MICHIGAN MEDICINE

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 120 / NO. 2

March / April 2021

MICHIGAN’S RUR AL HEALTH CARE LANDSCAPE

Ongoing Challenges, Emerging Solutions

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p resident 's Michigan's Rural Health Care Challenges This month, the Michigan State Medical Society is taking a look at the distinctive challenges facing our state’s rural health care settings. The COVID19 pandemic has impacted these communities in extraordinary ways that are likely to be felt for years to come.

With much of the Michigan medical community concentrated in the lower half of the lower peninsula, it can be easy to forget that nearly 70 percent of our state’s counties are rural. Effectively caring for patients in regions where distance, resources, and talent are huge factors means care delivery takes on a different form.

Fortunately, there are resources available to help address the challenges associated with rural medicine. Moreover, there are unique opportunities for practitioners to innovate and explore new approaches to their work. In this issue, we’ll introduce you to just a few of the trailblazing leaders and organizations that are working to make a difference. We’ll also examine the unique professional and personal assets that can help rural physicians be successful in their practices.

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

And finally, we’ll shine an important spotlight on some of the emerging issues and trends that have come about as a result of COVID-19. A sudden resurgence of physician interest in leaving the city. A new focus on telehealth. A renewed emphasis on ensuring an affordable, high-quality digital infrastructure in every corner of the state. All these trends can be directly traced to the pandemic— and the impact on rural medicine will be felt for many years to come.

Very quietly, across Michigan, rural providers are making an enormous difference.

Their leadership is extraordinary, their innovations remarkable. This month— and, indeed, every day of the year—we are honored to celebrate their work and achievements.

It has been an honor to serve as President of MSMS during this very unique year. I am as proud as ever to be a physician in our great state after witnessing how we have risen to meet challenges and continue to take care of our patients. Thank you for this wonderful opportunity.

S. “BOBBY” MUKKAMALA, MSMS PRESIDENT

MARCH / APRIL 2021 |

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FEATURES & CONTENTS March / April 2021

12 Michigan's Rural Health Care Landscape:

Ongoing Challenges, Emerging Solutions

Rural physicians’ ability to make do, to trust their own well-informed judgment, and to lead by example are just a few of the attributes that characterize Michigan’s rural health care landscape today. (Story begins on page 12.)

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03

Michigan’s Rural Health Care Challenges

MICHIGAN MEDICINE® VOL. 120 / NO. 2

S. BOBBY MUKKAMALA, MD

Chief Executive Officer JULIE L. NOVAK

06

Requiring COVID-19 Vaccination DANIEL J. SCHULTE, JD

Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org

10

Marketing & Sales Manager TRISHA KEAST TKeast@msms.org

It's Kindergarten Roundup Time: Ensure Your Pediatric Patients Are Up to Date on Vaccines HEIDI LOYNES, BSN, RN

22 08

Telehealth’s Newest Safety Risk: Distracted Patients SUE BOISVERT, BSN, MHSA, THE DOCTORS COMPANY

Addressing Common Employee Concerns about the Coronavirus Vaccine JODI SCHAFER, SPHR, SHRM-SCP

ALSO INSIDE 26 NEW & REINSTATED MEMBERS 28 EDUCATION

STAY CONNECTED!

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

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

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

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

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2021 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA. ©2021 Michigan State Medical Society

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ASK OUR LAWYER

Requiring COVID-19 Vaccination

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

Despite the fact that the vaccine has been made available to all my employees at this point a couple of them have refused to get it. Other employees say that they have been vaccinated but I wonder if I am being told the truth.

I was told I should not be asking whether an employee has been vaccinated and that I cannot terminate the employment of an employee who refuses to be vaccinated. Is this true? Can I require proof that an employee has been vaccinated? Can I terminate employees or place them on leave if they refuse to be vaccinated?

You’ve been given incorrect or outdated information.

On December 16, 2020, the U.S. Equal Employment Opportunity Commission (“EEOC”) issued guidance for employers regarding COVID-19 vaccination.

One thing the EEOC’s guidance makes clear is that it is legal to ask an employee whether he/she has been vaccinated and to require proof of the vaccination.

enerally, the EEOC guidance states that a healthcare employer with a valid job-related reason can require an employee to receive a COVID-19 vaccine as a condition of employment. However, there are two exceptions. The first applies to employees who are unable to receive the vaccine due to a disability recognized by the Americans with Disabilities Act. The second applies to employees having a “sincerely held religious practice or belief” (as contemplated by Title VII of the Civil Rights Act) preventing them from being vaccinated.

Employers are also entitled to ask questions regarding an employee’s disability to make a reasonable determination that a recognized disability exists. An employee’s generalized claims of “chemical sensitivities, allergies and the like” has been held by one federal appellate court in a recent case to not constitute a disability under the Americans with Disabilities Act. These inquiries must be job related and consistent with business necessity.

Generally, prior to excluding an employee with a recognized disability preventing him/her from receiving the

A COVID-19 vaccine can be required as a condition of employment with two exceptions: 1. Employees who are unable to receive the vaccine due to a disability recognized by the Americans with Disabilities Act. 2. Employees having a “sincerely held religious practice or belief” preventing them from being vaccinated.

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vaccine the employer must determine that the unvaccinated employee would pose a direct threat due to a significant risk of substantial harm to the health or safety of the employee or others that cannot be eliminated or reduced by reasonable accommodation. In a medical practice setting such reasonable accommodation might include requiring the unvaccinated employee to wear a different type and grade PPE that vaccinated employees are no longer utilizing. All determinations of what reasonable accommodations will be made for an employee unable to receive a vaccination due to a disability should be made on a case-by-case basis.

An employer is similarly required to accommodate employees who have a sincere religious belief that prevents them from being vaccinated, unless

doing so would be an “undue hardship.” This undue hardship standard is less stringent than the standard used for determining a reasonable accommodation for an employee with a disability, requiring only that the employer show that providing an accommodation imposes “more than a de minimis cost or burden on the employer.” Again, in a medical practice setting such an accommodation might include requiring the employee to continue to utilize PPE that vaccinated employees are no longer utilizing.

The EEOC guidance states that employees who are not vaccinated due to a disability or a sincerely held religious belief and that cannot be reasonably accommodated may be “excluded” from the workplace. Excluded does not mean only terminated. If an employee can

perform his/her job functions remotely this possibility medical practice setting remote work is not going to be a possibility for many employees (e.g., nurses, medical assistants, physicians, etc.).

Employees who do not have a disability or sincerely held religious belief preventing them from being vaccinated are currently not subject to the protection of any law that would prevent them from being disciplined or terminated for their refusal to be vaccinated and/ or providing proof of vaccination when requested by an employer.

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

MARCH / APRIL 2021 |

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ASK HUMAN RESOURCES

Addressing Common Employee Concerns about the Coronavirus Vaccine

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

Q:

Now that the coronavirus vaccine is available to my staff and me, a couple of team members have expressed hesitancy to get it. I am not planning on

mandating the vaccine in my practice, but I strongly encourage it. Is it appropriate to talk about this with my staff? If so, how do I address common employee concerns around safety and efficacy?

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You are not alone in this situation. Health care practices across the state are grappling with promoting vaccine compliance among their team without going so far as to mandate it.

s you know, the vaccine is one of the best tools we have to curb the pandemic and ensure a healthy, viable workforce. As health care providers, I believe you are well positioned to encourage vaccination, which means addressing fear and concern head-on. To build confidence with vaccine-hesitant team members, you must have a communication strategy and understand who is on the fence or opposed to the vaccine and why.

2. Skepticism regarding mRNA vaccines vs. traditional vaccines

1. Distrust of the expedited vaccine development/approval process

The Pfizer and Moderna vaccines use messenger RNA (mRNA), which cannot replicate or become part of your genetic code, rather than injecting a weakened or inactivated version of the coronavirus into the body, as a traditional vaccine would do. mRNA vaccines are not new. Researchers have been studying and working with such vaccines for decades. The already existing advances made in mRNA research were another contributing factor to the speed with which the current coronavirus vaccines were developed and tested. Although the coronavirus vaccines are the first mRNA vaccines to be brought to market, human clinical trials have been run with mRNA vaccines against the flu, Zika, rabies, and as potential cancer treatments.

Before developing Pfizer’s coronavirus vaccine, the fastest vaccine took four years to bring to market. Given the devastating effects COVID-19 has had, we couldn’t afford to wait that long. Operation Warp Speed was launched in early 2020 to remove any barriers that would cause unnecessary delays. Consequently, the increase in funding, the coordination of efforts among government agencies and private industry, and the green light to begin manufacturing while the clinical trials were being conducted have significantly reduced the timeline for the coronavirus vaccines’ development.

Operation Warp Speed allowed safety and efficiency protocols to be aligned and trials to proceed more quickly.

The benefits of using mRNA vaccines are many. Because the vaccine is not injecting an actual virus into the body, recipients cannot develop the viral infection from the vaccine, nor are recipients contagious from the vaccine after being vaccinated. Messenger RNA vaccines are also much easier and faster to create and produce than traditional vaccines. The results of early clinical trials have been impressive. “In the primary analysis [of the Pfizer vaccine], only 8 cases of Covid-19 were seen in the vaccine group [comprised of 21,720 participants], as compared with 162 in the placebo group [comprised of 21,728 participants], for an overall efficacy of 95%.” (New England Journal of Medicine) While this

Let me share the three most common reasons I have heard from clients as to why their staff have expressed hesitation or opposition to the vaccine, along with some helpful information that can serve as talking points for these staff discussions.

“In the primary analysis [of the Pfizer vaccine], only 8 cases of COVID-19 were seen in the vaccine group [comprised of 21,720 participants], as compared with 162 in the placebo group [comprised of 21,728 participants], for an overall efficacy of 95%.”

NEW ENGLAND JOURNAL OF MEDICINE

is incredibly promising, long-term data must be evaluated before full approval from the U.S. Food and Drug Administration (FDA) is granted. This is the primary reason why these vaccines have emergency use authorization (EUA) rather than having full approval.

3. Fear of long-term health risks associated with the vaccine Until the coronavirus vaccines are granted full FDA approval, you will inevitably have some employees who are fearful of unknown long-term risks. However, according to the FDA, the clinical trials conducted in tens of thousands of study participants and the manufacturing information submitted by Pfizer and Moderna show that potential benefits outweigh the known potential risks of the vaccines’ use.

A final, crucial consideration is that not getting vaccinated carries its own (much larger and more dangerous) set of risks. As of the writing of this article, COVID-19 has killed more than 450,000 Americans. Those who have contracted COVID-19 may not develop long-term immunity, and even those who experienced mild to moderate infection are not out of the woods.

Reinfection can occur, and health care professionals are continuing to learn of long-term health effects caused by the virus (i.e., Long-haulers Syndrome).

When you consider these known risks from COVID infection, vaccination is a much safer route to establishing immunity to assure our community’s safety and a return to our pre-pandemic lives.

It’s incumbent upon all of us to do our part in curbing this pandemic. Lead by example and use all available means to combat fear, confusion, and misinformation. Educate your team using evidence-based information and encourage them to do their research as well, so they can make well-informed decisions to protect their health and the health of the practice.

MARCH / APRIL 2021 |

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MDHHS UPDATE

It's Kindergarten Roundup Time: Ensure Your Pediatric Patients Are Up to Date on Vaccines

By Heidi Loynes, BSN, RN, Immunization Nurse Educator, Michigan Department of Health and Human Services, Division of Immunization

It is springtime which means it is time to start thinking about kindergarten roundup.

If you see pediatric patients between 4 and 6 years of age, think immunizations.

our kindergarten pediatric patients are ideal vectors for disease, especially in close group settings such as the classroom, cafeteria, and playground. It is important to assess their immunization record at every visit to see which vaccines they need. For the best protection, health care providers should vaccinate their pediatric patients from vaccine-preventable diseases according to the recommended child and adolescent immunization schedule from the Advisory Committee on Immunization Practices (ACIP).1

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By vaccinating according to the recommended ACIP schedule, you can ensure your patients will receive the vaccines required for school entry. Even though some ACIP-recommended vaccines are not required for school entry, they are important for children to receive. At the 4-year-old well visit, DTaP, Polio, MMR, and Varicella are recommended. The well child visit is a great time to ensure children are up to date for all recommended vaccines.

This includes Haemophilus influenzae type b (Hib) and pneumococcal conjugate (both up to 5 years of age, i.e., through 59 months), Hepatitis A and B, as well as

The administrative rules in Michigan require all kindergarteners and 4-6 year old transfer students to have appropriate documentation of vaccines protecting against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B, and varicella. other vaccines that may be needed due to a high-risk medical condition. It is also important for children to receive flu vaccine every year, possibly two flu vaccines in one season depending on their age and immunization history.

The administrative rules in Michigan require all kindergarteners and 4-6 year old transfer students to have appropriate documentation of vaccines protecting against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B, and varicella. Appropriate documentation of immunity is acceptable in lieu of vaccination for some of these diseases (e.g., varicella). For the 2019-20 school year, Michigan’s kindergarteners had adequate coverage levels of select vaccines (94.7% for 4 or 5 doses of DTaP, 94.8% for 2 doses of MMR, 94.4% for 2 doses of varicella). However, Michigan’s kindergarten vaccine exemption rate is at 4.4%.2 To help understand school and daycare vaccine requirements, the Michigan Department of Health and Human Services (MDHHS) has created easy-to-read handouts that target healthcare providers, schools and daycares, and parents. These documents are available on the MDHHS website.3 As a reminder, patients requesting a non-medical waiver for school should be referred to their Local Health Department (LHD). Health care providers should only provide parents with a medical immunization waiver (i.e., true medical contraindication to vaccine(s)) when needed.

Providers are encouraged to use the Michigan Care Improvement Registry (MCIR) for every patient at every visit, including sick visits, to determine which vaccines are needed. MCIR can conduct reminders and recalls ensuring patients are up to date on all their vaccines. Recall letters can be generated in MCIR and can assist with identifying cohorts of patients who are overdue for a specific vaccine. Reminders and Quality Improvement (Eligible Not Yet Overdue Immunizations) reports can also be generated in MCIR to identify those that may be coming due for vaccines. For more information on MCIR or how to run reminders or recalls, visit www.mcir.org or

contact your MCIR regional staff. Contact your LHD (www.michigan.gov/ LHDmap) for information on Quality Improvement reports.

The COVID-19 pandemic has brought numerous challenges to health care, including a decline in pediatric immunization rates due to the “Stay Home Stay Safe” executive order. However, we are seeing dose administration levels rebound. It is important to continue offering immunization services against these highly contagious diseases to keep your patients healthy, not just at school but everywhere. Through vaccination, it is crucial that we protect our pediatric patients from diseases, especially as we continue to fight the COVID-19 pandemic. By protecting your patients with all ACIP-recommended vaccines, you help young Michiganders stay healthy and ready to learn.

RESOURCES 1 Centers for Disease Control and Prevention (2020).

Immunization Schedules. Retrieved from https:// www.cdc.gov/vaccines/schedules/index.html on

Michigan kindergarteners’ vaccine coverage levels for 2019-2020 school year:

94.7%

for 4 or 5 doses of DTaP

94.8%

January 26, 2021.

2 Seither R, McGill MT, Kriss JL, et al. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2019–20 School Year. MMWR Morb Mortal Wkly Rep 2021; 70:75–82. DOI: http://dx.doi.org/10.15585/ mmwr.mm7003a2 on January 26, 2021.

3 Michigan Department of Health and Human Services (2019). Immunization Waiver Information.

Retrieved from http://www.michigan.gov/mdh-

for 2 doses of MMR

94.4%

for 2 doses of varicella

Michigan’s kindergarten vaccine exemption rate:

4.4%

MARCH / APRIL 2021 |

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FEATURE

MICHIGAN’S RUR AL HEALTH CARE LANDSCAPE

Ongoing Challenges, Emerging Solutions

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The country doc. It’s a tired old stereotype, and one our society might well be rid of.

It carries with it all the mid-century TV tropes our society knows so well: the black bag, the round hat, the grizzled air. f there are elements of the old pigeonhole we might wish to keep, however, it’s the rural physician’s ability to make do. To trust their own well-informed judgment. To lead by example, earn the trust of patients and families, and make a difference in communities that matter.

These are the attributes that characterize Michigan’s rural health care landscape today. Despite the myriad challenges today’s rural physicians face, they continue to uphold the timeless value of care excellence that is the hallmark of the medical profession, no matter where it’s at work.

(CONTINUED ON PAGE 14)

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Rural Medicine in Michigan

W

ith the state’s only true urban centers located in the bottom half of the Lower Peninsula, every community north of Clare falls into the “rural” category, along with many cities, towns and villages further south.

In fact, 57 of Michigan’s 83 counties are classified as rural.

Generally speaking, the social and economic environments in Michigan’s rural areas are less robust than in more regions of the state. The U.P. and northern Lower Peninsula have been steadily losing jobs and population throughout the last decade, and its population is aging rapidly. Residents and businesses must go further to procure necessary resources, services and supports. And with limited broadband access, opportunities for learning and connection can be harder to come by.

57 of Michigan’s 83 counties are classified as rural.

Rural Urban

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Together, these factors paint a somewhat bleaker picture when it comes to the social determinants of health. And these more fragile social determinants, in turn, often can translate into reduced health outcomes for rural residents. From routine medical visits to ongoing disease management, it is often true that people in less favorable socio-economic circumstances often do not experience the same level of care as their better-resourced and -connected counterparts.

To help address these inequities and advance the overall quality of medical care statewide, a variety of pioneering initiatives have been set in motion. From physician recruitment and collaboration programs to the expanded use of telemedicine, an array of game-changing innovations are underway to help support Michigan’s rural communities more effectively.

Attracting More Physician Talent

A

sk any practitioner in rural Michigan what their greatest challenges are, and the shortage of physician talent is sure to top the list.

“When you look at the state’s health professional shortage area designations, you see a lot of gaps,” says Rachel Ruddock, workforce development manager for the Michigan Center for Rural Health. “And while every state has rural shortage areas, a map of Michigan shows that we have a shortage of primary care physicians, we have a shortage of dentists, we have a shortage of psychiatrists, mental behavioral health providers. It's a huge, huge, huge issue.”

Ruddock notes that 31 percent of all Michigan counties lack even one single obstetrician.

“MSU’s College of Human Medicine has done some research that classifies certain parts of the state as OB deserts,” Ruddock says. “Many rural communities have had to drop their OB service lines due to low volume and high staffing costs. Now, it’s not uncommon for women to have to drive 150 or 200 miles to get to a birthing hospital.”

Given the seven medical schools and numerous physician residency programs working in Michigan—and the thousands of students who travel from around the globe to participate in them—it is

“If you look across the nation, about 20 percent of our nation comes from rural areas, but only four to five percent of our medical students are of rural origin.”

ANDREA WENDLING, MD, FAAFP

perhaps surprising that our state should experience such gaps in care.

“It’s simply maldistributed,” Ruddock says. “Physicians tend to stay where they train, so it’s not necessarily true that we have a huge shortage of them. It’s just that they all stay in a concentrated area.”

Andrea Wendling, MD, FAAFP, director of rural medicine for MSU’s College of Human Medicine, says there are proven strategies already in motion that are effectively increasing the supply of available talent in Michigan’s rural areas. Doctor Wendling operates one such pipeline program, which works to recruit and support undergraduate rural students with the hope they will return to serve in one of the state’s smaller communities.

“Many rural communities have had to drop their OB service lines due to low volume and high staffing costs.

Now, it’s not uncommon for women to have to drive 150 or 200 miles to get to a birthing hospital.”

“Rural students are underrepresented in medical school based on the population, but that's the group that's most likely to end up working in rural communities,” Doctor Wendling says. “If you look across the nation, about 20 percent of our nation comes from rural areas, but only four to five percent of our medical students are of rural origin.”

Doctor Wendling administers MSU’s Rural Premedical Internship Program, supporting rural undergraduates through the medical school admissions process.

“I work with them during the summer months, helping them gain the experiences they need for medical school and giving them admissions support,” she says. “They often end up training on one of our rural campuses, and I can begin to shepherd them through that experience while they're in undergrad.”

The approach is already working. Today, MSU’s medical school admission rate for students from rural communities sits at around 20 percent, which is about the same as the state’s proportion of rural population.

Doctor Wendling’s efforts complement those of the Michigan Center for Rural Health, where Ruddock is fostering the creation and management of a more robust talent pipeline.

“I’m helping rural health care employers find providers, find staff, as well as working with providers who are interested in working in our rural communities,” Ruddock says. “At the same time, I’m helping students cultivate that interest in rural medicine so that they will hopefully go to those communities and practice someday.”

RACHEL RUDDOCK, MICHIGAN CENTER FOR RURAL HEALTH

(CONTINUED ON PAGE 16)

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The Unexpected Impact of COVID-19

W

hile the COVID-19 pandemic has had a huge negative impact on providers and employers, everywhere, there has been two surprising upsides for rural health care.

The first has to do with the aforementioned physician recruitment in rural communities.

“Those of us who recruit rural health care talent across the U.S. have just been deluged by the number of physicians from urban centers that now want to go to rural communities,” Ruddock says.

The reasons for the change are many.

“Some are tired of living in the city— they want property and to be outside and to quarantine on land essentially,” Ruddock says. “Others have been laid off, some have been furloughed, some of their hours have been cut, some of their contracts have been reworked. And so they're looking for other opportunities.”

Second, the expansion of telehealth options under COVID-19 has improved access to health care options for many rural residents.

“With the public health emergency order and the policy changes, folks have been able to access telehealth a little more readily,” says Jill Oesterle, rural health clinics manager for the Michigan Center for Rural Health.

But still, issues remain.

“A lot of rural health communities don't have access to internet,” Oesterle says.

“And we know our rural communities tend to be much older and so you have technology barriers for individuals who aren’t familiar with these systems. So while use of the technology has advanced, we still have a lot of barriers.”

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Two surprising upsides for rural health care of the COVID-19 pandemic: 1. An increase in the number of physicians from urban centers that now want to go to rural communities.

2. The expansion of telehealth options has improved access to health care options for many rural residents.

Shifting Gears

M

ost of today’s physicians are trained in a large metropolitan tertiary care center, with plenty of equipment, resources and support. Leaving these settings to practice in a small, isolated hospital or practice is, in a word, uncomfortable.

“Some of it is purely clinical,” Doctor Wendling says. “Most of the physicians who practice in rural communities have expanded scopes of practice. They're generalists even if they are practicing within a specialty. Take, for instance, a general surgeon. She can't just do appendectomy and gall bladders. She really needs to be able to do a full gamut of general surgery, because she’s the only person who's providing those services, or her group is the only group providing those services in a rural community.”

Doctor Wendling notes there are fewer specialists on staff at rural hospitals.

“Working in a larger hospital, you have the support of many different types of physicians—ICU docs, cardiologists, pulmonologists, gastroenterologists. And so when a patient has a problem, it's pretty easy to get that level of help from the different people who also work there,” she says. “If you're a doc in a critical access

“Most of the physicians who practice in rural communities have expanded scopes of practice. They're generalists even if they are practicing within a specialty. ” ANDREA WENDLING, MD, FAAFP

“... you’re living in smaller communities that you are also serving as a physician, so you need to understand where to put boundaries up, so you can continue to treat people professionally while still having other relationships.”

ANDREA WENDLING, MD, FAAFP

hospital, there's no cardiologist on staff often. There's no pulmonologist, there's no ICU doc. If somebody gets transferred to the ICU, you're going to take care of them in the ICU as opposed to taking care of them on the floor.”

What does this mean for a rural physician? It results in a different way of assessing risk.

“You need to understand whether patients when they come in are in the right place,” Doctor Wendling says. “You need to be able to think ahead about what direction their condition might go and what supports they might need and how to manage available resources and logistics. These are skill sets that you don't necessarily learn if you only train in a hospital where you can call cardiology when there's a problem, and they show up.”

Doctor Wendling notes there are other problem-solving and communication skills that come into play.

“For the most part, you're living in smaller communities that you are also serving as a physician, so you need to understand where to put boundaries up, so you can continue to treat people professionally while still having other relationships,” she says. “You don't have the level of anonymity that you have in a metropolitan community, where some of that just doesn't become an issue.”

She goes on to add, “There's a lot of creativity and problem-solving that goes into serving distant and under-resourced communities. At the point you recommend a test or specialist, you also have to take a step back and think, ‘Okay. But do you have a car, or could somebody drive you? And is there a snowstorm?’ There's a whole level of anticipatory problem-solving that I think physicians need to be thinking about.”

But when it comes together right, it makes all the difference—for providers and patients alike.

I have personally picked up food from a local food pantry and delivered it... because that’s just what happens in rural medicine.

LAUREL SAWYER, SABLE POINT FAMILY CARE

“To me, it’s most satisfying when we can make things work,” says Laurel Sawyer, practice manager at Sable Point Family Care. “I have personally picked up food from a local food pantry and delivered it to patients when there was a need. I have seen providers personally purchase equipment or medication and deliver it to patient homes, because that’s just what happens in rural medicine.”

(CONTINUED ON PAGE 18)

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Hidden Opportunities to Make Medical Magic

D

espite the challenges associated with providing rural health care, there are opportunities for physicians who are keen to innovate.

Mark Hamed, MD, MBA, MPH, FAAFP, is medical director at McKenzie Health System in Sandusky, Michigan. Although he lives in the Metro Detroit area, he’s willing to make the 208-mile roundtrip trek to the Thumb seven times each month to serve the community he’s come to love.

“Our CEO, Steve Barnett, is very pro-provider. He makes sure we’re comfortable, that we have whatever we need to provide the best care possible,” Doctor Hamed says. “Today, our institution has a very progressive nature as far as trying

to advance and embrace new technologies and metrics. We are sharing services and consultants with other systems and working to provide telehealth consults in specialty services areas, like stroke and pulmonology.”

It was this progressive, highly interactive environment that helped Doctor Hamed’s institution respond swiftly to the COVID-19 pandemic.

“My CEO listens carefully to me and the other practitioners in our system,” Doctor Hamed says. “When we learned how transmissible the virus was, he was responsive to our urgent need to prepare.

So very early on, we were able to secure four of our inpatient rooms as being negative pressure rooms. We actually secured

extra ventilators. We even put in a request for rapid PCR testing, which we received in August. Because we were able to collaborate and be nimble, we were really, really prepared for COVID.” Doctor Hamed says McKenzie has innovated in other important ways.

“We are the first hospital in Michigan to actually be an opioid free—we call it the Oxy Free—ER. We actually started that in February 2013, before the crisis was officially the opioid crisis,” Doctor Hamed says. “And a lot of these other things like acute heart attack and acute stroke care—we were offering that. We get a lot of, ‘Hey, what's going on in a little place.

It's kind of buzzing there.’"

Other rural Michigan providers have found ways to collaborate for the good of their patients.

Driven by results.

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

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”Rural Michigan hospitals and their partners are launching medical assistant apprenticeship programs modeled after other very successful initiatives...to essentially grow their own pipeline of medical assistants because it's so hard.”

RACHEL RUDDOCK

“We know a lot of providers are setting up hotspots in their parking lots where patients can pull into a space and get on their device and have their telehealth visit because they don’t have access to the internet at home,” Oesterle says. “Sometimes they even host patients in their primary care offices for telehealth visits with specialists elsewhere in the state, free of charge.”

Doctor Wendling says the advent of technology has added additional opportunities for collaboration.

“There are programs like MC3 out of Ann Arbor, which offers psychiatry services to children and adolescents in rural Michigan,” she says. “As physicians, we can call them and consult about our patient and they’ll talk to us, build a chart around that patient and we can call back later and continue that specialty dialogue. It helps me expand my scope of care in that area.”

A similar program, Project ECHO, is a multi-state effort working to support cardiology patients in similar ways.

And finally, new northern Michigan innovations are occurring as rural providers work to address an ongoing shortage of nurses and medical assistants.

“Rural Michigan hospitals and their partners are launching medical assistant apprenticeship programs modeled after other very successful initiatives,” Rud-

dock says. “The idea is that they're going to essentially grow their own pipeline of medical assistants because it's so hard.”

Similar programming is urgently needed, Ruddock says, as leaders grapple with a shortage of EMS and other workers.

But most of all, rural providers agree, there is a major need for widespread internet access.

“It's a necessity. You can't say today, ‘Oh, you don't need internet access,’" Ruddock says. “Everyone needs some internet access in one form or another. We know that's just how the world works.”

Michigan’s rural digital infrastructure remains weak. Strengthen it, and the economic viability of many rural communities takes a major leap forward. And so, in fact, do their social determinants of health.

In addition to this high priority for our state, there is one other change that can make an enormous difference for rural health care.

“It’s really hard for rural residents to have a voice,” Doctor Wendling says. “Rural populations are a minority of the population, and they have really different challenges and different solutions than urban or metropolitan places do. I think that we need more people who are willing to look at it with that lens, with a rural lens, sitting at the table with the people who are making the decisions.”

The Michigan State Medical Society is eager to ensure rural physicians are active in setting its policy agenda. By establishing regional seats on its board of directors and convening statewide conversations about the work we do, we hope to help erase the stereotype of the “country doc” and create a new way forward that’s grounded in the innovative strategies, technology expansion, and a future that’s brighter for all Michiganders, no matter where they live.

MARCH / APRIL 2021 |

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Activate your political voice!

Get started at mdpac.org

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

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine.

Through MDPAC, you will activate your voice on issues important to Michigan physicians.

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Activate your political voice!

The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society.

It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

bring medical knowledge into discussions with political decision makers.

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

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

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

Take action now! Visit https://MSMS.org/engage and become a “virtual lobbyist.”

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

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UPDATED JANUARY 6, 2021

Telehealth’s Newest Safety Risk: Distracted Patients

By Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager II, The Doctors Company

22 michigan MEDICINE®

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Contributed by The Doctors Company

thedoctors.com

Without considering telephone medicine, telehealth has been part of the American healthcare landscape for more than 60 years.

Although the Centers for Medicare and Medicaid Services began reimbursing for rural telehealth in 1999, by 2019 telehealth accounted for only 0.1 percent of Medicare fee-for-service (FFS) visits.1 uring COVID-19, federal and state telehealth regulatory and payment concessions led to an enormous surge in use.

At the peak of the first surge of COVID19 in April 2020, Medicare FFS telehealth had risen to 45.3 percent of all visits, roughly 1.25 million visits per week.

Sudden widespread adoption of telehealth during the pandemic allowed millions of patients to receive care that might not have otherwise been possible. Rapid adoption of telehealth permitted practices that provided a significant amount of elective procedure‒related care or outpatient demographics to remain afloat.

Rapid implementation of telehealth services came with new challenges. For more information on that topic, please see The Doctors Company white paper “Your Patient Is Logging on Now: The Risks and Benefits of Telehealth in the Future of Healthcare.”

Our first inkling that a new risk may be appearing on the horizon came in the form of a helpline call from a primary care physician in California. The physician

called to discuss the risk management of a problem he was experiencing with some of his virtual patients. It seemed the patients were not always ready for, or engaged in, the telehealth visits. The physician gave examples that included a patient excusing himself to take a cell phone call and another answering a knock at the door, shouting that his ride had arrived, and leaving without disconnecting from the video visit. Depending on your level of telehealth use, these examples may or may not be surprising.

In October 2020, a telehealth company published its results of a survey to determine consumers’ attitudes to telehealth and healthcare. The survey of 1,002 consumers identified a wide number of distracted patient behaviors during telehealth visits. Not surprisingly, digital distractions were the most frequently reported and included using the internet (24.5 percent), watching TV or movies (24 percent), checking social media (21 percent), and playing video games (19 percent). The more unusual distractions included exercising, smoking, eating, driving a motor vehicle, and consuming

Not surprisingly, digital distractions were the most frequently reported and included using the internet (24.5 percent), watching TV or movies (24 percent), checking social media (21 percent), and playing video games (19 percent). The more unusual distractions included exercising, smoking, eating, driving a motor vehicle, and consuming alcoholic beverages.

(CONTINUED ON PAGE 24)

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(CONTINUED FROM PAGE 23)

alcoholic beverages.2 In addition to the distractions previously noted, members of The Doctors Company have reported patient behaviors that include no-shows, vacuuming during the visit, children sitting on the patient’s lap, and patients calling in from public venues such as a bus, airport, or café.

We know the effects that distracted doctoring can have on patient safety.

(For more information about distracted practice, see our article “Distracting Devices in Healthcare: Malpractice Implications.”) The risks incurred when the patient is distracted are similar. They include lack of engagement resulting in a limited history and assessment process; nonadherence with the treatment plan, discharge instructions, or follow-up; and privacy and security concerns.

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Risks incurred when the patient is distracted include: 1. lack of engagement resulting in a limited history and assessment process 2. nonadherence with the treatment plan, discharge instructions, or follow-up; and 3. privacy and security concerns.

Distracted patient behaviors can limit the provider’s ability to establish rapport with the patient and collect the information necessary to accurately diagnose and treat the patient’s condition. Patient nonadherence is a known contributor to delayed diagnosis and, consequently, to medical professional liability. Privacy concerns involve the discussion of patient-specific health conditions within earshot of others—which may lead the provider to restrict the extent of the clinical discussion.

Healthcare providers have limited control over the security of patient devices.

Therefore, providers should consider putting additional security measures in place to reduce the risk of malware intrusion, particularly if the telehealth system is on the same network or integrated with the electronic health record.

Contributed by The Doctors Company

thedoctors.com

Strategies to Address Distracted Patients

REFERENCES 1 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Issue Brief. Medicare beneficiary use of telehealth visits: early data from the start of COVID-19 pandemic. July 28,

Set technology expectations for telehealth visits.

Ask patients to connect to telehealth visits from a computer (rather than a mobile device) when possible.

For patients who intend to use a phone, advise them to activate their phone’s Do Not Disturb feature and close any open apps.

Some patients may have difficulty disconnecting from social media even during a health visit. Behavioral health experts have described this as “fear of missing out” (FoMO), a phenomenon considered to be a symptom of social media or digital addiction.

Experts recommend encouraging patients to disconnect periodically to reduce the risk of FoMO.3 Patients who have difficulty disconnecting can be encouraged to use positive self-talk in FoMO situations. For example, instead of thinking “I am unable to answer that call/message/post,” advise the patient to consider “I do not need to answer that now.”4

Set behavioral expectations for telehealth visits.

Advise patients to participate from a private location, preferably in their home.

Ask the patient to be seated facing the computer in a well-lit space away from distractions, including family members and pets.

Follow up on prior no-show visits if needed. Studies suggest that younger patients and those receiving surgical follow-up are less likely to present for telehealth visits. In addition to sending reminders, a face-to-face discussion of the risks of missed visits may reduce the likelihood of further occurrences.5

Assess the patient’s environment at the initiation of the visit and respond accordingly.

Public spaces: Advise patients of the privacy risks of conducting a telehealth visit in a public space and offer to reschedule the visit.

Driving: Ask patients who are driving to pull over. For patients who refuse, politely advise them that it is unsafe to continue the visit and they will be rescheduled, then disconnect. If the patient pulls over, discuss your concerns, and use your judgment about continuing with the visit.

Smoking: If the patient is smoking, discuss smoking cessation.

Drinking alcohol: If it appears that the patient is drinking alcohol, politely confirm and consider conducting a brief intervention using a tool such as Screening, Brief Intervention, and Referral to Treatment (SBIRT).

Document the interventions taken to address patient distraction.

Document what you did, how the patient responded, and the result. If the plan is to reschedule the patient, ensure that the patient is rescheduled.

2020. https://aspe.hhs.gov/pdf-report/medicare-beneficiary-use-telehealth 2 DrFirst survey: 44% of Americans have used telehealth services during coronavirus pandemic but some admit not paying attention [news release]. Rockville, MD: DrFirst; October 28, 2020. https://drfirst.com/press- releases/survey-44-americans-telehealth-coronavirus- pandemic/ 3 Brown L, Kuss D. Fear of missing out, mental wellbeing, and social connectedness: a seven-day social media abstinence trial. Int J Environ Res Public Health.

2020 Jun;17(12):1-18. https://doi.org/10.3390/ ijerph17124566 4 Alutaybi A, Al-Thani D, McAlaney J, Ali R. Combating fear of missing out (FoMO) on social media: the FoMO-R method. Int J Environ Res Public Health. 2020 Aug 23;17(17);1-28. https://doi.org/10.3390/ijerph17176128.

5 Kemp MT, Liesman DR, Brown CS, et al. Factors associated with increased risk of patient no-show in telehealth and traditional surgery clinics. J Am Coll Surg. 2020;231(6):695-702. https://www.journalacs.org/ article/S1072-7515(20)32300-0/fulltext

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

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

MARCH / APRIL 2021 |

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NEW & REINSTATED MEMBERS GENESEE COUNTY

KALAMAZOO COUNTY

MUSKEGON COUNTY

Nakia Allen, MD

Marshall Grillo, DO

Kelly Morga, MD

Daniel Alterman, MD

Sophia Allen, MD

Mark Bieszka, DO

Louis Andary, MD

KENT COUNTY

Justin Eisenberg, DO

Page Animadu, MD

HOUGHTON/BARAGA/ KEWEENAW COUNTY

Natalie Brenders, MD

Ehab Eltahawy, MD

Samah Arsanious, MD

Scott Cressman, MD

Laura Lozier, MD

Sheryl Parks, MD

Lance Furusawa-Stratton, MD

Srdjan Ostric, MD

Mekasha Getachew, MD

James Twesten-O’Toole, MD

Maryam Ghadimi Mahani, MD

Theodore VanderKooi, MD

Thomas Shuster, DO

INGHAM COUNTY Fariah Ahmad, MD

Megumi Asai, MD Megan Avesian, DO Fatme Awarke, DO Zain Azzo, MD Matthew Ball, MD

Ronald Hessler, MD

Amir Banihashemi, MD

David Homa, MD

OAKLAND COUNTY

MIchael Johnson, MD

Patricia Bonnefil, MD

Tyre Jones, MD

Duane DiFranco, MD

Gregory Shannon, MD

Bradley Kranendonk, MD

Rolando Estupigan, DO

Luis Mata, MD

Rohit Kakar, MD

JACKSON COUNTY

Christopher Mianecki, DO

Srikar Reddy, MD

Abigail Brackney, MD

David Mitchell, MD

Scott Silver, MD

Patrick Bradley, MD

Joseph Morehouse, DO

Maciej Uzieblo, MD

Alisa Bray, DO

Leslie Norris, DO

Daniel Wood, DO

John Buckley, MD

Divyakant Gandhi, MD, FACS, FRCS Hugh Lindsey, MD Kevin Nohner, MD

Sana Chams, MD Huiting Chen, MD Alfredo Davalos-Balderas, MD Thomas Fluent, MD Pamela Hackert, MD, JD, MPH Maurice Jones, MD, FACC Matthew Jonovich, MD Usman Khokhar, MD David Kolde, MD Samih Mawari, MD Joseph Medellin, MD Mumtaz Memon, MD Mark Morris, MD Elizabeth Pielsticker, MD, FACC Arvind Prabhu, MD Justin Rutt, DO Richard Santos, MD, PhD

Alexandra Baracan, MD Mollie Blanchard- Brown, MD Lindsay Boik Price, DO Alexander Boikov, MD Laurie Boore-Clor, MD

Shivang Patel, DO

Neil Caliman, MD

Michael Perone, MD

OCEANA COUNTY

Rachel Carolan, DO

Benjamin Pomerantz, MD

Julie Anne Shellhouse, MD

Audrey Carrasco, DO

Nabeel Porbandarwala, MD Alexander Serra, MD Charles Swallow, MD Wend Ann Thomas Brown, MD Emily Tomaselli, DO Richard Townley, MD Ronald Vander Laan, MD Philip Velderman, MD Stephen Vossler, MD

MACOMB COUNTY

Jonathan Carrier, DO Fiona Carroll, MD

SAGINAW COUNTY

Thomas Cerrone, DO

Ernie Balcueva, MD

Zieanna Chang, MD

Cynthia Blount, DO Channakeshava Indira, MD

SHIAWASSEE COUNTY Ronald Bishop, DO

WAYNE COUNTY

Nisha Chawla, MD Fan Chen, MD Nancy Cheng, MD Catherine Cherri, MD Eun Sook Choo-Choi, MD Avi Cohen, MD Daniel Cowden, MD

Syed Muneer Abidi, MD

Cassondra Cramer-Bour, MD

Amer Aboukasm, MD

Clark Creger, MD

Benjamin Abraham, MD

Katherine Cybinski, DO

Amnah Aglan, MD

Fauzieh Dabaja, MD

Rohit Aiyer, MD

Ngoc-Duyen Dang, MD

Mark Zande, MD

Munther Alaiwat, MD

Omar Danoun, MD

Hazem Zebda, MD

Asma Al-Hamid, MD

Eric Davies, MD

Zulekha Ali, MD

Robert Davis, MD

Jonathan Schweid, MD Abdullah Sharaf, MD Timothy Shinn, MD Zachary Virgin, DO

David Davis, MD Anthony Hamame, MD Onowenerhi Omene, MD Ava Powell, DO

MARCH / APRIL 2021 |

michigan MEDICINE®

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WAYNE COUNTY

Shree Kilaru, DO

Alita Rice, MD

Dharshan Vummidi, MD

Charles Day, MD

Sun Kim, MD

Derek Rizzo, MD

Jeffrey Weingarten, MD

Tiffany DeHondt, MD

Lusine Kirakosyan, MD

Joshua Romero, MD

Audley Williams, MD

Matthew Dellaquila, MD

Chad Klochko, MD

Carl Ross, MD

Jonathan Williams, MD

Komal Desai, MD

Nik Kolicaj, MD

Julie Ruma, MD

Bradley Wilson, MD

Komal Dhanoa, MD

Kurt Kralovich, MD, FACS

Nancy Sabal, DO

Christina Wood, DO

Sarah Dionne, MD

Cecilia Kraus, DO

Sala Sadaps, MD

Ryan Woolley, MD

Penny D’souza, DO

Geetika Kukreja, MD

Zarnab Sajjad, MD

Jedrzej Wykretowicz, MD

Samar El-Achkar, MD

Tariq Kutob, MD

Husain Saleh, MD

Joshua Yankelove, MD

Terry Ellis, MD

Joanne La Fleur, MD

Jasmine Sandhu, MD

Nicholas Yared, MD

Michelle Faber, MD

Jason La Vigne, MD

Matthew Santa Barbara, MD

Zeynep Yilmaz-Saab, MD

Humaira Fahim, MD

Alice Lee, MD

Navjot Sekhon, MD

Frederick Yoo, MD

Dominic Fano, DO

Carrie Leff, DO

Gassan Shahin, MD

Asad Yousuf, MD

Laura Favazza, DO

Wei Liu, MD

Shehbaz Shaikh, MD

Lisi Yuan, MD

Patrick Forrest, MD

Clifford Loeckner, MD

Bashar Sharaf Aldeen, MD

Ahmad Yusuf-Solaiman, MD

Domingo Franco-Palacios, MD

Shivangi Lohia, MD

Britiany Sheard Caple, MD

Michael Zimmer, MD

Rachel Freidman, DO

Renee Maan, MD

Yulei Shen, MD

Brittany Fuller, MD

Yousef Maaz, DO

Farida Shibli, MD

Mike Zintsmaster, MD

Shirish Gadgeel, MD

Amanda Mann, MD

Pritika Shrivastava, DO

Vasudev Garlapaty, MD

Peter Massa, MD

Mansoor Siddiqui, MD

Stefanie Gibson, DO

Lina Masso, MD

Mary Skoures, MD

John Gietzen, MD

Eoghan McGreevy, MD

Andrea Smith, DO

Brian Ginnebaugh, MD

Melinda Mitchell, MD

Danelle Stabel, DO

Marian Girgis, MD

Marjan Moghaddam, DO

Sara Stanley, DO

Amanda Godfrey, MD

Farah Mohammad, MD

Laurence Stawick, MD

Shivani Gupta, MD

Amit Mohindra, MD

Geehan Suleyman, MD

Bashir Hakim, MD

Naushaba Mohiuddin, MD

Neha Sykes, MD

Abdualrahman Hamad, MD

Joseph Montecalvo, MD

Kevin Taliaferro, MD

Bashar Hannawi, MD

Lynn Mubita, MD

Samantha Tam, MD

Nawras Harsouni, MD

Uzair Munshey, MD

Daizo Tanaka, MD

Katelyn Hartung, DO

Vinodkumar Murugesan, MD

Carly Tarr, MD

Tahir Hasan, MD

Owais Nadeem, MD

Alexander Tassopoulos, MD

Nancy Herringshaw, MD

Mallory Nagarah, DO

Kristina Tervo, DO

Miriana Hijaz, MD

Nithin Natwa, MD

Brian Theisen, MD

Adnan Hussain, MD

Kelechi Okoroha, MD

Athanasios Tsiouris, MD

Sufiya Hussain, MD

Jasmine-Yasmine Omar, MD

Tariq Turfe, MD

Leticia Huynh, MD

Brian O’Neill, MD

Rhead Uddin, MD

Jacqueline Huynh, MD

Alexander Orman, DO

Abdul Uduman, MD

Syed Khasim-Ali Jafri, DO

Olusegun Osinbowale, MD

Jawad Ul-Hassan, DO

Khatib Jafri, MD

Tiwalola Osunfisan, MD

Muhammad Usman, MD

Prasani Jayatilake, MD

Vikash Patel, DO

Christina V​o​u​g​i​o​u​k​l​a​k​i​s, MD

Ethelyn Johnson, MD

D’angela Pitts, MD

Marc Vander Vliet, MD

John Joseph, MD

Andrew Prussack, MD

Martha Vargovich, MD

Dean Josifoski, MD

Saher Quraeshi, MD

Christopher Vaughns, MD

Gaurav Katta, MD

Raveen Rai, MD

Murugusundaram Veeramani, MD

Raminder Khangura, MD

Supriya Raina-Hukku, MD

Jovica Veljanovski, MD

Neil Khanna, MD

Amarnath Rambhatla, MD

Annmarie Vilkins, DO

Sina Khoshbin, MD

Pavan Reddy, MD

Pedro Villablanca, MD

Rami Khoury Abdulla, MD

Berta Rezik, MD

Saifuddin Vohra, DO

Thank you for your ongoing support of organized medicine in Michigan.

MARCH / APRIL 2021 |

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MSMS ON-DEMAND WEBINARS The MSMS Foundation has a library of on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs.

Webinars that Meet Board of Medicine Requirements:

A Day of Board of Medicine Renewal Requirements Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Decision Making Capability Medical Ethics – Eliminating Disparities in Health Care What Can You Do? Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Medical Ethics – Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Pain and Symptom Management Series

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Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System (MAPS) Update Naloxone Prescribing Pain and Symptom Management 2020 Prescribing Legislation Tapering Off Opioids The CDC Guidelines The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019

COVID-19 Webinars:

Other Webinars:

2020 Fall Symposium on COVID-19 Day One

Coding Updates for 2021

2020 Fall Symposium on COVID-19 Day Two

Evaluation Management Updates for 2021

24th Annual Conference on Bioethics

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

AMA Advocacy and Physician Resources Best Practices for Implementation of Telemedicine CARES Act Impact

HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management

CARES Act Impact: Q&A with CPAs CARES Act Impact: Q&A with CPAs Part 2 Leading Through Crises: Financial Guidance and Strategies Medical Practices and Employment/ HR FAQs New Employment Policies for Practices New Waivers and Billing Changes for Telemedicine Race Inequalities and COVID-19: Contagion, Severity, and Social Systems Safe and Innovative Office Procedures for Seeing Patients Telemedicine and Other Technology Codes in a COVID-19 Environment Testing, Tracing and Tracking

Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media Medical Marihuana Law Medical Necessity Tips on Documentation to Prove it Non-Pharmacologic Management of Musculoskeletal Pain Syndromes Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting

The Changing Health Care Landscape: Preventing Diabetes During and Beyond the Pandemic

Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS

What Physicians Need to Know as Employers During the COVID-19 Pandemic

Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

To register or to view full course details, visit https://msms.org/ondemandwebinars

Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org MARCH / APRIL 2021 |

michigan MEDICINE®

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2021 CONFERENCE SCHEDULE

A Day of Board of Medicine Renewal Requirements Date: September 14, 2021 Time: 8:00 am – 1:15 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Grand Rounds

Annual Scientific Meeting

Dates: February 10, March 10, April 14, May 12, June 9, September 8, October 13, November 10, and December 8, 2021

Date: September 15-16, October 20-21, and November 17-18, 2021

Time: 12:00 – 12:45 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Monday Night Medicine Dates: April 5, May 3, June 7, September 7, October 4, and November 1, 2021

Time: 3:00 – 6:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

24th Annual Conference on Bioethics Date: November 13, 2021 Time: 8:45 am – 3:00 pm

Time: 6:30 – 8:00 pm

Location: Virtual Conference

Location: Virtual Conference

Intended for: Physicians and all other health care professionals

Intended for: Physicians and all other health care professionals

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

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

Spring Scientific Meeting

A Day of Board of Medicine Renewal Requirements

Dates: April 15-16, May 20-21, and June 17-18, 2021

Date: November 30, 2021

Time: 8:00 – 11:00 am

Time: 8:00 am – 1:15 pm

Location: Virtual Conference

Location: Virtual Conference

Intended for: Physicians and all other health care professionals

Intended for: Physicians and all other health care professionals

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

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

30 michigan MEDICINE®

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