Fall 2011: Volume 22, Number 3

TRIAD

The award-winning Journal of the Michigan Osteopathic Association

Fall 2011, Volume 22, Number 3

Office management issues for the 21st Century

contents

TRIAD

The award-winning Journal of the Michigan Osteopathic Association

Fall 2011, Volume 22, Number 3

Office management issues for the 21st Century

Fall 2011

features

Page 10 The Duties of Medical Office Managers

by Kimber Debelak, CMC, CMOM, Executive Dir. of Recovery Pathways, LLC Page 13 Electronic Medical Record and Social Medial Malpractice Risks

by David B. Troxel, MD, Medical Dir., Board of Governors The Doctor’s Company Page 16 Legislative Update

by Kevin McKinney Page 18 Preparing your office for ICD-10

by Rob Sawalski Page 20 MOA Business Member Primary Page 22 Summary Plan Descriptions – know the importance

by Mike Buck, Association Benefits Page 28 Michigan Osteopathic Association Political Action Committee

by Anthony Ognjan, DO, FACP

departments 7 President’s Page

by Kurt Anderson, DO

9 AMOA News

by Pam Kolinski

21 Dean’s Column

by William Strampel, DO

23 Practice Manager’s Column

by Stacey Kammer

24 Intern/Resident Perspectives

by Anastasia Arab, DO & Sean Abraham, DO

26 Student Perspective

by Noshir Y. Amaria

29 Last Word

by Christopher J. Allman, Esq TRIAD, Fall 2011 3

TRIAD

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.

Fall 2011; Volume 22, Number 3

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 under the direction of the MOA Editorial Committee. The committee develops policies regarding the content, advertising and format of all MOA publications. TRIAD is published quarterly. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for non-members (includes UPDATE newsletter). 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.mi-osteopathic.org E-mail: moa@mi-osteopathic.org POSTMASTER: send address changes to TRIAD, 2445 Woodlake Circle, Okemos, MI 48864. ©2011 Michigan Osteopathic Association 4 TRIAD, Fall 2011

TRIAD Staff Editors-in-Chief Bruce A. Wolf, DO John Sealey, DO Managing Editor Jennifer Trayan Contributing Editors John Bodell, DO Vance Powell, DO William Strampel, DO

Executive Director Director of Administration Manager of Communications Director, MOA Service Corp.

Manager of Membership Manager of Finance Advertising Representative Layout and Cover Design

Kris T. Nicholoff Lisa Neufer Kevin M. McFatridge Cyndi Earles Shelly M. Madden Marc Staley Gretchen Christensen Ellen Weeks, Village Press, Inc.

2011-2012 Michigan Osteopathic Association Board of Trustees President Kurt Anderson, DO

President-Elect Edward J. Canfield, DO

Immediate Past President George Sawabini, DO Deptartment of Professional Affairs George Sawabini, DO Secretary-Treasurer Michael D. Weiss, DO Trustees Bruce A. Wolf, DO & John Sealey, DO Department of Continuing Education Lawrence J. Abramson, DO & Sonbol A. Shahid-Salles, DO Department of Insurance Donna R. Moyer, DO Department of Judiciary and Ethics Lawrence L. Prokop, DO & Myral R. Robbins, DO Department of Membership Robert G. Piccinni, DO & Jesse A. Park, Student Department of Public Affairs

president’s page

by Kurt Anderson, DO

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MOA President Kurt C. Anderson, DO, is a private practice family physician and medical director for sports medicine at Central Michigan University.

He can be reached at kander54@aol.com.

t is hard to believe that already one-third of my year as MOA president has come and gone. Now that school has started once again, the next weeks will certainly pass by quickly.

As I had emphasized in my inaugural president’s message, the importance of our role as osteopathic physicians rests not only in delivering the best quality care to our patients, but also as a resource for our current legislature whose members are embracing our attempts to connect with them for the purpose of advocacy on behalf of our patients.

By this publication, many of the component societies will have met at least once, and I have been pleased to see that not only has physician turnout been good, but the legislators are heeding our call and making themselves available to us as well.

On a similar legislative note, we have recently seen the passage of Senate Bills 347 and 348 which repealed a 6% tax on the state’s Medicaid HMO and replaced it with a 1% tax on health insurance claims. This new tax will produce $400 million, is matched two to one by the federal government and will provide $1.2 billion needed to negate the shortfall in the coming budget. Many thanks go out to all of you who contacted your local representatives personally to help pass this on behalf of our patients. There are numerous other bills that will impact on his dramatically during the fall’s legislative session. I encourage you to contact Kevin McKinney or Kris Nicholoff to see where the MOA stands on various issues.

In late October I attended OMED in Orlando, Florida. One of my duties was to attend the AOA Board of Trustees meeting. As many of you know, your MOA Board of Trustees voted unanimously to donate $25,000 to the National Osteopathic Advocacy Center in Washington, D.C. The Center will be used to help advance the profession’s status and priorities in our nation’s capitol. Our donation will assure Michigan’s recognition and naming of the presidential office. The Center will provide a working and meeting area for the AOA president and other distinguished leaders when visiting Washington D.C. and conducting official business on behalf of the osteopathic medical profession.

Although the money is a hefty sum, I felt it was an opportunity for Michigan, as the nation’s largest state component to the AOA, to make our mark. The way I see it, with respect to our past, current and future leadership, that distinction will be ours for a very long time. It will indeed be my honor and privilege to present a check on behalf of the MOA to the AOA president, Martin Levine, DO, at the AOA board meeting.

In November, your MOA Board of Trustees will meet at our headquarters in Okemos. With input and support from MOPAC, the Council on Government Affairs, the component societies and any of you who wish to make a difference, we will look at what we have accomplished in the first six months of my tenure. More importantly, we will focus on what more we can do as your board for the members of the country’s largest and best state component the AOA has ever seen. With your support in terms of direct participation with your local legislators, the continued monetary support of MOPAC and the many membership benefits the MOA Service Corp. has to offer, the MOA can and will be second to none among our profession.

Thank you and God bless. m TRIAD, Fall 2011 7

amoa news

by Pam Kolinski Job requirements from a Craigslist ad:

“The physician practice manager is responsible for work flow, performance and the overall management of the practice’s administrative and clinical operations.

The medical practice is very busy, and the ideal candidate must be extremely organized with superior management and leadership skills. Proven experience is required.

Exceptional written and communication skills are necessary for the position.”

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here are people in our lives that do the things that just need to get done. At the office, that is most likely your practice manager. However, outside of your practice, if you are lucky, that person is your spouse or significant other.

As a spouse of a physician, the job requirements sound to me like a normal day in my life. My husband and I recently had this discussion as I attempted to answer the question, “What exactly do you do?” Similar to a practice manager, the Advocates; and therefore, spouses, significant others and family members, keep the household running smoothly while our osteopathic physician works his or her practice or medical education. Please do not misunderstand, there are many ways to interpret that task, and the Advocates realize that it is no longer simply keeping the kitchen floor clean and doing laundry. Advocates are working full-time jobs, participating in their own full-time education, volunteering countless hours; possibly in addition to attending to kids, extracurricular activities, and having some fun.

I challenge you to ask an Advocate member just how busy he or she is on a regular basis, and they will mention several of the points from the above job description.

People ask, “What do you DO?” We do what the Advocates have always done: We attend legislative meetings and speak to your congressmen and women when the MOA or AOA sends out a call for action. We provide support to the incoming osteopathic medical students and residents who come to Michigan from hundreds of miles away, often with young families. Primarily, we keep things running smoothly so that Michigan’s osteopathic physicians’ can concentrate on their patients.

Practice managers are important components to your practice…Advocates are important components to your life. We are grateful for the opportunity to support the Michigan osteopathic physicians in any way that we can. m

Pam Kolinski is president of Advocates for the Michigan Osteopathic Association.

She can be reached at michadvocates@yahoo.com.

TRIAD, Fall 2011 9

The duties of medical office managers

by Kimber Debelak, CMC, CMOM Executive Director of Recovery Pathways, LLC Bay City, MI

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hile the traditional definition of “human resources” conjures up entire departments of personnel dedicated to the function of keeping track of corporate policies and management of employees, the doctor’s office of today

cannot usually afford that luxury. A typical doctor’s office, regardless of specialty, has its human resources department minimized to one person: the office manager. Whole college degree programs focus on turning out a human resource specialist, and yet the expectation of many office managers is to handle all of the particular requirements relating to employment. His or her job includes hiring, firing, payroll, time off requests, scheduling, training and employee satisfaction all under the umbrella of human resources.

This portion of her job would be in addition to all the other daily respon­ sibilities of running the office smoothly and without incident between employ­ees, providers and patients. The office manager’s job is akin to the Greek titan, Atlas, with the weight of the world on his shoulders.

10 TRIAD, Fall 2011

When one person holds the key to the office success, the office manager role is critical to appre­ciate and under­stand.

Finding and keeping a good office manager is difficult. Providing him or her with the support and tools needed to do the job is imperative.

The office manager’s job is akin to the Greek titan, Atlas, with the weight of the world on his shoulders.

Plan for your office manager to hone his or her skills by encouraging attend­ance to a conference such as the Fall Update Practice Manager Program offered by the MOA on November 5, 2011.

Not only will he or she pick up techniques and knowledge that will improve the office, but will also allow networking with other managers who struggle with the same daily issues. Being a medical office manager (MOM) is like being a Mom; it is up to Mom to be sure everyone and every­thing is taken care of but does not get a lot of gratitude or appreciation in return.

So take a moment to show your MOM support and offer a word or gesture of thanks for all that he or she does above and beyond human resources.

For more information on the Fall Update Practice Manager program please visit http://www. mi-osteopathic.org/pages/office/ index.php or contact Devona Jameson at (800) 657-1556 ext. 103. m

POH Regional Medical Center combines the holistic heritage of osteopathic medicine with progressive medical education programs and practical patient care experiences.

We Offer: n Medical Student Electives in Numerous Specialties and Subspecialties n Traditional Rotating and Specialty Internships n 17 Residency Programs

Electronic medical record and social media malpractice risks

by David B. Troxel, MD, Medical Director, Board of Governors The Doctor’s Company

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Electronic Medical Record – Malpractice Risks he Doctors Company supports the integration of the electronic medical record (EMR) into medical practices and believes it has great potential to advance both the practice of good medicine and patient safety. However, there are always unanticipated consequences when new technologies are adopted – and the EMR is no exception. Real and potential liability risks are beginning to be recognized, and it is important for doctors to become familiar with them.  Doctors are responsible for information to which they have reasonable access – and there may be increased access to e-health data from outside the practice that enters the practice EMR or Web site or that is accessed from the practice EMR or Web site, i.e., hospital charts, consultants’ reports, lab results and radiology reports, community medication histories, etc. If patient injury results from a failure to access or make use of available patient information, the doctor may be held liable.  E-prescribing is being rapidly adopted, driven by federal financial incentives, and is currently used by approximately 25 percent of office practices. Potential capabilities and benefits include: • Most electronic prescriptions are transmitted via a Surescripts network (which has data on 200 million insureds) to all chain pharmacies, 60 percent of inde­pendent pharmacies, and most insurance formularies.

• Most electronic health records (EHRs) have an

e-prescribing module, which is a required capability under the federal financial incentives for “Meaningful Use” of EHRs. • Standalone e-prescribing software is also available at no cost from Allscripts and the National ePrescribing Patient Safety Initiative (NEPSI).

• Most programs also check for drug interactions, dosage errors, medication allergies, and patient-specific medication factors.

• Office prescription renewal requests can be synchronized with most e-prescribing systems and with some personal health records.

• E-prescribing encourages patients to fill prescrip­tions (currently 20 percent do not) because their prescrip­tion is sent to the pharmacy electronically and is ready to be picked up when they arrive.

• Costs are lowered by flagging generic and “on-formulary” drugs.  However, practices are exposed to community medication histories through e-prescribing. For example, Dr. A renews a medication, and his e-prescribing pro­gram sends an alert advising him that the medication could interact with another drug the patient is taking. He has not pre­scribed that drug, so his office staff will have to contact the patient to identify who has prescribed it, and then Dr. A will have to contact Dr. X to “negotiate” which drug will be discontinued or changed. If failure to take action results in patient injury from a drug interaction, the doctor may be liable. ➤ TRIAD, Fall 2011 13

 Because of “alert fatigue,” there is a danger that doctors may ignore, override, or disable alerts, warnings, reminders, and embedded practice guidelines. If it can be shown that following an alert or a guideline would have prevented an adverse patient event, the doctor may be found liable for failing to follow it.  Doctors may copy information from a prior note or visit and paste it into a new note or visit (known as “cloning”), making changes where appropriate or docu­menting by exception. This may result in irrelevant over-documentation, and the patient may appear to have more or less complex problems since the prior encounter. By substituting a word processor for the doctor’s thoughtful review and analysis, the narrative documentation of daily events and the patient’s progress may be lost, thereby compromising the record of the patient’s course. The quality of notes and documentation may be further compromised by the use of templates.  The computer may become a barrier between the doctor and the patient. When the doctor fills in a computer template, it may divert attention from the patient, limit interactive conversation, and restrict creative thinking. This may depersonalize and weaken the doctor-patient relationship. The computer’s location in the office is an important ergonomic consideration; i.e., the location of electrical outlets shouldn’t force you to sit with your back to the patient.  Many EMRs autopopulate fields in the history and physical (H&P) (from data derived from data fields in a prior H&P) and in procedure notes (from personalized or packaged templates). While over-documentation may facilitate billing, entering erroneous or outdated infor­ma­tion may increase liability. For example, an internist was deposed, and his EMR was the medical record. Some of the autopopulated fields contained obviously wrong information. At deposition, the plaintiff’s attorney asked these questions: • “So is the information in this record accurate or not?”

• “Do you bother looking at your records?”

• “If these ‘autopopulated’ fields are incorrect, can we trust anything in this record?”

• “Do you deliver the same level of care as you do in record keeping?”  “Meaningful Use” requires online patient connectivity. Some EMRs have patient questionnaires that use an algorithm to interview the patient. These questionnaires often address – and memorialize in the record – issues that many doctors are simply not prepared to pursue (depression, substance abuse, etc.). Lack of or incomplete follow-up can create potential liability – and provide a clear record for the plaintiff’s attorney to follow.  Vendor contracts may attempt to shift medical liability risks resulting from faulty software design or decision support data onto the doctor. They may also provide that the vendor has rights to utilize patient or provider data. Read all contracts carefully.

14 TRIAD, Fall 2011

 Electronic discovery: Lawyers may request not only printed copies of the EMR but also the raw e-data for metadata analysis. This includes logon and logoff times, what was reviewed and for how long, what changes or additions were made, and when the changes were made. Smart phone and e-mail records are also discoverable. Doctors need to know that all of their interactions with the EMR are time-tracked and discoverable.  Templates with drop down menus facilitate data entry. However, drop down menus are usually integrated with other automated features. An entry error may be perpetuated elsewhere in the EMR – and it may be overlooked, resulting in a new potential for error. Erroneous information, once entered into the EMR, is easily perpetuated and disseminated.  Many EMRs provide e-prescribing drug information and clinical decision support, and the government’s “Meaningful Use” requirements mandate minimum functionalities in both of these areas. Clinicians should know the source of drug and clinical decision support information in their EMRs, because they may be held accountable to the clinical standards of care for their specialty and for the information in FDA-approved drug labels or drug alerts.

Social Media – Malpractice Risks ocial media (YouTube, Twitter, Facebook, MySpace, blogs, etc.) are used by doctors for doctor-to-doctor networking. However, these types of media are not appropriate for doctor-patient communications because they are too informal and lack an atmosphere of professionalism – making it easy to lapse into casual con­versation and inadvertently cross the boundary between personal and professional relationships. The following recommendations are made regarding the use of social media:

S

 Do not discuss individual patients, dispense medical advice, respond to clinical questions from patients, or otherwise practice medicine on these sites.

These types of media do not use HIPAA-compliant secure networks, and inadvertently disclosing a patient’s health information will violate HIPAA.  Presume that anything you say or post is in the public domain, and remember that anything typed or e-mailed creates a permanent record that is subject to discovery.  Doctor office practices should have written confi­dentiality and communication policies with employees that clearly forbid online disclosure or discussion of patient health information. m The Doctor’s Company is exclusively endorsed by MOA as the medical professional liability insurer of choice for their members. For more information, visit www.thedoctors.com.

TRIAD, Fall 2011 15

Legislative update

by Kevin McKinney

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he Legislature returns from its summer recess with the same focus and energy to push major initiatives during the fall session.

With less than 30 legislative session days scheduled for the remainder of the year, the Governor and legislative leaders have

announced ambitious goals to be enacted prior to the mid-December break.

Certainly many of the controversial issues – which most seem to be – need to be addressed before heading too deeply into the 2012 election year. The Governor remains focused on improving the business climate by finding a replacement for the personal property tax imposed on businesses which is a critical revenue stream for many local municipalities. Two final addresses being prepared by the Governor will be on finding revenue for improve­ ments to our roads and bridges and, finally, on workforce development.

In September, the Governor presented a health and wellness address.

Included were proposals for health insurers to cover autism, voluntary reporting of BMI for children to MCIR, passage of the health insurance exchanges, fighting infant mortality, modernizing Michigan’s health insurance regulations – allowing all insurers, including Blue Cross Blue Shield, to compete under the same regulatory framework. Finally, the Governor’s message included a call to help fight obesity, especially in children. The Governor then followed up with an Obesity Summit calling for a much greater public awareness campaign to fight obesity.

16 TRIAD, Fall 2011

Numerous stakeholders from across the state were directed by the Mich­i­gan Department of Community Health to identify strategies that will reduce obesity and improve the general health of Michigan residents. MOA has parti­cipated in the Obesity Steering committee and at the summit and will continue to be supportive of the efforts.

The auto insurance reforms being pushed by the auto insurers (HB 4936) will be taken up in the House Insurance Committee the week of Oct. 4th. At least three hearings will be scheduled to allow for both sides to present their con­cerns and issues on how to preserve our current auto no fault system. MOA is an active member of the Coalition Protecting Auto No-fault (CPAN) which is strongly opposing these measures. See www.cpan.us for a complete analy­sis of the bill. However, the effects of the legislation will be a significant cost shifting to both Medicaid and other health insurers as the proposal allows for options of lower medical coverage other than the lifetime full coverage currently in statute. The bill will impose workers comp fee schedules on providers causing significant under-funding of medical treatment for severely injured accident victims. Hospitals, trauma centers, rehab providers will all see drastic reduction in reimbursement resulting in thousands of lost jobs in the health care industry. Unfortunately this broader insurance reform has been tied to the helmet repeal issue that is currently being discussed in the legislature. Some legislative supporters of the mandatory helmet repeal bill have successfully tangled this issue with passage of HB 4936 which provides a significant legislative boost for advocates of riding without helmets but also complicates passage of both bills.

Legislative leaders, including the Governor who has not personally weighed in on this issue yet, want to have both issues passed before the end of the year.

The Senate Health Policy Committee will be spending the bulk of its time this fall seeking passage of SB 693 (the health insurance exchanges). Introduced

by Senator Jim Marleau, Chair of the Health Policy committee, the new Mi-Health Marketplace – would create a nonprofit health insurance exchange for individuals and people in small businesses with less than 50 or fewer employees. It would establish an online clearinghouse for health insurers to sell low cost and federally subsidized coverage for people meeting certain income levels. The bill will move into committee and the Senate in October with an ambitious schedule to have it adopted by both chambers by the end of the year to be eligible for Federal implementing funds.

Most of the current legislative threats on scope of practice expansion have been temporarily put on hold as the Governor has called upon his Administration to review the current licensing and regulatory framework under the current public health code. MOA is actively monitoring this examination closely as it has the possible outcomes of changing the current scope for many of our health providers. m

Kevin McKinney is the lobbyist for the MOA. He can be reached at kevin@mckinneyandassociates.net.

is conducting a search for the position:

Associate Dean, Statewide Campus System (SCS)

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he Statewide Campus System is an educational consortium of 40 affiliated osteo­pathic teaching institutions, including and based at Michigan State University College of Osteopathic Medicine. The Associate Dean provides administrative leadership for the Osteopathic Postdoctoral Training Institution (OPTI), the SCS Educational Standards Committee, SCS staff, and academic and research support services, oversee the SCS budget, and lead strategic planning initiatives. The Associate Dean position is a full-time annual year appointment with a fixed term faculty appointment within a MSUCOM department and rank appropriate of the applicant.

Required Qualifications:

• D.O. or Ph.D. degree.

– D.O. applicants must have completed residency training and AOA certification.

• Significant osteopathic postdoctoral experience.

– At least five years of administrative experience such as DME, Program Director, Assistant/Associate Dean; or an equivalent combination of education and experience.

– Evidence of administrative success in previous leadership positions.

– Significant scholarly activity.

• Demonstrated ability to manage complex organizational systems.

• Experience and skills in curriculum development, teaching, faculty development, evaluation, research, program development, and accreditation policy.

• Possess effective written and oral communication skills, and understand the per­sonal commitments required of a service-orientated educational consortium.

Candidates may apply on-line https://jobs.msu.edu/. Review of applications will begin in August 2011 and will continue until the position is filled.

MSU is an affirmative-action, equal-opportunity employer. MSU is committed to achieving excellence through a diverse workforce and inclusive culture that encourages all people to reach their full potential. The University actively encourages applications and/or nominations of women, persons of color, veterans and persons with disabilities.

TRIAD, Fall 2011 17

D

Preparing your office for ICD-10

iagnosis coding for phy­sician offices is going to change. That’s a fact. A few years ago the gov­ern­ment man­­dated that,

by Rob beginning Oct. 1, 2013, all health care entities must use the ICD-10 code set in place of the ICD-9 code set. That includes diagnosis reporting on claims from physician offices. (It’s im­portant to note that this change affects diagnosis and inpatient procedure coding but does not impact CPT or HCPCS codes.)

It seems that every year brings new legislative, business and tech­ nological demands that compete for the limited resources of health care providers and payers alike. These competing priorities have become a huge challenge for medical practices all over the country. ICD-10 is no different.

With all these competing priorities, there could be a temptation to put off preparing for ICD-10 until “tomorrow” because the transition date (Oct. 1, 2013) seems far away.

However, when you consider the amount of effort that ICD-10 requires and the associated time­ines, this could be a dangerous strategy.

The importance of the transition ICD-10 represents a large, complex change (and opportunity) for all health care entities. From a payer’s perspective, it will impact nearly all aspects of our business. We have a feeling that statement is also true for our participating hospitals and physicians. Failing to make that change in a timely manner could mean major disruption in the health care system.

Any disruption would affect things like claims payment, member benefits, information integrity and quality, as well as long-standing relationships between patients, health care providers and payers. In short, there’s a huge amount at stake in this transition.

Just how big is the change to ICD-10?

Once you begin to dissect the nuances of the ICD-10 code set, it’s clear that this transition is more than a standard code update. It represents a fundamental shift in the way the ICD codes are structured and reported.

• The current ICD-9 code set of around 17,000 codes will increase to more than 150,000 ICD-10 codes.

• The way the codes are structured (number of charac­ters and positioning of letters and numbers) will change.

• The code set also has several new features to help provide accurate reporting of conditions and diseases.

Essentially, the ICD-10 transition means that the way you understand and use the codes today will cease to exist as of the compliance date.

18 TRIAD, Fall 2011

2013 is closer than you think If you haven’t started to look at the details, now is the time to begin. Here are some tips to get you started: Sawalski • Make sure that you and your office are aware of the details of the transition • Familiarize yourself with the new code set and the changes • Identify where ICD-9 codes currently exist (for example, in an encounter form, a superbill or other commonly used office paperwork), and understand how the shift from ICD-9 to ICD-10 will affect daily business processes.

Look at documentation standards within the office • and see what will need to be done in light of the ICD-10 code set.

• Know that your coders will most likely have to attend ICD-10 training, so plan ahead.

• Check with vendors, payers and other trading partners to determine if they know about the ICD-10 transition and have started to prepare their businesses.

What’s important to remember is that each member of your practice or your office will have a different per­ spective on the new code set. For example, the challenge of ICD-10 for physicians is the increased level of detail needed to choose the appropriate codes. Coders in an office must fully understand the new structure of ICD-10 and attend the necessary training.

The transition to ICD-10 requires a detailed under­ standing of how your business, office or practice uses and updates the ICD-9 codes today.

Blue Cross Blue Shield of Michigan preparedness BCBSM has been working on the transition since 2009. In the summer of 2010, we began talking to our partners (physicians, physician organizations, hospitals, state entities, vendors and other payers) to discuss ICD-10 and what it means to all our stakeholders.

As part of our implementation plan, we also began to make our systems ICD-10 compliant and planned for future business process changes and testing opportunities.

For more information about the ICD-10 transition in general, go to cms.gov/icd10. For BCBSM-specific informa­tion, visit our site at bcbsm.com/icd10.

The success of this transition to ICD-10 and how it will impact data quality and public health reporting for the next several years is up to the health care industry. m Rob Sawalskki is IDC-10 Program Communications for Blue Cross Blue Shield of Michigan. He can be reached at rsawalski@bcbsm.com.

MOA business member primary

MOA BUSINESS

Are you aware of the benefits that come with being a member of the Michigan Osteopathic Association? Along with practice efficiency, continuing education for physicians and practice managers, advocacy and osteopathic identity, the MOA has established relation­ships with a variety of companies who support the osteopathic profession and offer quality products and services to meet the needs of our osteopathic physicians.

Many of our MOA business members offer products and services at discounted rates. Whether it’s for convenience or price, please take some time to review the MOA business member benefits that are offered to our members.

MEMBERS

Please visit the MOA website for more information on each of these companies and to find new MOA business members as they become available at mi-osteopathic.org.

For more information on MOA business members, contact MOA Member Services Representative, Devona Jameson, at djameson@mi-osteopathic.org or 1-800-657-1556 ext. 103.

For information about becoming an MOA member or renewing your membership, contact Manager of Membership, Shelly Madden, at smadden@mi-osteopathic.org or 1-800-657-1556 ext. 120.

 9g Enterprises Patient satisfaction survey *90-day free trial

 Delta Dental Plan of Michigan Choice of two dental insurance options to meet your needs

 AAA Auto and home

 Epocrates Premium mobile products and software *20% discount for members

 ADP Payroll, HR, Retirement services and much more is now available to Michigan osteopathic members  Alliance Billing Services Web-based practice management system  AmerAssist Debt collection services *Fixed fee of 10% or less per account  Association Benefits Health, dental, vision, life, disability, long and short term care insurance  Athenahealth Billing & practice management service, electronic medical records, automated appointment and reminder call system *8% off the implementation start-up fee forathenaCollector  Avis Rental Cars Auto rental *10% discount off standard daily rates, 5% discount off special promotional programs  Blue Cross Blue Shield of Michigan Health and vision insurance for you, your family and staff  Comcast Business Class Phone, Internet, and business class TV *Best promotional rate available, one free month with 2 yr agreement, free site survey, free standard installation,10% discount on Comcast Spotlight advertising 20 TRIAD, Fall 2011

 HealthFusion MediTouch web-based EHR *Subscription discount  Hertz Rental Cars Auto rental *Variable discounts  IC System, Inc. Debt Collection Services *10% discount on additional products and services  Medical Informatics Solutions, LLC Technology consulting, practice management consulting, implementation and project management of EMR/EHR/PM *No charge for initial consultation (up to 2 hrs)

 Paychex HR services, automatic payroll processing and payroll tax filing *15% off basic payroll processing and HR set up fees  Pinkus Dermatopathology Laboratory, PC Diagnostic dermatopathology services  Prescriber’s Letter Subscription service on new developments in drug therapy *40% discount  Shred Docs Secure document shredding service *15% discount off standard pricing  Stafforce Health information management service *25% discount off service fees  Staples Office supplies *10% discount

 Michigan Retailers Association Merchant credit card processing *Lowest rates for MOA members

 The Doctor’s Company Medical liability insurance *3% discount

 MOA Career Center Job seekers - post your resume free via the MOA website Employers – post an available position via the MOA website

 VSP Vision insurance for you, your family and your staff

 MOA Discount Rx Drug Card Free discount cards for patients *Pharmacy discount of 30% to 70% off prescription drugs  MOA Glove Program Superior exam gloves – powder-free latex, powdered latex and nitrile *Discounted prices for MOA members

 Wild at Work Discounts and special offers on travel, entertainment, shopping, dining and services  Yeo & Yeo, PC, CPA Medical billing, coding training, audits, accounting, tax planning, payroll process­ ing, practice valuation, estate and financial planning, and information technology services

dean’s column

by William D. Strampel, DO

Cutting the Gordian knot of office management

I

William D. Strampel, DO, is dean of Michigan State University College of Osteopathic Medicine.

He can be reached at Pat.Grauer@hc.msu.edu.

n the office setting, we see more patients than ever. With the burgeoning knowledge base of medicine, we are responsible to understand more and more. Innovations in medical devices, information technology, and diagnostic tech­niques offer a dizzying array of choices. New pharmaceuticals, laden with all the permutations of risks of interaction with others, are on the market every week, and three-quarters of our patients leave our offices with these prescriptions. Our patients are often Web-informed or – misinformed, litigious, hurried, and have consumer-oriented expectations. Our staffs are larger and more specialized.

Many office functions are also out-sourced.

The bottom line is that a modern medical office is complex – a Gordian knot of social, logistical, financial, technological, physical and infrastructural systems. Only the best office management can cut through this tangle.

Most important, of course, is minimizing risk to our patients. An interesting study conducted by the Weill Cornell Medical College found that in 2009, of the nearly 11,000 malpractice claims, fully half were from errors that occurred in the doctor’s office, and most of those were diagnostic errors.

Kathleen Stilwell, regional patient safety risk manager for The Doctors Company, listed ten frequent risk management issues and suggested strategies to deal with them.

• Patient termination: Institute proper legal procedures to terminate patients and notify them of termination. Document everything.

• Test results: Track, follow-up, initial before they go in the record, and advise the patient of any abnormal results.

• Missed appointments: Have a formal tracking system, follow up with patients to find out why they missed, document in the patient record.

• Scope of practice: Never allow staff to act outside the scope of their job descriptions, never refer to medical assistants as “nurses,” and make sure all are trained and certified before using technology or equipment.

• Medication: Review at each visit with patients and provide written list of dosage, directions and side effects; record samples lot number in medical record in case of recall.

• Documentation: It’s our primary legal defense. Document objectively, use approved abbre­­­viations, never impeach the medical record’s integrity by altering it, and, for electronic records, ensure reliable backup and disaster recovery.

• Disruptive patients: Do not allow them to abuse staff or threaten the safety of people.

If violent, call 911. Do not hesitate to terminate a disruptive patient from your practice.

• Communication: Ensure patients understand instructions, and document the name and relationship of anyone acting as a patient’s translator.

• Patient satisfaction: Listen to your patients, obtain their input on how to improve your office practice, and review and evaluate all complaints with staff.

• Medical record retention: At minimum, keep records as required by law, or as alternative for 25 years after the last date of treatment. Destroy records appropriately, and maintain an inventory of those destroyed.

In addition, I would suggest that we work to better communicate from health professional to health professional. When test results, prescriptions, new diagnoses and treatments, and emerging issues are not shared among health care providers, our patients, especially those with chronic diseases, become the messengers and the translators among us – with ample opportunity for confusion, mistake, vested interest and worse to alter the communication.

Though the challenges are complex, sometimes it’s the simplest things that can make the most profound differences: hand-washing, clear communication, taking time to listen to the patient, writing it all down. m TRIAD, Fall 2011 21

Summary plan descriptions – know the importance

by Mike Buck, Association Benefits, MOA Business Member

A

s the exclusive agent for the Michigan Osteopathic Association not only do we assist MOA members with all their insurance needs, we also assist employers with keeping compliant.

What does this mean to you? If your practice offers employee benefits, you are required to provide plan participants with a copy of your company’s Summary Plan Description (SPD) to be certain that they under­ stand your benefits and rules accurately. The Employee Retirement Income Security Act (ERISA) specifies what information must be included in the SPD for almost every employee benefit plan. This includes the most important facts the employees need to know about their retirement and health benefit plan including plan rules, financial information and documents on the operation and management of the plan as well as the participants’ rights.

While Benefit Summaries or Benefits-at-a-Glance may describe plan benefits, they often do not meet the requirements of ERISA and should not be considered an SPD. Employers need to make sure that their SPDs satisfy ERISA requirements as it is not the responsibility of an insurance provider or third party administrator to provide these documents.

One of the many advantages of enrolling in a MOA Health Insurance program is access to a legally compliant Summary Plan Document. Our MOA clients are provided a template that is a starting point in preparing a customized SPD for your employees so that you remain compliant with current Department of Labor (DOL) requirements. We work with Butzel Long, a leading law firm with lawyers and offices throughout Michigan as well as a number of other states. They provide us with the creativity and superlative service we demand so that we can then share that expertise with our clients.

We always recommend that your company’s legal counsel review your SPD before it is distributed to employees to be sure it addresses items unique to your practice. Such things as plan identifying information, eligibility provisions, description of benefits, termi­ nation and subrogation provisions, plan contributions and funding all need to be addressed.

One important item to keep in mind when preparing an SPD – the intent is to make benefit and plan rules understandable to the average plan participant. It is the employer’s responsibility to make sure that employees understand the SPD. Therefore you must proofread your plan document to make sure it is easily understood.

Association Benefits Company has provided MOA members and their staff benefits consulting services for more than 20 years. As a licensed independent agency, we provide employers with benefit solutions including life, health, dental, long term care and disability. We can provide clients with competitive quotes from a variety of carriers. m

For additional information contact the Association Benefits dedicated MOA representative, Julie Watson at 1.800.782.0712 extension 167 or direct at 248.359.6489.

22 TRIAD, Fall 2011

practice manager’s column

by Stacey Kammer

Drawing the Line: Managing Patient Discharges

A

Stacey Kammer is the Enterprise Manager at Metro Health in Allendale, MI. She can be reached at Stacey.Kammer@metrogr.org.

lthough dismissing patients from your practice can be a challenging process, a few key pointers can help guide you through terminating a patient-provider relationship in an amicable manner.

Like any issues you may face in your office, always document every issue.

For patients, this can include no-shows, excessive cancellations, rude or aggressive behavior towards staff and drug seeking behavior. Many practices choose to adopt policies pertaining to no-shows and cancellations. It is not uncommon to use the “three strikes and you’re out” rule; meaning after three no-shows or same-day cancellations, patients can be dismissed from the practice. Having a set rule creates clear boundaries for patients, especially those who tend to push the limits. Standardization also protects your practice from any claims such as discrimination or unfair prejudice from patients asked to leave. Of course, aggressive behavior should never be tolerated and is certainly grounds for immediate dismissal.

If it comes to the point where you feel a discharge is necessary, gather your docu­ mentation and keep it with the patient’s chart. Retain the documentation as long as you would store the chart (up until destruction). As a good rule of thumb, create a generic letter that you can use for each discharge and have your legal counsel review the verbiage.

This also insures that your prefab letter doesn’t state anything that could come back to haunt you.

Sending a letter in the mail is a great idea to avoid conflict at the office, and by sending it certified, you will obtain notification from the mail service that it was received by the patient. Although sending your letter certified cost around five dollars, in the end having the documentation behind you is definitely worth it. Any local United States Post Office can certify your letter.

Take into consideration that although your chronic ‘no-shower’ may not be the best fit for your office, they may still need their medications refilled to get them by until they find a new physician. Many offices choose to continue emergent care and medication requests for 30 days (or whatever time frame your providers deem appropriate). Make sure you state in your letter exactly how long the patient has before you conclude all care. You can also move things along by directing your dismissed patient to call their insurance company (if insured) to assist in finding a new provider. Taking these extra steps can insure that you protect yourselves from patient abandonment.

In the circumstance where you suspect that a patient may be receiving prescriptions or narcotics from multiple offices, visit the Michigan State website at www.michigan. gov/mimapsinfo. Licensed providers can sign up for MAPS, which is the Michigan Automated Prescription System. This site allows you to see prescriptions that have been filled for the patient, along and who prescribed it.

Just remember to always encourage strong documentation during your exploratory and final dismissal process. Your practice will be better off and you will have created a smooth transition for the patient to depart the office. m TRIAD, Fall 2011 23

intern/resident

by Anastasia Arab, DO

Anastasia Arab, DO, is a medical student applying for residency in OB/GYN. She can be reached at anastasia.arab@gmail.com.

Specialty Focus: Gynecology

A

s a medical student, there are moments during the clerkship experience that capture your attention and allow you to imagine the type of physician that you want become. Many times it’s a patient interaction, a connection you develop while learning how to embrace the doctor patient relationship. Sometimes it’s a clinical exper­ ience, learning a new procedure and developing the clinical skills that you need master. Often times, it’s putting it all together and looking at the big picture; how to blend the interpersonal elements with the clinical knowledge and technical skills to create the perfect marriage in the practice of medicine.

For many students, when you have this experience in clerkship it helps guide you in selecting a field of medicine you would like to pursue as a resident physician. Some students have this moment early in their clerkship experience, others can spend much of their clerkship years in pursuit of this experience. I consider myself one of the lucky ones. Once I stepped foot in an operating room, I found my calling. The only question was, which surgical specialty was the right fit for me. The answer came quickly, Obstetrics and Gynecology (OBGYN). OBGYN as a specialty field is unique in that it is a beautiful balance of medicine and surgery, often offering many opportunities to serve as a primary care physician for women. The continuity of care in being able to take women from childhood and adolescence through childbearing into menopause and onto the geriatric years all while promoting health and prevention yet being able to employ surgical interven­ tions for both diagnostic as well as therapeutic care is very appealing. In addition, there are opportunities to further specialize in areas such as maternal fetal medicine, reproductive endocrinology, gynecological oncology, urogynecology, pelvic reconstruction, family planning, and minimally invasive surgery to name a few.

24 TRIAD, Fall 2011

Obstretricians and Gynecologists are no stranger to the rapidly evolving technological advances in medicine.

In fact this is one field in which there is a strong push for continued advancements in the field of minimally invasive surgery and further investigation into the benefits of robotic assisted laparoscopic procedures. As a medical student, being able to observe an operation involving a Da Vinci Robot can be a thrilling and awe-inspiring experience. The first time I saw one I felt like a kid in a candy store, my eyes lit up with excitement, the hairs on my arms stood on end, and I had to hold back the urge to jump up and down in the operating room. As I looked up overhead on the wall of the operating room a large screen television monitor caught every intricate detail as the surgeon sitting at the console manipulated the controls that directed the robot arms to delicately separate tissues to expose underlying vasculature that needed to be ligated and tied off. I was overjoyed and overcome with excitement when the surgeon invited me to sit at the console and observe the surgical field from his vantage point. I was amazed by the resolution and three dimensional quality of image before me; the ability to see pulsating arteries magnified with such clarity was astounding. I was caught – hook, line and sinker! I needed to know more, to see more, to evaluate more. The questions came to mind rapidly, what was more interesting was how the response varied from one OBGYN to the next.

“Robotics in Gynecology” is a broad topic that can spark a heated discussion amongst colleagues and often times can even divide a room. As a medical student pursuing a residency in OBGYN, it is worthwhile to sit back and listen to each side of the debate while resisting the urge to align yourself on one side or the other. As with many things in life, everyone is entitled to an opinion – the questions are, “Is one opinion more valid than another?” For now, I will stick with staying neutral in that for certain gynecological procedures there is a place for robotically assisted techniques in order to achieve some of the reported advantages, such as decreased blood loss and improved recovery times. For other pro­ cedures there is no substitute for open techniques in order to preserve the ability to use your hands and employ tactile sensation. Personally, I am hoping to find a program here in Michigan that will educate its residents in not only the value of both but also adequately train its residents in mastering the technique of both. m

perspectives

by Sean Abraham, DO

I

Why Stay in Michigan?

have to begin this article with a disclosure of my bias: I was born in Michigan, went to college here and, save a two year hiatus in Kirksville, have lived my entire life in Michigan. I love it here and can’t imagine why anyone would want to leave.

However, the mass exodus of many of my friends after college made me realize maybe this unabashed devotion to my home doesn’t take hold of everyone who sets foot here. After much discussion with those who intend to leave, I’ve realized that there’s a lot of negativity directed towards Michigan. Some of this bad press stems from actual fact; every state has its ups and downs. Unfortu­nately, the downs tend to grab our attention, leaving us asking ourselves, pessimistically, “Why stay in Michigan?”

Stay in Michigan, because it’s cold here. The variety of weather we experience in the mitten provides the opportunity to enjoy the warm summer days, without running for the shelter of an air-conditioned house. The great lakes give us beaches, fishing and boating just a short drive from anywhere in the state. The vegetation that thrives here supplies a cornucopia of fresh fruits and vegetables, followed by fall colors that few other states can match. Once winter settles in, the same snow that we curse on our daily commutes stays for the week­ ends, when we strap on our boards, wax our skis or fire up our snowmobiles for fun unheard of to the south.

Stay in Michigan, because you’re not in New York, Chicago or Los Angeles. We don’t live from hand to mouth on a resident’s salary; many of us even purchase homes.

The convenient (albeit choppy) highways and roads are rarely clogged. On the other hand, we enjoy many of the same perks that pilgrims to a giant metro­polis seek:

Sean Abraham, DO, is a second year emergency medicine resident at Genesys Regional Medical Center in Grand Blanc. He can be reached at seanabraham@gmail.com.

Michigan boasts competitive teams in every professional sport, not to mention two colleges with top-tier athletics.

Our cities offer a broad palette of cuisine from every corner of the world; and a multitude of wineries and breweries offer libations with which to wash it down.

Just about every musician’s tour makes a stop in Motown, and the land itself offers breathtaking views for hikers, golfers and hunters alike.

Stay in Michigan, because the economy has taken a downturn. As physicians, we often take pride in our beneficent leanings, our dedication to those left behind by wealthy society. When it comes down to serving people who truly are down on their luck, how­ever, some find it easier to flee for more affluent locales.

While physicians who spend a month in Africa or Central America certainly deserve admiration, perhaps the greater honor belongs to those who spend their careers in Flint or west Detroit. The very taxpayers and auto workers who supported the institutions where many of us train, now, all too often, find themselves lacking the resources to adequately care for their own physical needs.

These pleasant peninsulas, while often maligned, offer much to entice young physicians establishing their careers. The climate and natural resources support a multitude of recreational activities. The moderate sizes of Michigan’s municipalities provide big city attractions with small town convenience. Most importantly, the recent downturn in this once booming economy provides an opportunity for us to give back to the same population that has given us so many opportunities.

While many look at Michigan and say, “Why stay?”

I often shake my head and answer, “Why leave?” m TRIAD, Fall 2011 25

student profile Noshir Y. Amaria is a first year osteopathic intern at Sparrow Hospital. He can be reached at noshir.amaria@gmail.com.

Spotlight: Noshir Y. Amaria, DO, ATC

Q

Why did you choose the Michigan State University College of Osteopathic Medicine over other osteopathic medical schools?

When the time came to apply to an osteopathic medical school, the number one ranked osteopathic college, and one that was in the top 10% of medical schools in the nation for Primary Care was right in my backyard. Wanting to go into osteopathic medicine as well as primary care made this an easy decision. I was already familiar with the community having done my under­graduate study at Michigan State University. And the Michigan State University College of Osteo­pathic Medicine admissions advisors and I had stayed in close contact every semester for a few years leading up to my acceptance into MSUCOM. This was the logical choice, as well as the most comfortable one.

Q

What did you like most about MSUCOM and the experience it gave you?

There is much to like about MSUCOM. The number one thing had to be the support that I got from the faculty. I was a student that struggled with test taking at this level. MSUCOM gave me avenues to overcome this problem of taking tests, and I took full advantage of them. What I liked was that when they saw a student like me trying hard to overcome my setbacks, they offered me more support and helped me in any way that they could instead of casting me aside or writing me off. MSUCOM really helps students who help themselves. MSUCOM helps students like me achieve our dream of representing the osteopathic profession.

The other great thing about MSUCOM is that they accept well-rounded, passionate students. In this day and age of compe­tition to gain entry into a top medical school, it could be very easy to just accept any student with a high MCAT score and 4.0 GPA. MSUCOM focuses on more than just academic success. MSUCOM wants to know they are taking good, diverse, well-rounded people, from many backgrounds with a passion to be an osteopathic physician. That was another reason why this was a school that was my top choice.

26 TRIAD, Fall 2011

Q

What field of medicine do you plan to practice and why?

I plan on going into Family Practice with the intent on doing a one year fellowship in Osteopathic Manual Medicine (OMM) as well as a Primary Care Sports Medicine fellow­ship after that. My dad is a general surgeon and family practice doctor. Growing up I had a lot of exposure to Primary Care medicine by working in his office for many summers. It was always an area of medicine I admired based on its foundation in the field of medicine.

Primary Care doctors are vital to the health and well being of our commu­nities. The thing that intrigues me the most about being a family doctor is how one has to have a solid foundational knowledge about many specialties of medicine. The family practice doctor is like a quarter­ back on a foot-ball team. They are able to make decisions about the well-being about the patient they take care of by working together with specialists, as well as the other allied health fields. They are able to see patients of any age at any stage of life, and be able to develop sustained relationships with their patients by having and maintain­ ing solid continuity of care. That is exciting to me, as I am a person who loves listening to people and being able to help people as a much as I can, as often as I can.

Q

What is your favorite part about being in osteopathic medicine?

It is exciting knowing that I get to be a part of a fast growing medical field. It is exciting knowing that my classmates and I are the ones spreading the word about DOs and how valuable they are to a hospital, to a com­ munity, to any medical specialty, our nation and our world.

I wish there were DO schools in every state, and I wish there were more DO residencies available in every specialty. I hope we get to that point one day. It is exciting knowing that my generation of osteopathic physicians will be the ones to get us there.

Q

Why did you choose osteopathic medicine over becoming a medical doctor?

I choose osteopathic medicine because the training incorpor­ated a philosophy of medicine that I identified myself with. My father, who is an MD, always tended to take care of the person, and not the disease or ailment.

It was a philosophy of medicine I was exposed to early, just from an MD. Having been exposed to patient care as an athletic trainer, I got to observe that I had the mentality of a DO and that it made sense for me to pursue being a DO and only apply to DO schools.

It didn’t matter what the specialty was, most of my mentors were well-rounded, passionate osteopathic physicians. I wanted to be like them.

Q

What interests you most about osteopathic medicine?

The holistic approach the physician takes with their patient as well as their commitment to the doctor/ patient relationships is one of the best things about osteopathic medicine. The fact that DO students have 6 semesters (or more) worth of training in osteo­pathic manual medicine was the main reason I pursued the field. The commitment to primary care within osteo­ pathic medicine was also truly remarkable.

Q

Do you plan on staying in Michigan to practice?

Why or why not?

Yes I do plan on staying to practice in my home state of Michigan. This state is one of the leading states in the country in opportu­nities for osteopathic physicians as well as top hospital systems. I often meet colleagues in training who are from another state who have come to Michigan just for their schooling or resi­dency training. They often tell me how they “can’t wait to leave” or how sick they are of the weather here. My advice to them is always the same; Go where your heart desires and where you will be happy. I will stay and take care of the good people here.

Q

What is your favorite part about your job now?

Being an intern is rough, as everybody in my field knows. The best part about being an intern at a big hospital is how much you learn. It is kind of like drinking through a fire hydrant. You see so much in this internship year alone. You see so much through­out all the years of residency train­ing. Our job is to not only serve our patients and work hard for our hospital, but to learn as much as we can as well.

Residency training is just that, being able to learn and experience as much as you can so that you can be a better clinician later. I also love working with people. I love working with attending physicians, other residents, nurses, therapists, social workers and everybody else. Being able to function as a team is crucial in the world of health care. Ultimately, our goal should always be the same, to provide the best care possible for the people who seek our care. m

TRIAD, Fall 2011 27

Michigan Osteopathic Association Political Action Committee

MOPAC

Michigan Osteopathic Political Action Committee

by Anthony Ognjan, DO, FACP

A

s a professionally and politically engaged physician, you may wonder what Michigan Osteopathic Association’s Political Action Committee (MOPAC) does during the “off election years.” Physicians not too familiar with Michigan’s political or legislative process might think the need to consistently raise funds for MOPAC is not necessary or not of high priority. However, nothing could be further from the truth.

Yes, it is true, that during the off years in an election cycle, the intense and “free wheel“ spending of candidates on the campaign trail does diminished.

The high costs associated with maintaining campaign staff, support offices, paid political consultants and public opinion polling are usually not being incurred.

However, looking toward the future, the elected officials quietly, and sometimes not so quietly, focus their fund raising efforts on raising money for their next election. Correspondingly, the four legislative caucus, (House and Senate Democrats and Republi­ cans), continue to raise money to erase their debts from the 2010 campaigns, and are attempting to increase their financial footing going into the 2012 election cycle.

There will also be three Michigan Supreme Court races for 2012 that will be critical to the direction of the Court in future years. Justice Marilyn Kelly (D) has reached the constitutional age limit and cannot seek another term. Republican Justices Stephan Markman will be seeking re-election and newly appointed Brian Zahra will be running for a new term having filled out the final two years of former Justice Corrigan who moved over to the Snyder Adminis­tration to run the Department of Human Services.

Additionally, Michigan’s Congressional landscape has changed as well. All of the U.S Congressional seats will be up in 2012 and running in “new districts” due to the completion of redistricting using the 2010 consensus figures. U.S. Senator Debbie Stabenow (D) is up for re-election and will face a stiff challenge by her likely Republican opponent – former congressional member, and gubernatorial candidate Peter Hoekstra.

This race will be a top targeted race on the national level. However, since MOPAC is not a federally registered PAC, it will not be able to make contributions to the federal candidates.

As you can see, politically and legislatively, in Michigan, political activities are just as busy as ever, and for MOPAC, the “off election” years are 28 TRIAD, Fall 2011

“business as usual”. No exceptions. Fortunately, the Michigan Senate and the Governor will not be up for election – until 2014 – so only the Michigan House of Repre­sen­tatives, and the Michigan Supreme Court races are in play in 2012.

Your MOPAC continues to focus on the Michigan’s legislature (House of Representatives and Senate) giving “strategic” contributions to key members of critical committees, legislative leadership and physician friendly legislators, to build trust, access and overall support for our key issues. Working closely with our political consultant /lobbyist, we are already frequently meeting with candidates, who have officially announced their candidacy for running in the Michigan House next year.

Strategically, MOPAC will identify a handful of legislative candidates and establish the working relationships that are key for the support of our issues. MOPAC will provide them with the tools and information they need to become better and stronger candidates for our constituencies and our patients.

Actively, MOPAC has already identified two recently announced candidates, running in “open House seats.”

We are reaching out and working with our Physician membership in the districts the candidates wish to run, providing early campaign money, and educating the candidates on the issues important to physicians and our patients.

Politically and legislatively, as we head into the fall months of 2011, MOPAC continues fundraising to build up the necessary funds, to have sufficient resources, to make a difference with candidates that support our issues and our health care policies.

When you add the education component and local advocacy efforts by MOA members, MOPAC’s efforts increases the opportunities for our voice and our patients’ voices, to be effectively heard in the legislative process.

So, if you have yet to give to MOPAC for 2011, please do not be shy in doing so. We are using MOPAC to effectively and strategically advance our osteo­pathic legislative goals and objectives now, into next legis­ lative session, and beyond. m

Anthony Ognjan, DO, FACP is the chief of Infectious Diseases for the Mount Clemens Regional Medical Center. He is also the chair for the Michigan Osteopathic Political Action Committee.

He can be reached at aognjan1@gmail.com

last word

by Christopher J. Allman, Esq

How Healthcare Reform Will Impact Your Practice: Now and Future

T

Christopher J. Allman is a Partner in the Detroit law firm of Ottenwess, Allman & Taweel, PLC, a firm who specializes in healthcare law and medical professional liability defense.

He can be reached at callman@ottenwesslaw.com.

here is no doubt that the world of healthcare is changing and the Patient Protection and Affordable Care Act of 2010 (PPACA) is likely to further impact the practice of medicine in the future. This article will discuss a few of the areas that PPACA has affected.

Do more with less. Medicare and Medicaid reimbursement reductions are likely. President Obama has proposed $320 billion in reductions to Medicare and Medicaid as part of a $3 trillion deficit reduction plan and plans to cut Medicare by $248 billion and Medicaid by $73 billion over 10 years.

What this means for your practice. You will have to get “leaner and meaner” now. Even though you may experience double-digit percentage cuts in your reim­ bursement rate from the federal government, the number of Americans insured by the government will increase due to the aging baby-boomer population and the increase in eligibility for persons earning up to 133% of the federal poverty level who will be eligible for Medicaid by 2014 under the PPACA. More government oversight. The PPACA provides an additional $350 million over the next 10 years to ramp up anti-fraud efforts, including heightened scrutiny of claims, investments in sophisticated data analytics, and more law enforcement agents to fight fraud in the healthcare system.

What this means for your practice. You will have to be increasingly careful about the claims you submit for payment to government programs. Since June 2011, the Center for Medicare and Medicaid Services (CMS) is using “predictive modeling” software to analyze claims. Predictive modeling software helps CMS identify poten­ tially fraudulent Medicare claims in real time and uncover fraudulent providers and suppliers, flagging both for investigation, referrals to law enforcement and payment stoppage before claims are paid.

Accountable Care Organizations (ACOs). Under the PPACA, CMS is required to establish a Medicare Shared Savings Program through the use of ACOs by January 1, 2012.1 An ACO is “formal legal entity that integrates certain clinical and administrative functions of the participating providers in order to achieve improved quality outcomes and cost savings for the Medicare program.”

What this means for your practice. Formation of an ACO is voluntary. Even if you treat Medicare patients, you are not required to participate in an ACO. Because of the costs of establishing an ACO, likely only large networks and hospitals will be able to form ACOs. The proposed regulations for ACOs are complex and add substantial regulatory oversight and new practice requirements. If you are considering partici­ ation in an ACO, you should have a significant voice in the process, since much of the burden of making the ACO effective will be on you.

Needless to say, the delivery of safe and effective healthcare is complex and will grow increasingly so in the future. To ensure that you are in compliance with all of the current and new rules and regulations, you should be sure to consult an experienced healthcare attorney. m

1. Section 3022 of the Patient Protection and Affordable Care Act of 2010 TRIAD, Fall 2011 29

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T R A N S F O R M AT I O N

Healthcare Management Primary Care / Wound Physicians MichaelCare Plante, CEO needed! Grow­ing company seeks part-time to full-time physicians 21415 Civic Center Drive • Suite 111 • Southfield, MI 48076 to practice in-home care.

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MEDICAL SPACE FOR LEASE: 1,100 square feet with three exam rooms avail­ able immediately. Lo­cated on North Woodward just north of I-696. Suite is fully plumbed with cabinets. Pre­s ent ten­ ants include intern­ ists and other medical spe­ c ialists.

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30 TRIAD, Fall 2011

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