak with your local family physician about this matter, please do so. If not, then I would suggest you make plans to make a longer drive to establish with a new physician when your present physician retires early.

Sincerely, Daniel Kulick, DO TRIAD 2017 | ISSUE 3

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DO

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Just what the doctor ordered. Announcing DOs Together, a Physician’s organization dedicated to empowering independent practices. DOs Together gives you direct access to a network of experts providing guidance on issues affecting quality of care, patient access, and medical reimbursement. As the landscape of healthcare continues to change, let DOs Together show you the strength in numbers.

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WHY IT’S TIME FOR THE DO COMMUNITY TO

TAKE A CLOSER LOOK AT VIRTUAL ACOS BY EWA MATUSZEWSKI, CEO, MEDNET ONE HEALTH SOLUTIONS

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hile Virtual Accountable Care Organizations (ACOs) have taken shape over the past ten years, the DO community has largely watched from the sidelines. That’s understandable, as ACOs can be complex to organize, difficult to administer and challenging to quantify in terms of healthcare dollars saved. Both well-run traditional ACOs or virtual ACOs have significant positive impacts on patient care and quality outcomes, not to mention potential financial benefits; however, a virtual ACO should now move to the top of DO leadership’s to-do list. ACOs change the business model of medicine; shifting the focus from providing individuals acute medical care towards an outcomes-based, population health approach. They also remove the distasteful movement toward market share among hospitals and physicians. There are six Centers for Medicare & Medicaid Services (CMS) guidelines necessary to successfully create and manage an ACO whether it be virtual (aligning with many health systems) or traditional (aligning with one health system). Let’s focus on Understanding the ACO model, given it’s been the foundation for getting started and understanding the Who, What When Where and How of ACOs. Understanding the ACO model CMS defines Accountable Care Organizations (ACOs) as “groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients.” ACOs are committed to improving the quality of care, decreasing hospital admissions and readmissions, and ensuring that post-acute care services are provided as efficiently as possible.

CMS identifies the following entities as eligible to form a virtual or traditional ACO:

• Physician group practices • Networks of individual practices • Partnerships or joint venture agreements between hospitals • Physicians employed by hospitals • Medicare providers and suppliers determined by the Secretary of the Department of Health and Human Services

Other CMS parameters organizations must comply with to function must as an ACO:

• The ability to manage at least 5,000 Medicare beneficiaries for a performance year • A leadership and management structure that includes clinical and administrative systems • Processes for promoting evidence-based medicine and coordination of care with the ability to report on quality and cost outcomes • The presence of a formal legal structure to receive and distribute shared savings payments • A three-year participation agreement for the ACO project The investment of time and money required for providers to be successful in an ACO is extensive. But, thriving ACOs (traditional or virtual) generally succeed because they include, at a minimum:

• A multi-specialty group practice with a number of primary care physicians and specialists large enough to provide medical services to all enrollees • A community or primary care hospital for most inpatient services • A tertiary care center or academic hospital for specialty services • Home healthcare services • Mental health services, both inpatient and outpatient • A structure to manage post-acute care services • Rehabilitation services • A children’s hospital or children’s tertiary care center if pediatric patients are enrolled in the ACO DOs should be engaging in discussions on virtual ACO opportunities in their regions. ACO management components can be structured as ownership by one entity, a partnership of multiple entities or mutual agreement among the entities for discounted fee for services in exchange for referral volume. Its time to take advantage of healthcare evolution. Ewa Matuszewski is the CEO of MedNetOne Health Solutions, a physician organization based in Rochester, Michigan. TRIAD 2017 | ISSUE 3

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Economic Impact of Healthcare on Michigan

Healthcare providers invest in their local communities in ways beyond helping restore and support good health. Total Impact*

929,400 jobs

$50 billion a year in wages, salaries and benefits

Direct Impact

588,000

healthcare jobs

$35 billion a year in wages, salaries and benefits

$15 billion a year $65 billion a year in tax revenue

in total value

Indirect & Induced Impact

341,000

healthcare-related jobs

$15 billion a year in wages, salaries and benefits

*Total Impact = sum of direct, indirect and induced impacts. The sum of the individual number may not equal the total due to rounding.

Visit www.economicimpact.org to learn more and view data by region or county on our interactive map. Brought to you by the Partnership for Michigan’s Health –

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MHA KEYSTONE CENTER LEADS THE WAY IN PATIENT SAFETY BY GARY ROTH, DO, MBA, FACOS, FCCM, FACS CHIEF MEDICAL OFFICER, MICHIGAN HEALTH & HOSPITAL ASSOCIATION

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he focus on healthcare quality and safety has historically been on errors and harm that occur in the hospital setting.

“The hospital is the most complex human organization ever devised,” said Peter Drucker

“The hospital is the most complex human organization ever devised.”

Pronovost’s work involved the occurrence of harm within critical care units and hospitals and how to reduce central-line-associated bloodstream infections and ventilator-associated pneumonia by implementing checklists. Pronovost’s work was a cornerstone project for the MHA Keystone Center – it involved a major change of culture, and culture scores strongly correlated with reduction of harm.

– Peter Drucker – Our healthcare system is antiquated with respect to safety. The issue is often not of individual competence, but the system’s weaknesses. In medicine, there has been inadequate atten- The MHA Keystone Center’s early charge was to identify tion to system design compared to other industries, such as and implement practices that improve healthcare safety and aviation and nuclear power. Human factors research indi- quality and reduce cost. The vision of healthcare being free cates education is an ineffective method to change behavior from harm became the impetus to engage all Michigan hospitals in becoming recognized as the best in the nation. – it requires a change in culture.

MHA Keystone Center The Michigan Health & Hospital Association (MHA) Keystone Center works with hospitals, health systems, and state and national patient safety experts to implement evidence-based, best practices supported by the use of data to improve patient safety and healthcare quality, prevent harm, and reduce healthcare costs in Michigan and beyond. A statewide quality collaborative was born in 2003 through the innovative foresight and leadership of the MHA. The MHA Keystone Center was founded as the result of a two-year federal grant from the Agency for Healthcare Research & Quality. Furthermore, a partnership with patient safety experts was created after Peter Pronovost, MD, intensivist, anesthesiologist, Johns Hopkins Hospital, sought out Michigan to be his “laboratory.” Pronovost chose Michigan due to the MHA Keystone Center’s involvement with intensive care units within Michigan hospitals, the MHA’s 100 percent membership rate of Michigan hospitals and healthcare systems, and the MHA Board of Trustees’ commitment to create a patient safety organization (MHA Keystone Center).

For the past 14 years, the MHA Keystone Center has improved patient safety and saved countless lives in Michigan due to its diligent efforts to bring together Michigan hospitals and their team members to participate in programs to improve the quality of healthcare. The MHA Keystone Center is currently made up of 13 professionals led by Sam R. Watson, MSA, CPPS, senior vice president of patient safety and quality, and Brittany Bogan, MHSA, CPPS, vice president, patient safety and quality. The MHA Keystone Center remains focused on its current mission, “to lead the nation in quality and patient safety through the diffusion of change using patient-centered, evidence-based interventions supported by cultural improvement,” as well as its vision for “healthcare that is safe, effective, efficient, patient centric, timely and equitable.” Individuals practicing in the quality and patient safety arena are keenly aware of the lifesaving work being performed by the MHA Keystone Center on a daily basis, its subsequent successes and how it is leading Michigan and the entire nation in quality and patient safety. TRIAD 2017 | ISSUE 3

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THERE’S NO QUIT IN US. BECAUSE THERE’S NO QUIT IN YOU. There’s no quit in a patient who runs a marathon after hip replacement. Battles back after open-heart surgery. Or overcomes a stroke. People who never quit deserve a health care system with the same philosophy. That’s Beaumont. Thousands of medical minds working together as one—for one reason: you. Talk to a Beaumont Doctor. Beaumont.org

WHEN YOU NEED CARE, MAKE SURE YOU’RE COVERED. MOA members have the option to purchase a variety of insurance plans directly through the association at affordable rates. Contact us today to recieve the latest insurance information.

MICHIGAN OSTEOPATHIC ASSOCIATION

MOA will develop a customized insurance program based on your individual needs. We offer: • Health Insurance • Vision service plan • Delta Dental options • Medical Malpractice, Professional Liability • Life insurance • Long-term care insurance • Long & short-term disability, group & individual options • Home and auto insurance • MOA Prescription Rx Drug Card

Get more info at DOMOA.ORG/INSURANCE • JRUEDISALE @ DOMOA.ORG • 1-800-657-1556 22

TRIAD 2017 | ISSUE 3


CONTROLLING RISK OF C. DIFF SAVES LIVES, PREVENTS INFECTION AND REDUCES HEALTH CARE COSTS BEAUMONT HEALTH & WELLNESS NEWS The constant fear of having an embarrassing bathroom accident paralyzed Judy Post. Mental, physical and emotional stress consumed her. She wondered if her life would ever return to normal. “It was very difficult on me. I kept thinking nothing was going to help me,” Post said. “I was really scared.”

P

ost was diagnosed with a Clostridium difficile infection and was treated for it with vancomycin and got better. However, a few days after she stopped the vancomycin, the diarrhea would come back as the infection relapsed. After talking with several doctors she was directed to Matthew Sims, MD, PhD, director of infectious disease research at Beaumont Hospital, Royal Oak, who enrolled her in a research study and broke the cycle of relapses.

“I had no idea what C. difficile was. My family members hadn’t heard of it, either,” she said. C. difficile is an infection that causes life-threatening diarrhea. According to an article published in the New England Journal of Medicine, nearly 30,000 people die from C. difficile every year in the United States. Doctors say more than 450,000 are battling the infection. Twelve percent of all hospital-acquired infections are C. difficile. The Agency for Healthcare Research and Quality recently awarded Dr. Sims with a $2.4 million grant to study a theory that could prevent thousands of C. difficile infections and deaths all over the world. This is one of the largest grants Beaumont Health has ever received.

“Treatment with oral vancomycin will not kill the spores. It will not cure people. Patients will still carry the spores in their body. However, the drug should prevent those spores from turning into a full blown C. difficile infection, holding them at bay like the good bacteria would have, and thus prevent the patient from becoming sick.”

— Matthew Sims, MD, PhD

Some people carry C. diff spores in their colon, but don’t get sick because their good bacteria keeps it in check. However, when C. diff carriers take antibiotics to treat an infection elsewhere in the body, those antibiotics can also kill off the good bacteria. When good bacteria dies, this removes the restraints on the C. diff and allows it to grow out of control, which causes the person to become sick. Dr. Sims believes oral vancomycin can keep the C. diff in check when the good bacteria is killed by other antibiotics and should prevent the patient from becoming sick. Participants in the study will be given vancomycin or a placebo along with the antibiotics treating the original infection. “Treatment with oral vancomycin will not kill the spores. It will not cure people. Patients will still carry the spores in their body. However, the drug should prevent those spores from turning into a full blown C. difficile infection, holding them at bay like the good bacteria would have, and thus prevent the patient from becoming sick,” Dr. Sims said. The StoP CDI study will test this idea in a randomized, double-blinded, placebo-controlled trial. If successful in demonstrating that vancomycin can prevent the disease, the research could save thousands of lives, stop tens of thousands of infections, and save millions of health care dollars. Post is not part of the StoP CDI study, but she says the research study she participated in with Dr. Sims was like a miracle that changed her life and she’s eager to see what the new study will find. “Every day, I become more positive about my life. I still carry a bottle of vancomycin with me, just in case I might need it,” Post said.

See more at: https://www.beaumont.org/health-wellness/news/ controlling-risk-of-c-diff-saves-lives-prevents-infection-and-reduceshealth-care-costs#sthash.Gy1ejku6.dpuf TRIAD 2017 | ISSUE 3

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118TH SPRING SCIENTIFIC CONVENTION May 18-21, 2017 – Westin Southfield Detroit

The Michigan Osteopathic Association’s DO family met at the Westin Southfield Detroit for the 118th Annual Spring Scientific Convention from May 18 – 21, 2017. The convention attracted over 700 physicians, medical students and exhibitors. Speakers addressed topics such as safe opioid use, recognizing victims of human trafficking, geriatrics, behavioral health, cardiology and much more. There was also a special TeamHealth Specialty track on Saturday that featured Hospitalist and Emergency Medicine sessions.

Scientific Research Judges.

Scientific Research Exhibits—a record number of submissions this year!

Co-chairs Emily Hurst, DO and Rachel Young, DO presented Carol Monson, DO with the Annual Women of Excellence Award accompanied by MOA President John Sealey and CEO Kris Nicholoff.

Congratulations to all of our Scientific Research winners! 24

TRIAD 2017 | ISSUE 3

William Morrone, DO, MS, FACOFP, DAAPM, ASAM presenting on safe opioid prescribing. The course satisfies part of the State of Michigan’s new licensing requirements. For details, please see page 5.


2017 HOUSE OF DELEGATES MEETING Westin Southfield Detroit

MSUCOM-class colleagues reunite at the MOA House of Delegates meeting.

MOA Education Department chairs David Best, DO, Patrick Botz, DO, and Lawrence Prokop, DO give their report at the House of Delegates meeting.

Oakland County Osteopathic Medical Association President, Adam Hunt, DO, speaks up at the MOA House of Delegates meeting.

MOA House of Delegates meeting. Welcome students and residents to policy making!

At the 2017 meeting at the Westin Southfield Detroit, 15 resolutions were presented. The over 100 delegates present voted to pass 12 resolutions, six of those were to be submitted to be considered at the American Osteopathic Association’s House of Delegates meeting in July. Thank you to all of the delegates who served, helping to shape policy for the future of osteopathic medicine and patients. Resolution

Subject

Submitted By

Resolution 2017 A

Universal Physician Awareness of Nutrition and Lifestyle Science

David Brown, DO

Resolution 2017 B

Sexual Harassment and Sexual Misconduct in the Medical Workplace

Southwest Osteopathic Medical Association

Resolution 2017 C

Equity in Medicare Payments

Oakland County Osteopathic Medical Association

Resolution 2017 F

Home Health Licensure

Oakland County Osteopathic Medical Association

Resolution 2017 H

Opposition to Conversion Therapy

Oakland County Osteopathic Medical Association

Resolution 2017 I

Oral Health Enhancement

Oakland County Osteopathic Medical Association

Resolution 2017 J

Physician Aid in Dying

Macomb County Osteopathic Medical Association

Resolution 2017 K

Physician Well Being and Burnout

Oakland County Osteopathic Medical Association

Resolution 2017 L

Sunset Provisions for Resolutions

Lawrence Abramson, DO

Resolution 2017 M

Support for Adult Immunizations

Oakland County Osteopathic Medical Association

Resolution 2017 N

Transparency in Prescription Drug Pricing and Cost

Oakland County Osteopathic Medical Association

Resolution 2017 P

United States Immigration Executive Order

Council of Interns and Residents

Highlight indicates Resolutions sent to AOA. TRIAD 2017 | ISSUE 3

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NEW CARE TEAM PROMOTES STUDENT MENTAL WELLNESS BY PAI LIU, MSUCOM COMMUNICATIONS

It’s no secret that medical students face stress — lots of it. Unabated stress can significantly hinder academic performance, resulting in depression or worse.

As part of a school-wide effort to address student wellness issues, the MSU College of Osteopathic Medicine has launched the CARE Team to identify potentially troubled students early, and to offer assistance to help them overcome their difficulties. CARE Team members will take a proactive and preventative approach to risk assessment and want to engage everyone in the MSUCOM community in their work.  The goal is to educate students, faculty and staff to recognize signs of student distress.  “Medical students tend to be high-performers who are sometimes reluctant to ask for help,” said John Taylor, director of the MSUCOM Office of Personal Counseling/ Health Promotion. “We want to create a culture of helpseeking behavior. We’re all in this together.” While students can seek help on their own, building a corps of others who are trained to recognize signs of distress might help prevent the future doctors from suffering or losing ground in their studies. 

“The goal is not to discipline or interfere in the student’s life, but simply to offer help, to let the student know that they do not have to face their challenges alone,” Taylor continued. “The student may then voluntarily take advantage of the resources provided by the CARE Team, or they may choose not to.” Coordinating wellness efforts within MSUCOM has always been a challenge. “Because the services are not centralized, oftentimes someone will want to help a student in need but not know who to call, so they don’t call anyone,” said Kim Peck, director of the Office of Academic Success and Career Planning. The CARE Team serves as a central hub for directing appropriate services to the student, depending on what their issue is. Services that may be recommended include personal counseling, academic advising, tutoring and medical care. All CARE Team communications and services are strictly confidential. To learn more about the CARE Team, visit http://com.msu.edu/ About/CARETeam OR email msucomcareteam@hc.msu.edu. 26

TRIAD 2017 | ISSUE 3


ADVERTISERS TRIAD STAFF Patrick Bell, DO, and Larry Prokop, DO, Department Chairs William Strampel, DO, Contributing Editor Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Cyndi Earles, Director, MOA Service Corporation Marc A. Staley, Manager of Finance Virginia Bernero, Executive Assistant & Advocacy Liaison 2017-18 BOARD OF TRUSTEES John Sealey, DO, FACOS, President Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President-Elect Craig Glines, DO, MSBA FACOOG, Secretary/Treasurer Bruce Wolf, DO, Immediate Past President Department of Socio Economics - Directors Andrew Adair, DO, FACOFP David Best, DO, MS, ABAM Department of Education - Directors Jeffrey Postlewaite, DO, MPH Patrick Botz, DO Mariam Teimorzadeh, DO, Resident Department of Membership - Directors Emily Hurst, DO Kevin Beyer, DO Augustine Nguyen, Student Department of Healthcare Technology & Informatics - Directors Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM Stephen Bell, DO, FACOI The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another. TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA. TRIAD (ISSN 1046-4948; USPS 301-150) is published quarterly by the Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for non-members. All correspondence should be addressed to: Communications Department, Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864 Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org

Beaumont Health.................................................................22 DOs Together......................................................................18 IVaccinate..............................................................................2 Kerr Russell...........................................................................6 McLaren Health Care ........................................................12 Michigan Health and Hospital Association..........................20 MOA Autumn Convention..................................................16 MOA Insurance...................................................................22 MOA Practice Managers Committee......................................9 MOPAC.................................................................................4 Sparrow Health System.........................................................6 The Doctors Company..........................................................8 University of Michigan Metro Health Network......................4

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POSTMASTER: SEND ADDRESS CHANGES TO TRIAD, 2445 WOODLAKE CIRCLE, OKEMOS, MI 48864. ©2017 MICHIGAN OSTEOPATHIC ASSOCIATION TRIAD 2017 | ISSUE 3

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TRIAD 2017 Vol. 28 Issue 3  

The TRIAD for Summer of 2017 offers articles on physician wellness and burnout, as well as a piece on student mental wellness. Patient safet...

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